Tuesday, June 20, 2006

Is there anyone in America who doesn’t know our hospitals are in trouble, along with the rest of the health care system?

Three reports released last week by the Institute of Medicine confirm that. As The Washington Post summarized it, “Emergency medical care in the United States is on the verge of collapse.” Dangerous overcrowding and an inability to provide necessary expertise to treat patients in a safe, timely and efficient manner are the main reasons.

The report recommends Congress should create a new federal agency and spend billions of dollars to fix the problem. That is the worst possible recommendation, because it is not a solution. Another federal agency is precisely what is not needed. What we need is “Systems thinking.”

What is “systems thinking”? As described by veteran reporter Lloyd Dobyns in a new documentary for Public Television that has received some airings, but needs wider exposure, “systems thinking” is “basically how you see things. Instead of seeing a huge mess with one problem piled on top of another, you see differently. You see with what people call ‘new eyes.’ You see how you and your work fit into the system, and how you and your work connect to the other people in the system.”

This is not theory. It is being tried at several hospitals throughout the country, reducing patient waiting time, dramatically cutting costs and delivering quality care to patients, making them happier and healthier. It has also resulted in doctors, nurses and other hospital workers enjoying their jobs more instead of worrying about other things. With systems thinking, the patient comes first. When that happens, other concerns take care of themselves.

This is what is known as the “Toyota model.” When one focuses on the person or customer and his or her satisfaction, profits and efficiency result.

The PBS documentary, titled “Good News: How Hospitals Heal Themselves,” shows how St. Joseph’s hospital in St. Charles, Mo., adopted “systems thinking,” dramatically improving its emergency care. Simple things like moving the X-ray room closer to the emergency room, allowing doctors to get their X-rays faster; or coordinating with housekeeping so a room is clean when a patient needs it, thus reducing waiting time, has substantially reduced costs, increased efficiency and contributed to patient satisfaction.

St. Joseph’s set a time limit of 30 seconds for an emergency room patient with life- or limb-threatening symptoms to be seen by a health-care professional. All others would be under active care within 30 minutes of arrival. At the time of the filming, St. Joseph’s performance record for these goals was 90 percent. They even hired a “hospitality person” who keeps patients informed as to what is happening, again contributing to patient contentment.

Lloyd Dobyns says: “You have to see the whole hospital system. You have to see how blaming people does not help. You have to see how to practice continual improvement.” At St. Joseph’s and at 40 hospitals in the Pittsburgh area, which the producers also examined, everything is focused on the patients. “It is not focused on reducing staff, reducing costs, or improving profits,” says Mr. Dobyns. “But as you focus on the patients, all the other things occur naturally. You want to help the hospital? Help the patients.” In hospitals where “systems thinking” is used, health-care costs have been reduced by as much as half.

This proven system does not require more staff or expensive consultants and it certainly does not need another bureaucratic, costly and inefficient government agency, which can only make things worse. Improvements can be made, says Mr. Dobyns, starting today and in every hospital in the country. Costs will decline. “So the question now becomes, can we afford not to heal our hospitals? We can, if we want, not do anything. But if we decide not to do anything, we have to accept that every day — every day — 500 people will die in hospitals in the United States who did not have to. You and I might be among them.”

Co-producer Clare Crawford-Mason (the late former NBC News President Reuven Frank was the other co-producer) tells me systems thinking also works with schools if students become the focus and not cost, buildings or even teachers. It works anywhere and can liberate us from big government.

In fact, says Ms. Crawford-Mason, some government agencies that have adopted this Toyota model already show dramatic improvements. If ever there was an idea whose time has come, this is the idea and this is the time.

Local PBS stations can be contacted and encouraged to run this documentary. For more, visit www.managementwisdom.com.

Cal Thomas is a nationally syndicated columnist.

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