8 years later, Still Pursuing Perfection?

April 10, 2013
8 years later, Still Pursuing Perfection?Organizational Change Takes Patience; Grant Funding May Be Essential, Too.   This posting started off as a
8 years later, Still Pursuing Perfection?Organizational Change Takes Patience; Grant Funding May Be Essential, Too.
This posting started off as a grateful reaction to Gwen Darling’s blog post. But it grew. She was blogging on the Top Ten Hospital Tech Hazards.
I went to and read the WSJ and ECRI links she provided. In the process, I saw ECRI’s tag line: “The Discipline of Science. The Integrity of Independence.” Sounds great! Then I pondered, which of these 10 hazards can be fixed with HCI technology? Yes, that’s laughably sincere framing of a big problem, but perhaps a reasonable starting point for anyone trained, in part, as a technologist. So, “Misleading displays” jumps out. The focus was medical devices, including medication pumps and vital sign monitors. Fast forward. Readers of HCI are keenly focused on work needed for the real, system-level fixes, some percentage of which benefit from technology enablement: - change management- human-computer interactions- risk management- organizational behavior- workflow redesign- productivity improvement- organizational culture- safety- quality- etc.
(see yesterday’s post, Top Ten Informatics Events; for AMIA’s Meryl Bloomrosen slide click here) Not a New Problem – It's Systems, not individuals, not working harder, and not about blame Almost a decade ago, I was invited to help healthcare provider organizations pursuing an interesting grant: Aiming High for PerfectionWhat if health care delivery in the United States aimed to be perfect? What would it look like? We now have some preliminary answers, thanks to a project known as Pursuing Perfection (PP) — funded by The Robert Wood Johnson Foundation and led by the Institute for Healthcare Improvement (IHI). The work of Pursuing Perfection, which began in 2001, is anchored by a shared desire to totally transform health care delivery. There are 13 participants in the US and Europe, and their efforts, taken as a whole, offer some of the best evidence yet that fundamental improvement in patient care is possible across and within a wide range of health systems. Most important of all, the Pursuing Perfection sites have learned that the pursuit of perfection, or aiming high, raises the bar on health care performance and leads to clinical and operational results once considered out of reach. and this from Hackensack's site : Pursuing Perfection challenges its grantees to set new, higher standards for the delivery of healthcare services and then to share their methods for achieving this goal with providers across the country. The grant sponsors call this sharing component “ transparency” since it requires that grantees expose the details of their journey — the good and the bad — outlining the lessons learned along the way as well as their formulas for success. (emphasis mine) So what happened with Pursuing Perfection and the Grant Recipients? Good news: Lots of impressive results in safety, mortality and costs. The primary source, RWJ and IHI, contact information here. My favorite resource has been the related Remaking American Medicine DVDavailable through PBS. I’ve purchased dozens of copies of the DVD and given them as gifts to people who have otherwise shown significant healthcare improvement leadership. Note: There is a Pursuing Perfection in Health Care Series DVD. Unfortunately for me, it’s priced above the level where I can give it as a gift, given conflict of interests rules. (The RAM $30 DVDs are just about perfectly priced and packaged) Sad news: My personal experience with Pursuing Perfection is bittersweet. On the provider side, a CEO I knew who publicly supported transparency at his institution, including talking about their SMR (standardized mortality rates) stepped down from his CEO role shortly thereafter. I was assured this was unrelated to his PP leadership. But I still took a lesson from it, because other brilliant, accomplished and charismatic leaders also seemed to struggle with transparency and move-on or retire. In this case, the organization's executive sponsors had challenges carrying out their roles as well. So did a number of other internal thought leaders. Objectively speaking, they also "moved on." This raises a question regarding what "sponsorship" can mean in such improvement projects. And the product and product strength relative to Pursuing Perfection in this medication management process? Major changes in the code base were required and initially released in 2007. I would expect that a majority of the affected institutions will be able to take significant advantage of this work in the 2010 to 2015 timeframe. I understand that most of these institutions contracted for this software several years before 2007. Is that sad news, bad news or good news (factoring in appropriate patience)?Grant FundingGood or Sad, would we have the objective progress without the grant funding that seeded PP and other related initiatives? No. My personal opinion, based on insider visibility of the processes at provider and vendor organizations is that the grant process and it’s funding were instrumental. So, when I saw and read Mark Hagland’s Show Me the (Grant) Money, I felt validated in my conclusion. The high journalist quality of this article, as well as other books and articles from Mark, reminded me how extensive and important grant funding is to HCI. So I’ll end this post with an excerpt amplifying Mark’s article: In the end, all those interviewed agree, it's all about alignment: going after healthcare IT grants means developing an organization's healthcare IT strategies, and then looking to see what kinds of grant funds might be available to match the organization's strategies — not the other way around. Grant-seeking really “needs to align with your organization's priorities,” Eastern Maine's Bruno summarizes. “You need to do your homework, because it really is more work to get a grant. And you need to understand that and put a structure in place. Of course,” she says, “it really helps to have a fantastic group writing grants.”Do any of you readers have observations to share about Pursuing Perfection, or anything else in this post?

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