Crossing the Quality Chasm: A Systems Approach Richard J. Schuster, MD, MMM Boonshoft Chair and Director Health Systems Management Wright State University
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Crossing the Quality Chasm:A Systems Approach
Richard J. Schuster, MD, MMM
Boonshoft Chair and Director
Health Systems Management
Wright State University
Chasm …
Grand Canyon
Grand Canyon
South Rim
Grand CanyonNorth Rim
A Double Oxymoron…..
Health
Systems
Management
Why ???
The History of AmericanMedicine is One of
Organizational Autonomy
Doctors Hospitals
Hospital
System
Doctor
Doctor
Doctor
Doctor
It’s Been Nearly Impossible to Establish a Health System
Doctor
Best Practice Analysis:Best Practice Analysis:Can all of these physicians be doingCan all of these physicians be doing
the Best Practice ???the Best Practice ???
Outlier
? Benchmark2 SD
StatisticalNoise ?
Unexplained Clinical VariationMust be Reduced…
� Explained ClinicalVariation
� Unexplained ClinicalVariation
David Nash
(W. Edwards Demming)
How Do You Create a HealthSystem?
� Collaboration� Interdisciplinary Teams� Human Factors Analysis and
Design� Aligned Financial Incentives
� Physicians� Hospitals� Insurers / Employers
Cultural
Change
Educational
Change
How Do You Create a HealthSystem?
� Information Systems
� Rapid Adoption of Best Practices� Not 17 years from research to practice
� Acceptance of practice guidelines &clinical pathways as a means to reducevariation and improve quality
� Evidence Based Practice
� Data Driven Outcomes Analysis
Cultural
Change
Educational
Change
Key Points
� Aims� Rules
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Aims for the 21st-CenturyHealth Care System
� Safe – avoiding injuries to patients from the carethat is intended to help them.
� Effective – providing services based on scientificknowledge to all who could benefit and refrainingfrom providing services to those not likely tobenefit (avoiding underuse and overuse,respectively).
� Patient-centered – providing care that isrespectful of and responsive to individual patientpreferences, needs, and values and ensuring thatpatient values guide all clinical decisions.
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Aims for the 21st-CenturyHealth Care System
� Timely – reducing waits and sometimes harmfuldelays for both those who receive and those whogive care.
� Efficient – avoiding waste, including waste ofequipment, supplies, ideas, and energy.
� Equitable – providing care that does not vary inquality because of personal characteristics such asgender, ethnicity, geographic location, and socio-economic status.
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Ten Rules� Care based on continuous healing relationships
Patients should receive care whenever they need itand in many forms, not just face-to-face visits.
� Customization based on patient need and values
� The system of care should be designed to meetthe most common types of needs.
� Have the capability to respond to individualpatient choices and preferences
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Ten Rules
� The patient as the source of control. Patients shouldbe given the necessary information and the opportunityto exercise the degree of control they choose overhealth care decisions that affect them.
� Shared knowledge and the free flow of information.
� Patients should have unfettered access to their ownmedical information and to clinical knowledge
� Clinicians and patients should communicateeffectively and share information
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Ten Rules� Evidence-based decision making.
� Patients should receive care based on the bestavailable scientific knowledge
� Care should not vary illogically from clinicianto clinician or from place to place.
� Safety as a system property. Reducing risk andensuring safety require greater attention to systemsthat help prevent and mitigate errors.
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Ten Rules� The need for transparency. Make information
available to patients and families allowinginformed decisions selecting health plans,hospitals, or clinical practices, or choosing amongalternative treatments. This should includeinformation describing the system’s performanceon safety, evidenced-based practice, and patientsatisfaction.
� Anticipation of needs. The health system shouldanticipate patient needs, rather than simplyreacting to events.
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Ten Rules� Continuous decrease in waste. The health
system should not waste resources or patient time.
� Cooperation among clinicians. Clinicians andinstitutions should actively collaborate andcommunicate.
Institute of Medicine, Crossing the Quality Chasm, National Academy Press, 2001
Grand Canyon
Health Care in the Future:Systems Promoting Quality & Efficiency
Crossing the Quality Chasm:A Systems Approach
Richard J. Schuster, MD, MMMBoonshoft Chair and Director
Health Systems ManagementWright State University
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