“True health care reform cannot happen in Washington. It has to happen in our kitchens, in our homes, in our communities. All health care is personal.”
—Dr. Mehmet Oz
This is a health care reform column through a completely different lens. I had the distinct pleasure of serving as a moderator at the recent event titled “Cracking the Code on Healthcare: Quality and the Patient Experience,” which was attended by more than 400 people. Donald Berwick M.D., who is the president emeritus for the Institute for Healthcare Improvement (IHI), provided the audience with the most stimulating and thought-provoking presentation related to health care reform that I have ever experienced. Berwick’s presentation was titled, “Current Health- care Challenges: Changing the Balance of Power.” The Cracking the Code seminar was organized by the Northstar Network, an organization that is doing some amazing things in the healthcare reform sector. To learn more, go to http://www.northstarnetwork.org/
Berwick, who is the former administrator of the Federal Center for Medicare and Medicaid Services, as a physician focused his presentation on reforming healthcare from the patient’s point of view. It was indeed a fascinating presentation that will certainly affect the opinions and attitudes of those who were there.
IHI has formed a Leadership Alliance that has developed a collective assessment of New Rules for Radical Redesign in Health Care. In summary, the new rules are designed to achieve “care better than we have ever seen, health better than we have ever known, at a cost we can all afford … for every person every time.” The logical objectives resulting from radical redesign can certainly be embraced conceptually by virtually every citizen. What was most intriguing in Berwick’s presentation was the 10 areas of Radical Redesign Principles, which were presented as follows:
Change the balance of power: Co-produce health and well-being in partnership with patients, families and communities.
Standardize what makes sense: Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care.
Customize to the individual: Contextualize care to an individual’s needs, values and preferences, guided by an understanding of what matters to the person in addition to what’s the matter.
Promote well-being: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require healthcare.
Create joy in work: Cultivate and mobilize the pride and joy of the healthcare workforce.
Make it easy: Continually reduce waste and all non-value-added requirements and activities for patients, families and clinicians.
Move knowledge, not people: Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
Collaborate/cooperate: Recognize that the healthcare system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
Assume abundance: Use all the assets that can help to optimize the social, economic and physical environment, especially those brought by patients, families and communities.
Return the money: Return the money from healthcare savings to other public and private purposes.
Berwick further explained each of the radical principles through the presentation of real-life anecdotes. Each of the anecdotes achieved demonstrable success in achieving the goals of radical redesign by engaging and accepting the individual’s view of logical, rational, common-sense approach to addressing a healthcare challenge.
The most impressive of his anecdotes described an initiative implemented at St. Ninian’s Primary School in Sterling, Scotland. The school had 420 students in grades one to 10, and at the start of this particular initiative, 45 percent of the student population was overweight. The initiative was referred to as “The Daily Mile” and the objective motto for the initiative was known as “fit to play, fit to learn.”
In a logical, rational and common-sense approach, the school principal—with support from parents and pupils—made a commitment to have every pupil run or walk a daily mile during school hours. The results were astonishing in that after three years, not one of the pupils was obese. For more information, go to http://www.thedailymile.org/. What was particularly impressive were the quotes provided by the students who participated in the initiative, including a student who said, “I like Run a Mile because I have to push myself a bit more every day.”
The most significant challenge to achieving the radical redesign principles of IHI was focused on How to Shift the Balance of Power. In our complex and fragmented healthcare delivery system, power exists in many different components of the delivery system. Berwick’s proposed solution places the power with the individual patient. He stated that adopting the following principles was the key to shifting the balance of power in health care delivery to the individual patient:
- Use what the patient and family bring. Accept their gifts.
- Talk less. Ask more. “What matters to you?”
- Make transparency limitless.
- Protect privacy, but “repeal and replace” HIPAA.
- Equip homes and communities to replace institutions.
- Share decision-making.
- Do not design core systems around hard cases.
- One patient = one episode of care.
I encourage you to visit the IHI website at http://www.ihi.org/
Berwick’s presentation was followed by Rear Admiral Jeffrey Brady M.D. of the U.S. Public Health Service. His presentation focused on “Moving Toward a Safer Health Care System.” Brady’s presentation was more focused on statistics. I would also encourage you to visit the website for the Health and Human Services Agency for Healthcare Research and Quality at https://www.ahrq.gov/.
I firmly believe that every presentation elicits a golden nugget idea that can and should be considered for implementation by all organizations, not just healthcare and tax-exempt service providers. In the case of Berwick’s presentation, his golden nugget was to periodically survey the employees of your organization for the sole purpose of identifying stupid rules. He presented remarkable results in the form of cost and service efficiencies derived by asking the simple question of each employee, “Please identify the stupid rules that you follow in your daily work activities.” Try this approach in your organization, and I am certain that you too will identify a number of cost and service efficiencies.
Gerald Archibald is a partner serving both of our Rochester, NY, and New York City offices.