“In God we trust…and all others must bring data.”
Dr. William Edwards Deming
Quality improvement concepts and techniques, such as Six Sigma and Lean practices, have been used to transform almost every major industry in the world with dramatic results. The last holdouts, the last passions of resistance, are primarily healthcare, higher education, and government. Healthcare professionals will take clear data and twist it just enough to make an argument, or they simply will refuse to accept the data being presented. Some will tell you that they are a skilled healthcare practitioner and simply will not be told how to deliver quality healthcare to patients by “someone who possess the name of a karate belt in their job title.”
The question is why does healthcare continue to resist the results presented from other industries and their significant success?
Can We Ever Have Real Quality Healthcare?
It just seems that no matter how much data can be thrown on the table, quality healthcare practices continue to be resisted like a despotic dictator. We all can acknowledge healthcare is very complex, but it’s really not fundamentally different from other industries. Healthcare is really made up simply of thousands of interlinked processes that result in a very complex system. If we focus on the processes of care one at a time, we can fundamentally change the game and deal with the challenges facing healthcare. We also understand Pareto’s Principle, which tells us 20% of the processes that will give us 80% of the results.
In healthcare, the real problem remains in two familiar circles. The first is silos. Healthcare is deeply entrenched in its divisions. Each group feels that they are doing a great job, and present arguments that the others are really responsible for making the changes required to find quality healthcare. This leads to back-and-forth finger pointing and blame games. Nursing will tell you that the problem is the physicians, and physicians will tell you that nursing is the group that needs to shape up. Then, you will hear from physicians and nursing that if you really want to improve quality healthcare initiatives, you must fix support services or even worse, the patients are at fault. They are the real problem.
The second challenge that faces quality healthcare initiatives is leadership support. C-suite executives are more than hesitant to challenge physicians or nursing on clear issues within their control. Physicians bring in significant amounts of revenue to the organization and could cripple a healthcare facility if they moved on. Nursing ensures care is delivered and is on the front line of quality healthcare. They will tell you that things work just fine using the same procedures and processes that have been in place for years. C-suite executives tend to shy away from powerful and strong-willed nursing departments.
Continuing on the Road to Quality Healthcare
There are numerous organizations that can clearly demonstrate significant levels of success in quality healthcare improvement. Just as many continue to resist embracing the practice, others implement Six Sigma and Lean programs, with a ’nod and wink’, taking on easy projects that don’t stop on toes of the powerful in the organization. It continues to baffle how a healthcare organization can have Lean Six Sigma programs in place for years and fail a Joint Commission survey because of serious quality issues.
There is a long road ahead for all.
Do you think things are changing in healthcare, or is there still some major resistance?