Not that long ago, one of the prime examples given by Keith Swenson in support of the "ACM approach" was a medical example (picture Dr. House examining the really-out-there cases) - check out the comment stream from this post for background.? Jacob Ukelson and I, not long after, proposed a way to think about ACM and BPM approaches in a complementary fashion - where ACM is concerned about an individual case, whereas BPM is concerned about the aggregate of all "cases" or processes.? I used Keith's medical analogy to make my point.
From twitter (thanks @elliotloh), I ran across this PBS story on a Denver Hospital that fairly well proves my point with respect to hospitals. There's video, but I've quoted a few passages below.? First, what was the outcome of this focus on aggregate quality of care?
DR. PATRICIA GABOW, Denver Health and Hospital Authority: What that translated to at Denver Health last year is that 213 people walked out of here alive who would have been expected to die. So, that makes the statistic into a very personal aspect for people who, in fact, lives were saved.
Think about that - 213 people alive today that statistically, would have passed away at the average hospital.? And they're not cherry-picking the patients and doctors, as the following passage demonstrates:
DR. DONALD BERWICK, Center for Medicare and Medicaid Services: They are getting levels of performance that most of the rest of us in health care can only envy. The vast majority of their patients are either uninsured or Medicaid patients. They deal with a very, very stressed population. And they are proving that that kind of care isn't just kind of good enough. It can be the best care -- actually, the best care in the country. They are showing the rest of us what's possible.
But was this process improvement effort really goal-driven? (emphasis added in italics):
BETTY ANN BOWSER: One of Berwick's chief goals is to reduce hospital-acquired infections in the next two years.
Was this really anything at all like a BPM project? Well sure it was, absent the BPMS software (emphasis added):
BETTY ANN BOWSER: CEO Gabow wanted a cultural change, so she brought in a team of efficiency experts from the business world and asked how they solve problems.
Out of that grew adoption of the Toyota automobile production system's Lean principles, to eliminate waste, fix problems, and promote constant improvement.
WOMAN: So, as a group, we're going to process-map it. We're going to identify your waste. We're going to pick part those defects.
It sounds pretty familiar, doesn't it? And they looked at process times, steps, measurement, alerting -? not the checklists a doctor might operate from, or a nurse, but the systemic approach to the overall care-giving processes:
SELEEM CHOUDHURY, Denver Health: People come in and they are sick. And when they are sick, we need to see them as soon as they arrive upon -- you know, upon arrival.
And so we had to reexamine our process. We got Post-it notes -- we put them on the wall -- from every single aspect, from walking through the door, to seeing the nurse, to going through registration. And we had up to maybe two hours' wait to be seen for that process. And just by making some simple changes, we cut that wait time by half.
(It does pain me a bit to see that they had to resort to post-it notes rather than software...)
But what is driving this change? A change to Medicare payments - tying them to efficacy and safety rather than just performing a service.? This is going to force hospitals to re-examine how they provide care and think about how to serve patients more effectively.? Of course, we can bemoan the fact that it takes a financial incentive to drive this change in quality of care, but maybe we should take improvement at face value, whatever the driving force behind it.