Innovation and Improvement the Harvard Way

Day 4 started with the head of patient safety from Partners talking about the value of experimentation in patient safety development. Much of this was driven by the work of David Bates which showed that when Brigham and Women’s Hospital experimented with CPOE in the 90s they showed huge decreases in medication related adverse events. Since then they have experimented with some other things, tiered Drug Drug Interaction alerts have led to significant increase in uasage of these alerts. Before the experiment there was an over 80% over ride rate, but with the tiered system the rate for tier 1 was basically zero because you could not over ride it, but the tier 2 events where clinicians had the option to override, the positive response to the alert doubled. They experimented with barcode usage and showed huge improvements. The willingness to experiment differentiates them and demonstrates their leadership. Starting with a hypothesis and testing it seems to be the key secret, and giving people the freedom to think of hypothesis. Experimentation drives innovation learning and improvement.

The second speaker came from the Harvard Business School Richard Bohmer, a physician and a Kiwi. Amazing how many areas doctors have gotten into at Harvard. He started with a claim by Brent James from Intermountain Healthcare “Our business is clinical medicine”. He looked at the changes needed from a management perspective. Terms such as changing production mode seem out of place in a healthcare discussion, but he actually made it sound reasonable. Some interesting stuff from 1984 which looked at the role of uncertainty in physician practice. He emphasised the need for well developed science in healthcare, almost like an engineer. He spoke of the four habits of high value delivery organisations. Specify, design, measure and learn.This talk was teh highlight of the entire event, it seems the guys at Harvard Business School are thinking about healthcare in a way few others can.

After the break William Lester an engineer who decided to go back and study medicine spoke on Population Management with Health IT. Another brilliant speaker with amazing information and to use the quaintly American term “we were drinking from a fire hose”. He dived into the issues around disease management, something close to my heart. Population/patient selection, metrics and clinical effector activity was the core theme. His quote “It’s all about the workflow, silly” followed by “It’s the technology, silly”. In reality it is both, it’s how you link them up. Engagement is the key for bringing providers onboard, and you need to use every tool you have, including leveraging their competitive streak.

The next speaker was from a 300 provider clinic who spent $24 Million on setting up their EMR, and showed how it improved their clinical and financial success. It came down to thinking about how they use, providing clinicians with some flexibility, but not too much, and as they had a large capitated population they were able to drive continuous improvement clinically and financially. The interesting statistic was that they expected a big hit in productivity on implementation, what they actually experienced ws a 15% drop for 2 weeks followed by a return to above their baseline.

After lunch Partner’s head of Quality Data Management, basically the guy who was responsible with what they do with the huge amounts of data they have collected in their data warehouse. Yet again a physician who still does some clinical work and in the rest of his time massages a huge data warehouse to drive improvement within Partners which seems to be the secret to Partner’s success. He was followed by Micky Tripathi from the Massachusetts Ehealth Collaborative who spoke of the experience of getting a HIE type structure up and running in HIE type clinical data exchange.

The final session was a panel of two thought leaders from non healthcare arenas. Richard Swanborg from ICEX and Tom Koulopoulos from Delphi looking at innovation. Tom defines innovation anything that creates value and change behaviour.It is teh gretest enabler of behaviour change, he used the mobile phone as an example. He now sees industries using IT as the centre of their innovation, not of the IT, but of the business. He spoke of the three eras of how we use IT. It started with information, went to integration, and now moving to predictive analytics. Innovation was the key message.

It was a very interesting day, and as much as it hurts me to say, the Kiwi Richard Bohmer was the class act.


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