In 2001 the Institute of Medicine published Crossing the Quality Chasm. This seminal work identified the chasm between what we know about providing high quality health care and what was actually being delivered. Many of the improvements identified in this book can be seen today in the various health care proposals from the White House, Congress and health care advocacy groups.
Progress has been slow, however. As Carolyn Clancy, the director of the federal Agency for Healthcare Research and Quality, recently stated regarding current quality improvement efforts –
“An example of success in 2007 was removal of the quality measure that assesses the delivery of beta blockers to individuals who have had a heart attack to reduce subsequent mortality from the list of measures used to score health plan performance, because performance has become routinely excellent. Any sense of elation, however, is tempered by the slow speed of improvement, that is, the landmark clinical trial results from which this measure derives were published 25 years ago. This is but one example of many illustrating that we face a longstanding challenge assuring rapid uptake of scientific advances.
Belief in the existence of ‘transformative’ interventions – from health information technology (IT) to disease management to many others – which will effect dramatic improvements, feeds the illusion that clarifying the targets of opportunity is equivalent to addressing them. Moreover, the urgent need to build the science (of execution) has not yet been clearly articulated in a persuasive way to encourage much-needed investments in improvement methods, training, and demonstrations.”
The failure to execute is a common problem in many organizations but more so in health care. The barriers are well understood and include an incredibly complex system, splintered leadership, strategies that vacillate between financial goals and patient care, and no external pressure strong enough to force change.
Because we work in the Opus College of Business, we see this failure to execute in contrast to many of our clients and students that work in businesses that do execute well. For example one of our large retailing client’s informal motto is “Speed is life.” Their need to get the right product on the shelf at the right time is a key factor in their success and a high value in their enterprise. Executing strategies effectively and quickly is a known science – but it appears to not have crossed the chasm into the health care field.
Companies that execute well use the following tools:
Business Intelligence systems for analysis and automation
Balanced scorecards and strategy maps
Formal PMI based Project Management with a Project Management Office
A disciplined leadership approach
An ongoing strategy of employee engagement and culture improvement
A number of recent posts by my colleague, professor Jack Militello, have outlined various approaches for strategy formulation. Future posts will provide more details on how these strategies can be effectively executed using these contemporary business tools.
Healthcare organizations can effectively execute – but they need to understand that they do not need to reinvent the tools already successfully being used throughout rest of the business world.
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st century. National Academies Press.
Clancy, Carolyn. “Building the path to high-quality care.” Health Services Research 44.1 (Feb 2009): p1(4).