Monday, November 23, 2009

"What health care needs is process innovation, not product innovation."

Wow- I love it, this is a simple but great explanation of where we should focus on innovation in healthcare (from Dr. Devi Shetty, a cardiac surgeon and efficiency expert in India). To clarify further: we actually know how to do a lot of things very well (e.g. prevent infections, manage diabetes, cure many cancers)... but instead of trying to make sure we follow these processes 100% of the time, we seem more intent on coming up with the newest product or service that will only be incrementally better than the last one (and which may actually be used by less patients because it is more expensive)!

As it turns out, much of the time, all we need to do are create some easy and cheap process improvements which simply enforce the standards of care we all accept- and we would get much better bang for our buck than any new medication or device! This was highlighted by Dr. Atul Gawande in "The Checklist", an article about Dr. Peter Provonost's simple checklist procedure to prevent line infections in the ICU - which saved a significant amount of lives and money... and yet which has not yet been widely accepted because that is not how American's like their innovations! As Dr. Gawande describes:

The still limited response to Pronovost’s work may be easy to explain, but it is hard to justify. If someone found a new drug that could wipe out infections with anything remotely like the effectiveness of Pronovost’s lists, there would be television ads with Robert Jarvik extolling its virtues, detail men offering free lunches to get doctors to make it part of their practice, government programs to research it, and competitors jumping in to make a newer, better version. That’s what happened when manufacturers marketed central-line catheters coated with silver or other antimicrobials; they cost a third more, and reduced infections only slightly—and hospitals have spent tens of millions of dollars on them.

A more recent WSJ article reviews Dr. Shetty's experience and philosophy about how increasing volume can save money and improve quality:

The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.

His model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major health-care overhaul. "Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr. Shetty says. "What health care needs is process innovation, not product innovation."

In the healthcare innovation program I help lead (the Szollosi Healthcare Innovation Program), we have used a similar philosophy to come up with some simple process improvements which have started making a difference. The ExpectED project created a web-based tool which formalized the hand-off from outpatient physician to the Emergency Department. Further evolutions of this project have moved this formalization into our EMR system.

Meanwhile, the Inflection Navigator system allows physicians to send a single order which then triggers a cascade of processes related to one of the defined "inflection points" we are studying (Cancer, Hematuria, Atrial Fibrillation). These processes (including radiology orders, specialist consults and patient education) are carried out by a team of people knowledgeable about each of their separate duties. The result is a more efficient and more consistent process for both patients and physicians.

So as Thanksgiving rolls around, let's rejoice in the fact that there is plenty of innovation left to do in healthcare... much of it right before our eyes!

1 comment:

  1. If you liked that, you'll love Jim Walkers article:

    From Tasks To Processes: The Case For Changing Health Information Technology To Improve Health Care

    James M. Walker and Pascale Carayon