A brilliant analysis of a “new paradigm” of networked health care
It is difficult for me to believe that almost two decades have passed since Reengineering the Corporation was published. In it, Jim Champy and co-author Michael Hammer define reengineering as “the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality, service, and speed.” More specifically, “fundamental” refers to how work is performed and the basic questions that need to be asked, “radical” means going beyond superficial changes in the way things are being done, “dramatic” indicates that reengineering isn’t about marginal or incremental improvements, and “process” refers to a group of activities that uses one or more kinds of input to create an output of customer values.
What we have in this volume, co-authored by Champy and Harry Greenspun, M.D., are multiple collaborative applications of the same four basic principles to the challenge of reengineering the provision of health “and it must be done by clinicians. No angel of government, even under the auspices of `national health care reform.’ Can reduce the cost and improve the quality of health care without the work and leadership of clinicians. It’s time for all clinicians – physicians, nurses, technicians, physician assistants, and pharmacists – to assume their rightful role in directing change.” This is a key point. Champy and Greenspun insist, and I agree, that those who are centrally involved in the provision of health care should be centrally involved in the process of radical thinking by which to determine the nature and extent of reengineering initiatives.
According to Champy and Greenspun, the approach they propose is based on three “pillars”: Technology (“In any science-based enterprise, technology developments offer daily opportunities for redesigning work”), Process (“Whether or not new technology is applied, an organization’s work is best understood as a collection of processes”), and People (“No process can work properly without people trained as a team to execute”). Throughout their lively narrative, Champy and Greenspun focus on exemplary leaders of reengineering initiatives that vary in nature and extent but all of which rely (to varying degree) on the aforementioned three “pillars.” With all due respect to the value of various real-world examples, their purpose is to illustrate core principles rather than prescribe how those principles should be applied. It remains for each reader to make that determination.
Hence the importance if several reader-friendly devices that can help to guide and inform those decisions. They highlight key insights and action steps. For example:
• Ten lessons to be learned from MultiCare Health System’s deployment of its electronic health records (EHR) program (Pages 67-87)
• “A Checklist for Implementing New Technologies” (Pages 92-95)
Note: As a supplementary resource, I highly recommend Atul Gawande’s The Checklist Manifesto: How to Get Things Right, published by Metropolitan Books in 2009.
• How to change medical processes that have been developed and ingrained for decades (Pages 99-135)
• “A Checklist for Process (Pages 135-138)
• Lessons to be learned from various reformers that are “not only valuable, but replicable” (Pages143-165)
• “A Checklist for the People Side” (Pages 165-167)
• How to look for and locate reengineering opportunities (Pages 190-204)
However different the health care “reformers” may be in most other respects, they share in common what aspiring reformers must also possess. Specifically, “an ambition to improve the quality and safety of care in dramatic fashion; a deep respect for the experience of patients; a passion for improving the outcome of treatment; a desire to create a better workplace for clinicians; an appetite for change to create better medical practice; the clinical leadership required to bring about change; the persistence to overcome the inertia of current practices and processes; and a willingness to acknowledge their own shortcomings or detrimental behaviors.”
Jim Champy and Harry Greenspun offer a manifesto, not an operations manual. Encouraged as they obviously are by the successful reengineering initiatives they have observed in various health care organizations, they have no illusions about the challenges and difficulties that new initiatives by other organizations must overcome. In some instances, it will take years of effort to achieve success. That said, I am reminded of the Chinese proverb that suggests that the best time to plant a tree was 20 years ago. The next best time is now.