Continuous Improvement and Continuous Learning

VPQHC's Integrated Approach to Healthcare Redesign - Infinite Opportunities for Change

Changing to a Population-Based Healthcare System

In 2001, the Institute of Medicine (IOM) released their landmark study called “Crossing the Quality Chasm”, which detailed the deficiencies in the US healthcare system and proposed strategies for radical improvement. It showed the healthcare delivery system was disjointed, inefficient, and full of waste at all points, which contributed significantly to the
cost increases experienced year upon year. It proposed a 6-point aim statement
encompassing Safety, Effectiveness, Patient Centered-ness, Timeliness, Efficiency, and
Equitableness. These six aim statements were adopted as Vermont Program for Quality in
Health Care’s guiding aims as well.

Sixteen years later, and many of the strategies proposed in that report have beenimplemented or started, and slowly the US healthcare system is changing from fee-for-service to a population-based system. Along the way, the Institute for HealthcareImprovement (IHI) coined their “triple aim” of Improving the Health of Populations, Improving the Patient Experience of Care, and Reducing the Per Capita Cost. This has been widely adopted by organizations who continue to improve and change their structure and operations to provide service in the new population-based environment.

Recently, three senior IHI executives produced an article that took the work of the IOM and IHI, and brought it up to date in their “10 New Rules to Accelerate Healthcare Redesign”. It was a set of “bold aspirations to guide healthcare organizations during an era of reform”. In an era where changing from fee-for-service to population-based health, medical professionals and their organizations often feel like they have “one foot on the dock, and the other in the canoe”. In order to combat this, they propose organizations need to:

  1. Change the balance of power – Co-produce health and well-being in partnership with patients, families and communities.
  2. Standardize what makes sense – Standardize what is possible to reduce unnecessary variation and increase the time available for individualize care.
  3. Customize to the individual – Contextualize care to an individual’s needs, values and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
  4. Promote well-being – Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require healthcare.
  5. Create joy in work – Cultivate and mobilize the pride and joy of the healthcare workforce.
  6. Make it easy – Continually reduce waste and all nonvalue-added requirements and activities for patients, families, and clinicians.
  7. Move knowledge, not people – Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are – literally.
  8. Collaborate and cooperate – Recognize that the healthcare system is embedded in a network that extends beyond traditional walls. Eliminate silos and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
  9. Assume abundance – Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities.
  10. Return the Money – Give the money from healthcare savings to other public and private purposes.

VPQHC and the 10 New Rules

VPQHC is incorporating the “10 new rules” into our own work, and can share our expertise in expanding the integration of these vital concepts of change acceleration across the system of care. Through systematic assessment of current operations, organizations can actualize the 10 New Rules in a comprehensive, integrated radical redesign process which
addresses Systems Improvement (#s 2, 3, 5, 6, and 8), the Role of Leadership in leading this change (#s 1, 4, 5, 9, and 10) and Integration with the wider social environment (#s 4, 7, 8, 9, and 10). This integrated evaluation reveals a truly holistic view of theorganization, puts the patient front and center in all the focal points in the system and guides redesign using state of the art thinking and methodologies rooted in the Toyota Production System, Organizational Lifecycle Analysis, Systems Thinking, and Advanced Change Management.

As the IHI report states, “Surfacing, testing and then spreading comprehensive, radical redesign is not for the timid”. We have been in the trenches with hospitals, primary and specialty care practices, and many other non-healthcare organizations undergoing radical change. There is no more effective way of guiding the redesign process, and implementing the changes it requires until the organization is truly transformed. Over-hauling systems
to place patients and family’s needs squarely in the center of a supportive and caring delivery team requires coaching, experience leading change, and expertise to evaluate delivery systems.

If your organization seeks to grow on a change improvement pathway, VPQHC would be excited to share our vision, talents, and leadership with Vermont healthcare organizations that are committed to accelerating the change from fee-for-service to population-based

Ready to find out more? Call or email us at (802) 229-2152 or