Re-Engineering Healthcare
Early December, 2010 I was contacted by Mr. Stephen Will of The Hendra Agency in New York, New York. Mr. Will had read one of my articles online concerning Lean Healthcare. The Hendra Agency represented Jim Champy, co-author of Reengineering Health Care, A Manifesto for Radically Rethinking Health Care Delivery. Mr. Will proposed that I chat with Mr. Champy, since we seemed to have many of the same interests. I agreed and on January 5 Mr. Champy and I discussed our mutual concerns about health care. Following are some excerpts from that discussion as well as a review of some of the material in his book.December 21, 2010 Laura Landro, healthcare columnist for the Wall Street Journal, recommended Reengineering Health Care written by Jim Champy and Harry Greenspun, M.D., as one of two must-reads for healthcare executives. The other was Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. Both books advocated focusing on the quality and safety of patient care. Both books recommended major changes in the way patient care is delivered.In my discussion with Jim Champy I asked if his approach to changing healthcare was similar to the Toyota Production System (Lean Healthcare) and if so, what was the difference (I found his recommended approaches quite similar to the TPS when I read the book). He stated that the approaches he illustrated in the book were quite similar to the TPS but that the difference was that he advocated such dramatic changes in a shorter time frame. The TPS can take 4 or 5 years to significantly change the culture and processes at a healthcare site. According to Mr. Champy, such a gradual approach is too long given the inefficiencies, costs and safety and quality issues plaguing healthcare today. He supports reengineering healthcare in a much shorter time frame.Mr. Champy in our discussion and in his book advocated that clinicians lead the change at healthcare sites. In order to meet the time frame he advocates change must be directed by clinicians and senior executives. One of the early chapters of the book illustrates this approach by detailing the changes Zeev Neuwirth, M.D., brought about in his career. Dr. Neuwirth early in his career instituted significant changes in patient care in the Bronx Veterans Administration hospital. He spent his time there improving the patient experience by focusing on communication and team building.Another section of the book focuses on the lifetime work of Debra Geihsler, who was at different times VP of Mercy Health System in Wisconsin, president of the Advocate Medical Group in Illinois, and CEO of Atrius Health in Boston. Ms. Geihsler focused in much of her work on building the capacities of physician groups. At Mercy she helped build a unified system that provided services on many levels, just short of in-patient hospitalization. The seamless integration of services provided much better communication among the multiple providers in the system, improving both the quality and safety of care delivered while significantly improving the bottom line.Jim Champy in his comments to me said he wrote this book with an eye to readability and easy application. There are many books that give significant details, charts and graphs about improving the delivery of healthcare. He wanted to avoid being too technical, making the book an easier read for executives and laymen. Thus, he focused on real stories about individuals who have made significant changes in the way that care is delivered. He focuses on three main elements of change in the book-technology, processes and people. Technology provides significant opportunities for improved communication and viewing change at the population level, to see the progress of change. Significant change cannot occur without viewing the delivery of care as a process. Making these elements work requires commitment by individuals who have the means to carry out the change.I asked Mr. Champy how he approached overcoming barriers to change. Physicians and other clinicians who have been in the system for some time are often reluctant to endorse changes and, thus, can significantly impede progress. He stated that he would take such individuals to “come and see” the positive changes that have already occurred. In the book, he says it is often easier to start changes with clinicians who have not been in the system too long. They are more eager to welcome changes in the environment. Starting with the younger clinicians, those who are directing the changes should after achieving significant gains, take those who are resistant and demonstrate how the new ways of delivering care have improved quality and safety and that those involved are happy with the achievements and their efforts in making the changes. The resistant clinicians are usually willing to go along with the changes after seeing such positive outcomes. After all, says Mr. Champy, most physicians and clinicians really want to deliver very effective care to their patients but do not understand how to make the changes necessary to deliver ever better care.I asked Mr Champy what one additional chapter he would like to add to the book if he could. He said that he would like to add some additional focus on the continuum of care, such as advocated by Debra Geihsler. The medical care that he receives is coordinated by his primary care physician. He feels much better that the care he receives is not fragmented but is overseen by his personal physician. He believes that the best care is based upon this patient-centered medical home model.I highly recommend this book for organizations that want to significantly improve the care that they deliver and want to understand quickly good ways to effect the changes necessary. The book is a quick read and effectively describes for those who will be directing changes at their site what is necessary to accomplish their goals. The book does not say the path is smooth and easy but that change can be effected through individuals who are dedicated and knowledgeable.