The Quest for Best Practices in Hospitals: Top-Level Measures

I recently read a great article by the AMR Research's Healthcare Exchange entitled "A Hippocratic Oath for the Healthcare Supply Chain".  The article suggests actions for creating a more efficient value chain for hospital patients based on best practices learned in sectors outside healthcare.  In this blog, I'm extrapolating how to take those lessons learned and apply them toward any top-level measure on your hospital scorecard.

The most common roadblocks in reaching targets on a top-level scorecard measure are:

1. The top-level measure is focused internally, not on patients' needs
2. There is no drill down from the top-level measure into the contributing departments/silos that are part of the process
3. There is a fundamental lack of understanding from each silo as to what their process is
4. Performance reviews that cut across silos from an executive champion of the top-level measure are seldom (if ever) conducted

These roadblocks result in a lack of trust between silos and poor planning within the silos.  Furthermore, we see incredible amount of waste in terms of time, money, and inventory due to the poor planning, which in turn leaves less time and money for making improvements.

So what are the best approaches for overcoming those roadblocks?

1. Think about the patient -- pick the top-level measure (and target) with patient needs in mind, not department needs.
2. Think lean -- develop a process flow (value chain) that starts with the patient and maps back to the beginning.  This will help you cut across the silos.
3. Get representatives of all the silos in a room and have them identify waste and engineer it out of the process.
4. Offer drill down from the top-level measure into process measures from each silo that will track reduction in the waste.
5. Hold consistent performance reviews -- data doesn't change behavior; good questions on a regular basis from the executive champion does.

As the AMR article discussed, results that arise from adopting these best practices include better planning, lower costs, and more time to make improvement.