Dell: Reengineering Healthcare

By now you know that the delivery of healthcare can be transformed for the benefit of patients, physicians, and the people paying the bills. Almost every area of healthcare offers opportunities for improvement, and no area is free of error, inefficiency, or escalating costs. So where should a clinician, hospital, payer, integrated healthcare system, or physicians practice begin to tackle its own challenges?

Choosing a Starting Point

The field of work you need to reengineer first might be as narrow as a single process or it might be as broad as the work of an entire hospital unit. Our research shows that several factors come into play in choosing a field of work for reengineering. Most often a physician sees an opportunity to improve the quality of delivery, outcomes, or service to patients. Doctors often complain about dysfunction but in fact, it is dysfunction that points to the needopportunityfor improvement.

Finally there is always an element of pragmatism in deciding where to reengineer. Lets get specific about how to look for reengineering opportunities.

Focus on areas of risk: The delivery of healthcare is a risky proposition, with hazards that extend well beyond the success of a particular medical treatment.

Handoffs and complexity make the problem worse.

There is no single or simple answer. Healthcare delivery depends on complex set of processes. To help assure that the correct medication gets to the right patient, for instance, technology and processesrobotics, electronic ordering, bar coding, etc, have been introduced into healthcare. But the work still consists of multiple tasks with various opportunities for error. In many cases, reengineering will simplify the work to be done; in others, increased vigilance and more thorough checking will be needed.

Focus on high-cost areas: There are many reasons for high healthcare costs. Some say the cause is so-called defensive medicinesometimes unnecessary tests and treatments ordered by doctors fearful of overly litigious malpractice attorneys. Other observers criticize healthcare providers who are too focused on the volume of their work and what they bill, rather than on outcomes and value delivered. Some experts say that there is not enough competition to keep costs down. Still others blame lack of evidence based medicine for the inefficiencies of the healthcare delivery system. Then of course a growing number of consumers demand the latest pill, medical device, or procedure regardless of whether it offers any advantage over less expensive, established treatmentsand their physicians comply.

High costs limit access to healthcare. Healthcare costs will therefore continue to rise unless delivery becomes substantially more efficient and effective to offset the costs of new treatments.

So how do we lower the costs of healthcare while increasing the quality of outcomes and access to care? Every healthcare delivery unit, from individual physicians to nationwide hospital systems, must ask whether high-cost areas can be reengineered to lower costs while improving quality. The practice of disease management, where patient care is actively monitored and managed, has already shown that costs can be reduced while quality improves. Better yet, there are still more cost and quality benefits to be achieved.

Focus on the work of the physician: Technological, economic, social, and political forces are changing the work of medical practitioners. But it is critical that doctors do not allow themselves to be overwhelmed. They must take back their rightful role in the redesign of healthcare delivery, especially in any discussion of healthcare reform. On the national front, we believe physicians have been too quiet in the debate over how the delivery of healthcare must change.

Focus on the patient: A main premise of reengineering dictates that change should be made keeping in mind the customers, and when it comes to healthcare, patient is the customer. The mystery is why patients arent demanding better care. Consumers already live in a future that medical providers are just now striving to join.

Perhaps the greater challenge is to help patients deal with the fragmentation of healthcare. These days, patients are challenged by the system. Some are overwhelmed by the process of just getting into it, while others find it hard to navigate once they are in.

Focus on areas where you can succeed: Pragmatism should always play a part in deciding where to reengineer, and the fields of work to target are those with the best case for action. These areas provide visible opportunity for significant performance improvementthe so-called burning platform. A burning platform might be a field of work where quality problems threaten the safety of patients, or where cost issues block access to needed care. A strong case for action comes from the field that best energizes the people who must execute the change.

We suggest that you search out areas where teams of people have an appetite for change and great ambition for improving the quality of care. You will know them by their enthusiasm for whats possible, their talk of better patient outcomes, their desire to help patients navigate the flow of care, and their wish to improve clinicians lives at the same time. They will have great respect for the culture of healthcare workers but will not fear disturbing the status quo. Look for areas where there is a clinician leader who can shepherd the clinical staff through the reengineering journey.

Taking the Work in Hand

Once you have chosen your starting pointwhether its a high-risk field of work, an opportunity to cut costs, the work of the physician, unmet patient needs, or simply the field that seems likeliest to welcome changethe next step in reengineering must be to tackle processes. But since you have to understand processes and how they interact if you are to change them, you will have to draw up a chart of all the processes in your organization.

Deciding on the actions required to improve performance is both an art and science, and these decisions inevitably begin to invoke the third major reengineering pillar, changes involving people.

One final piece of advice is that the quality of your ambition will be critical to your success. The goal of reengineering healthcare delivery should be a quantum leap in performance, not just incremental improvements. Whats needed are enormous reductions in costs and drastic improvements in quality and safety. Small improvements will not solve the challenges of healthcare delivery. The objective is to create what we all dream of, and that is, the best healthcare system possible. What patients and caregivers alike want and deserve is not out of our reach.