Conference News – Ready for the Challenge: IHI’s National Forum
Each December, I head to the Institute for Healthcare Improvement’s (IHI) National Forum for a reliable dose of news, education, colleagues from around the world, and plenty of new ideas to keep things interesting. It’s always energizing. After all, “improvers”—those who engage in process improvement—are optimistic by definition; to work on improvement requires belief or faith, at least, that things can be better. We may have problems today, but there is hope for tomorrow, especially once we get to work!
Despite years of uplifting experiences, the optimistic can-do spirit of this year’s Forum caught me by surprise. For months, the news has been full of stories about how national efforts to reform access and the cost of healthcare have run into a meat grinder of misunderstanding, political manipulation, legislative gridlock, and legal challenges. IHI’s former president and CEO, Dr. Don Berwick, came to this year’s Forum having just resigned his position as chief of the Centers for Medicaid and Medicare because Senate republicans refused to approve his nomination, using him as a scapegoat for “Obamacare.” Hospitals and providers face declining revenues, while patients and employers struggle to cope with rising healthcare costs. The health policy landscape has been looking bleak.
So it was especially pleasant and instructive to hear notes of sincere, realistic, confident optimism at the National Forum about the future of healthcare in the United States:
- We can become a force for improvement despite the dysfunction of government.
- We know how to do this.
- The best days for medicine are ahead of us.
This optimism came from many quarters, but I heard it most often from health system CEOs who have been working on improvement and can show that it’s possible to increase quality and reduce cost. Virginia Mason Medical Center (VMMC), for example, has applied the Toyota Production System (also called lean manufacturing or lean) to healthcare delivery: reducing waste, improving safety, and sharpening its focus patient-centered care. Using what they now refer to as the Virginia Mason Production System, VMMC has reduced costs for patients, payers, and employers while improving service and outcomes. Chairman and CEO Gary Kaplan, MD, started Virginia Mason on the path to improvement in 2000 and led his first trip of senior managers to Japan for TPS training in 2002. Now, nearly 10 years later, his confidence that VMMC can continue to improve is based on experience and results. It was Kaplan who declared, “The best days for medicine are ahead of us.”
Berwick, too, encouraged attendees to see this as a time of hope and opportunity, saying, “The possibility has never been greater — not in my lifetime.” While not underplaying the challenge, Berwick declared that those who deliver care—represented by the the nearly 5,700 at the National Forum and another 14,000 by satellite—must be the ones to address the financial crisis in healthcare.
Our nation is at a crossroad. the care we have simply cannot be sustained. It will not work for health care to chew ever more deeply into our common purse. If it does, our schools will fail, our roads will fail, our competitiveness will fail. Wages will continue to lag, and, paradoxically so will our health.…We can do this… we who give care. And nobody else. The buck has stopped.…I am not sure any of us would have chosen “efficiency” — the reduction of waste — as our favorite [dimension of quality]. It’s not my favorite. Nonetheless, it is the quality dimension of our time.…If you are a student of lean thinking or quality, itself, you know that great leverage in cost reduction comes directly — powerful — exactly from focusing on meeting the needs of the person you serve. “Waste” is actually just a word that means, “Not helpful.”…In very large measure, improving care and reducing waste are one and the same thing.
A confluence of circumstances in healthcare is delivering the biggest challenge and opportunity the quality improvement movement has faced, at a time when the movement seems to have developed confidence and maturity.