To give some perspective, the committee contrasted healthcare with other consumer-oriented industries. If those industries operated like the healthcare system, the committee said in the report, airline pilots would design their own pre-flight safety checks and grocery stores wouldn't post their prices.
“If banking were like healthcare, automated teller machine (ATM) transactions would take not seconds but perhaps days or even longer as a result of unavailable or misplaced records,” according to the report. “If home building were like healthcare, carpenters, electricians and plumbers would work with different blueprints, with very little coordination.”
But Smith said the committee's framework for “a learning healthcare system,” developed during the past year and half, can change that.
One component emphasized repeatedly throughout the report is the importance of systems engineering and other management strategies for redesigning flawed processes. Those can be as simple as a short checklist, or more complex approaches—often borrowed from other industries—such as Lean and Six Sigma.
Such process improvements can make measurable effects on quality and can also result in significant savings, said Eugene Litvak, president and CEO of the Institute for Healthcare Optimization, Newton, Mass., and a member of the IOM committee.
The Institute for Healthcare Optimization, which specializes in operations management—specifically smoothing patient flow—has worked with a long list of well-known healthcare organizations, including Johns Hopkins Medicine, Baltimore, and the Mayo Clinic's satellite in Jacksonville, Fla.
Litvak argues that it's the peaks and valleys in bed occupancy that contribute to a host of problems, including high readmission rates, increased risk of mortality and nurse burnout. And despite average bed occupancy rates that hover around 65%, hospitals are plagued by overcrowded emergency departments and related problems like premature discharge, he said.
“We are one-third idle and we're overcrowded,” Litvak said. “Only in healthcare could you manage that. We should have enough beds for everyone if we use them properly.”
One of the tactics Litvak and his colleagues often use is smoothing out elective surgery schedules so procedures are not clustered on certain days of the week. Not surprisingly, that strategy has been met with plenty of pushback, he said. But it's also produced results.
At Cincinnati Children's Hospital Medical Center, for instance, they were able to increase bed occupancy rates to 91% from 76%. Additionally, the hospital saw $100 million in avoided capital costs and another $100 million in additional revenue following implementation of the institute's recommendations.
“I think it's very important for patients to know that when they sit for hours in the emergency room, it's not because everyone got sick at once,” Litvak added. “It's not a shortage of beds; it's a shortage of knowledge and leadership.”
He predicted a sea change in the use of process improvement strategies, propelled by new payment models that emphasize value. Accountable care organizations, in particular, he said, will drive organizations to look more closely at how their systems can be adjusted to make care better.