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Next Generation Quality
Next Generation Quality

Bob Luttman
I'm Baaaack!

Well, you all asked for it. My thanks to Healthbond for the opportunity to continue our conversation about cost, quality, and how healthcare organizations can deal with these and other issues. Apparently, many of you found my hosted forum last month to be informative and helpful. Thanks to all of you.

I would like to go forward by going backwards, to outline what I define as "next generation quality" and why I think it is important. Next generation quality is about stepping back, taking a deep breath, and thinking about what you do and how you do it. The original inspiration(s) for the model came from doing exactly that, so I know it works. It is also based on the work of many people and organizations, in healthcare and other industries, who have taken that step back and thought through some of these issues. And my thinking has evolved through reading these stories, work with clients, and talking to people, lots of people, around the world and around the Internet. The issues we face in healthcare are not unique to industry or geography.

Look around at great organizations. What do they do? How do they do it?

I think they do, very well, a few things:

  • Great processes
  • Great understanding of thoses processes, and when to ignore them
  • Great people
  • Great information
  • Great sense of purpose
  • Continuous improvement, almost a fanaticism to be better

    None of these are more important than the others (though the engineer in me did put processes first). Integrating them into a coherent system is the essential, and most difficult, task. The Baldrige criteria provide a good model for doing this.

    The components of the Next Generation Quality model are:

  • Clinical pathways
  • Variance management systems
  • Balanced scorecards
  • Continuous improvement
  • Self-directed care management teams

    Over the next few months I will present more details about these and the tools and techniques you can use to do these well. And, this is where you come in, we will discuss them. Together we can all learn something.

    To give you a little teaser, here's some of the details:

    Clinical Pathways. What do you do and how does your work interact with the work of others? Is there really a process here? How can you better create and implement clinical pathways. More importantly, how can you use pathways to better manage care? We will talk about using pathways to identify improvement opportunities, develop and manage costs, and better coordinate care.

    Variance Management Systems. No process is perfect, no process can anticipate all contingencies. Variation is unavoidable. In fact, variances are good; within limits. They are
    learning opportunities, something happened that the pathway didn't anticipate or adapt to. The abundance of information that variances could provide is lost in most organizations. Traditional variance systems are too labor intensive and bury the important information in a pile of details. Since I can honestly say I wrote the book on variance management systems, I will talk about how to do a better job of collecting and using variance data. We will talk about next generation variance management, the Gateway Model.

    Balance Scorecards. Also called value compasses, balanced scorecards integrate management reporting. The "vital few" critical indicators in the four performance dimensions
    (financial, quality, outcomes, and satisfaction). These indicators are integrated, usually through the budgetting and/or strategic planning processes, throughout the organization. The idea is to provide "bedside to boardroom" management information; with the bedside (or clinic or wherever else you deliver care) getting the most immediate and detailed information. The data belongs where the action is. We will talk about selecting indicators, collecting data, statistical tools, and graphing data.

    Continuous Improvement. A performance improvement process built around quarterly "quality" meetings and chart reviews, or, worse, the next JCAHO visit rarely generates sustained or meaningful change. Ad hoc quality improvement teams are not a whole lot better. Continuous means just that, all the time. Everybody involved. We will talk about "rapid cycle improvement", which the Institute for Healthcare Improvement has used to great advantage on a variety of healthcare issues. We will talk about the ins and outs of managing an improvement process, motivating people to change and keep changing, and how to make sure you don't drive yourself crazy doing it.

    People. People are the glue of healthcare. The processes of care occur at the bedside, in the emergency rooms, in the labor and deliver suites, in the labs, in the pharmacies, in the clinics, in the patient's home, and many other places. Healthcare needs to energize, organize, and
    empower care givers and supporters to provide better and more economical care. Many organizations are creating teams of people to manage and improve care for distinct patient
    populations. We will talk about issues surrounding these teams and how to best use them.

    We will also discuss the Baldrige criteria and how it can help you integrate all of these into a coherent whole.

    This should keep us busy for awhile. If you have any questions or comments, feel free to use the opinion section below or the quality discussion section. I moderate the Quality discussion (click here) on HealthBond and would be glad to have a continuous dialogue.

    Bob Luttman is a member and contributor of HealthBond. View his expert page on HealthBond.
    Bob Luttman is Principal Consultant with Robert Luttman & Associates, a healthcare management consulting practice specializing in clinical pathways, quality and performance measurement, process improvement, and total quality management.

    As a leading healthcare and quality management consultant Bob has written and presented extensively on a variety of topics including Statistical Process Control (SPC) in healthcare and organizational performance assessment. He is actively involved in regional and national organizations, currently serving as the Healthcare Chair of the Boston Section of the American Society for Quality Control. In the past he has served as President and Board Member of the New England Healthcare and Information Systems Society. Bob is also a Certified Examiner for the Massachusetts Quality Award, based on the Malcolm Baldrige National Quality Award.

    November 1, 2000

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