Five Deming Principles That Help Healthcare Process Improvement

The approach they developed to improvement was remarkably simple, yet extraordinarily powerful. It’s centered on the fact that quality improvement is really about process management. These quality improvement concepts and techniques have been used to transform almost every major industry in the world with dramatic results. The last holdouts, the last passions of resistance, are primarily healthcare, higher education, and government. Now, it’s happening to healthcare. I believe higher education is imminent; it’s anyone’s guess whether government will ever succumb to these forces.

Now, we all know healthcare is very complex, but it’s not fundamentally different from other industries. Healthcare simply consists of thousands of interlinked processes that result in a very complex system. If we focus on the processes of care one at a time, we can fundamentally change the game and deal with the challenges facing healthcare. Now, this may seem like a tall order, but thePareto principletells us that there are probably 20 percent of those processes that will get us 80 percent of the impact. So, the challenge of every organization is to identify that 20 percent, roll up their sleeves, and begin the important work of addressing those challenges.

2. For quality control in healthcare, if you cannot measure it—you cannot improve it.

戴明清楚地明白数据的重要性。有意义的质量改进必须由数据驱动。在医疗保健的质量控制方面尤其如此。如果你试图与医疗保健提供者合作，而且你没有良好的数据，你基本上是死路一条。我想每个人都认识到这一点。

Deming said, “In God we trust…and all others must bring data.” I love this quote because it reflects that reality. I’ve had physicians during my career tell me pretty much the same thing, only they’re not quite so polite. They basically say, “Dr. Haughom, John, get lost! Bring the data. And then we’ll decide if we believe it.” So, data is critical if we’re going to have a meaningful impact in healthcare.

3. Managed care means managing the processes of care, not managing physicians and nurses.

An important application or clarification of a Deming principle was put forward by my good friend,Dr. Brent James. Managing care means managing the processes of care. It does not mean managing physicians and nurses. What James said is very true. One of the big mistakes made in the 90s with the managed care movement was naively thinking that managing care meant telling physicians and nurses what to do. The reality is that you need to engage clinicians in the process because they understand the care delivery process and they are best equipped to figure out how to improve the process of care over time. And for this reason, I strongly believe that these changes will, in fact, ultimately be very empowering for all clinicians who try to get involved.

4. The right data in the right format, at the right time, in the right hands.

如果临床医生要管理护理，他们需要数据。他们需要正确的数据以正确的格式在正确的时间和地点交付。数据必须传递给正确的人——参与操作和改善任何既定护理过程的临床医生。

5. Engaging the “smart cogs” of healthcare.

If quality improvement is going to work in healthcare—if we are going to realize value—it means we must engage clinicians. To use Deming’s term, clinicians are healthcare’s so-called “smart cogs.” They are the frontline workers who understand and own the processes of care. And as I said in an earlier slide, we’re very fortunate in healthcare because we have a workforce dominated by clinicians who are extraordinarily committed, very intelligent, and highly educated.

但我们生活在一个原始时代。我曾经收到过一封来自一位医师同行的电子邮件，他在一家领先的国家分娩系统工作。我不会透露这个配送系统的名字，但我可以告诉你，如果你让有见识的人列出全国前10大配送系统，几乎每个人都会把这个组织列在他们的名单上。尽管如此，这位医生还是写信给我，感叹让他的同行医生看到一个新的未来是多么困难。在他的电子邮件中，他简洁地描述了这个问题，称他的医生“历来受到阻碍，士气低落”。我喜欢他简洁的描述，因为他基本上是在说，他们执着于过去，意志消沉，因为他们看不到新的未来。在这短短的一句话中，这位非常优秀的医生领袖几乎概括了问题并为我们指出了解决方案。

Are Physicians Willing to Change?

A2011 McKinsey surveyclearly demonstrates that the majority of physicians are, in fact, willing to change. McKinsey more than 1,400 US physicians and found that 84 percent said they were willing to change if a reasonable course and argument could be made that change was necessary.

So, how do we reconcile this? I believe we need to help clinicians figure out how to give up the past by helping them see a new future and help them understand their role in creating and sustaining that new future. In fact, I believe one can make a very strong case that the future will be very empowering for clinicians of all types if we can successfully inform them, engage them, and inspire them. Applying these key Deming principles to healthcare process improvement can help every healthcare organization show the workforce why change is necessary, what they need to understand to participate in meaningful change, and what success will ultimately look like.

The Health Catalyst Data Operating System (DOS) — The Key to Data-driven Improvement

From population health management to value-based care, healthcare providers face a quagmire of reimbursement schemes and quality initiatives, each requiring precise analysis of clinical, financial, and patient data. Yet to get there, they must unravel a Gordian knot of diverse information systems that cannot communicate with each other and that separately lack the data needed to succeed. The explosion of information from wearables, mobile phones, genomics, and other sources outside the traditional healthcare sphere is exacerbating these problems while also enabling personalized healthcare and management as never before, assuming organizations can manage the transformation.

Clinical and financial decision support at the point of care is almost nonexistent in healthcare, restricted to a few pioneering organizations that can afford the engineering and informatics staff to implement and maintain it. With the Health Catalyst® Data Operating System (DOS™), this kind of decision support is affordable and effective, raising the value of existing electronic health records and making new software applications possible.

简而言之，质量和成本的改善需要智能地使用相关的财务和临床数据，并为推动流程改进的多学科团队提供教育。由于其灵活性，DOS为医疗保健提供了理想的分析平台类型。世界杯厄瓜多尔vs塞内加尔波胆预测DOS是一种与供应商无关的医疗保健数字骨干。使用DOS，团队将能够应用本文中概述的原则，并最终实现高价值的结果。

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