Health-care industry confronting its ‘second curve’
By Thomasn Mosgaller, for SBT
There’s a quiet revolution going on in health care – an upheaval promising benefits to consumers and purchasers of health-care services. It’s a development of great interest to small businesses, which, for a change, won’t have to feel as if they’re left on the sidelines.
All too often, health care "reform" has amounted to exercises in cost-shifting to see which 800-pound gorilla would end up paying less than everyone else; tinkering at the margins trying to fine-tune a system when what’s really needed is major systematic overhaul; and endless finger-pointing as costs continue to skyrocket while quality fails to improve.
For many small businesses, that has meant reducing health-care coverage for their employees or eliminating it altogether.
What’s coming is a new era of patient-centered health care based on the importation of quality management methods and heretofore-unprecedented levels of collaboration among provider organizations, physicians and employers.
The new approaches start from the premise that increasing quality and patient safety will lead to reduced cost. It’s a win-win situation for everyone, including those who have traditionally lacked clout within the health-care system.
The Milwaukee-based American Society for Quality has been bringing together some of the influential thought leaders of this revolution and showcasing some of the more promising Wisconsin-based initiatives.
The most recent effort was a series of meetings in Milwaukee that featured health policy expert Dr. Martin Merry and offered an initial look at the work of the newly formed Wisconsin Collaborative for Healthcare Quality.
Dr. Merry believes that health care has reached the end of the line of what he calls its first curve and must now make a major leap onto the second curve. This new phase incorporates the best of the healing/caring arts and medical technologies with the disciplines of the management and quality sciences.
The current system is not only collapsing under the weight of its size and complexity, but it also tends to be designed around the needs and demands of the system rather than the genuine needs of patients.
In the parlance of current thinking on quality, the system is capable of performing at a 3-sigma or perhaps 4-sigma quality level, not at the 6-sigma level sought by the world’s smartest businesses. That’s why we see reports form the Institute of Medicine describing thousands of deaths annually caused by errors in the health-care system.
"Trying won’t work," says Merry. "We can’t ‘try’ our way to 6-sigma quality levels. We need the wholesale importation of the ideas of [quality gurus] Deming and Juran, human factors, 6 sigma, ISO 9000 and Baldrige."
The seeds of the second-curve revolution in health care have already begun to take root. "It’s the kind of things we’re doing in our communities, not by a bunch of smart people in Washington making policy," according to Merry.
That’s where the Wisconsin Collaborative for Healthcare Quality comes in. The Collaborative is a voluntary statewide consortium of some of the state’s premier quality-focused health-care organizations. In addition to its nine provider members – Bellin Health (Green Bay), Dean Health System (Madison), Froedtert Hospital (Wauwatosa), Gundersen Lutheran (La Crosse), Marshfield Clinic (Marshfield), Medical College of Wisconsin (Wauwatosa), St. Mary’s Hospital Medical Center (Madison), St. Joseph’s Hospital (Marshfield) and ThedaCare (Appleton) – the Collaborative is endorsed by participating members representing employers, employees and labor unions and businesses.
These groups are working together to develop measures of health-care quality that are verifiable by independent third parties. They intend to share and refine best practices among themselves and to publicly report the performance of collaborative members using these measures. That’s a sizable task, given that the current health-care system contains tremendous built-in disincentives against sharing information among providers and with the public.
The aim is the freer flow of information about the quality of health care in order to make health-care consumers more informed and more powerful in their choice of providers that are both low cost and high quality. In turn, providers will have powerful incentives to improve quality and patient safety.
And that’s good news not only for patients but for the employers who pay for their care – regardless of their size.
To learn more about the Wisconsin Collaborative for Healthcare Quality or the Wisconsin health care summit, visit the ASQ Web site, www.asq.org/news/interest/040403hcmeeting.html.
Thomas Mosgaller is the organizational development director and human resources officer at Marshall Erdman & Associates in Madison.
May 2, 2003 Small Business Times, Milwaukee
