The Onus of Kaizen: Realizing the Full Intentions of Healthcare Reform

By Tom Best and Priya Khatri

This article has both an informative and implorative intent. First we summarize the themes of a speech we attended on Sept. 21 by David Cutler, a Harvard economist and the senior healthcare advisor to President Obama during his campaign. Then we try to stoke the interest and involvement of our profession and our society in current and future healthcare reform. 

In his talk, "The Unrealized Opportunity in Healthcare," Cutler began stating that the five reform bills before Congress will be the most substantive the U.S. has seen in 40 years. He also warned (or even appealed) that if reform does not happen this year it will stall at least until 2011. While Priya and I are too (un)informed to testify for or against either of these claims, the pure fact that the claims were made implies that broad change to our health system will be enacted before year’s end.

All of us are aware that at least two of these reform bills intend to cover the 30 to 40 million uninsured Americans. The primary theme of Cutler’s speech was to describe how healthcare organizations and practitioners can help achieve the potential benefit of this increased coverage by addressing the innate inefficiencies that plague our industry. He mentioned a few components of the roughly $700 million in estimated "health system waste" that are all too familiar to the SHS community: redundant and antiquated care documentation, disparate and excessive care utilization, and lethargic and reactive improvement hierarchies. He stated that with $30 million in stimulus reserved for electronic health records and portions of the upcoming legislation slated to reward top quality and to fund comparative effectiveness research, our government is instilling financial incentives for individual care organizations and practitioners to eliminate this system waste.

After he finished, multiple audience members questioned the ability of the U.S. government to purge health system waste. One individual identified healthcare as an industry already over-burdened with regulation and suggested a causal link between regulation and the continually increasing costs of the industry. Another suggested that the government would not stimulate ingenuity with the new incentives but actually stifle it by adding still more levels of bureaucracy.

Cutler responded clarifying the distinction between the pending legislation’s plans to enable improvement and the actual process of organizational improvement. While this transfer of responsibility may be a sobering message for us all, to a large extent he’s right. It is up to us as leaders in health systems improvement to continuously eliminate our system inefficiencies and capture the potential value of these reforms. With our tools and training, we are capable of methodologically addressing widespread problems in our organizations. For example, our training reminds us that $30 million will only cover initial start-up costs for electronic health records. We will then have to match the HER to the specific context of implementation, and then lead continuous refinement and integration, all the while minimizing differences between standard EHR design principles and the end-product. We will need to empower our peers and staff to inform and conduct these refinements, and to follow the new processes, shifts in responsibility which can require a significant change in culture and work allocation.

We can bet that Capitol Hill will soon pass legislation adding incentive to our healthcare kaizen, but the onus is then on us to act on the stimulus. If you’d like to publish examples of improvement actions at your organization in upcoming SHS newsletters, please contact the authors.