Dr. Gary Kaplan on "systems approach" to fix healthcare

I cannot recall a time during my 35 years in healthcare when changes in reimbursement models, government regulations, quality measures and cost controls were not being debated, planned or implemented.

Amid this ebb and flow, we must remain focused on fundamentals such as access, appropriate care, safety, value and transparency.

The Affordable Care Act has survived, for now, but the work of Congress and healthcare leaders is far from finished. We must pledge to work together, regardless of political affiliation or ideology, to make the ACA better. Access to affordable healthcare is essential to the quality of life for all Americans.

I urge President Donald Trump and members of Congress to launch an initiative that will address the broken processes that allow preventable waste and avoidable cost to shackle the U.S. healthcare system. They should invite providers, payers, patients and policymakers from across the political spectrum to participate.

American healthcare is in a danger zone. Islands of excellence exist, but there is too much variability and inconsistent performance in quality, safety and patient experience.

By some estimates, more than 30% of healthcare expenditures are unnecessary or wasted. Yet national healthcare spending is projected to rise an average of 5.6% annually through 2025, outpacing growth in gross domestic product by 1.2 percentage points per year.

How can we ensure we get the highest value in return for this ever-growing healthcare bill? The answer is to apply structured systems-engineering approaches to healthcare delivery across the nation.

Bringing a Systems Approach to Health, a discussion paper published in 2013 by the Institute of Medicine and the National Academy of Engineering and for which I had the honor of serving as a co-author, notes that systems approaches have improved efficiency, quality and safety in the aviation and automotive industries and "could be similarly transformative for health and healthcare."

A systems approach, the paper explains, applies scientific insights to understand the elements that influence health outcomes and alters processes to produce better health at lower cost. Tools include production system methods and other management interventions that help organizations improve operations while better understanding how humans interact with technologies and processes.

A systems approach relies on evidence-based principles to reduce variability by standardizing processes, embedding best practices and driving continuous improvement. This approach would make it a priority to identify and eliminate waste—anything that adds cost but no value—and thereby restrain costs for consumers, providers and insurers.

For example, the process for determining whether an MRI is necessary and appropriate should be the same in Seattle and Bangor, Maine, and everywhere in between. Standardizing processes, where variation adds no value, also minimizes the potential for human error, increasing care quality and patient safety.

I know a systems approach accelerates quality, safety and efficiency based on our experience at Virginia Mason. We adapted engineering principles of the Toyota Production System more than 15 years ago and use them to improve how we serve our patients and support our organization's culture of innovation. Patients often participate alongside Virginia Mason team members in our continuous-improvement workshops. They are our partners as we use our systems engineering approach to design processes based on their ideas and needs. It's exciting to imagine where this important work will take us.

As a nation, we have more knowledge than ever about how to provide appropriate, high-quality care and keep patients safe. There is no legitimate excuse for hesitating to apply this knowledge to make care better, safer and more affordable. Accepting the status quo will yield more of what we have—a healthcare system hobbled by inefficiency, waste, unnecessary variability and, all too often, less than optimal quality and safety.