Q:
What misconceptions do people sometimes have about balancing quality
improvement and cost reduction in health care?
There are two misconceptions that are most often
stated. First, people
think that it’s a tradeoff: you either work on quality or you work on cost
reduction. Second, people often assume quality costs more. But, in fact, if we
think about quality from the patient’s eyes, the person who’s seeking the
service, there’s a lot of waste in that system and we have to consider cost and
quality together. To patients, waste is frustration and unnecessary use of
their time and energy. We can understand it by measuring what they value. Our
challenge is to ask what are we going to do to make care better so it’s more
affordable for the person paying for insurance, paying co-pays and using the
care delivery system? That’s really the calling card for our generation of
health care improvers.
Q:
What are the keys to successfully improving health care quality while
controlling costs?
First,
involve the patient. Map the journey and the experience from the patient’s
perspective, and assign not only a dollar value to the cost, but also calculate
the personal cost. It illuminates what we don’t see in the system when we view
it from the patient’s perspective.
Second,
understand the purpose of efforts to improve quality while controlling costs.
This isn’t a QI project. This is about running your business differently.
Third,
stay with it. Involve finance, quality, care delivery, and support systems in
planning and executing against strategic priorities. When we put everybody in
the same room as a team, working together to make improvements, then we learn a
lot more about cost and quality at the intersection points.
Q:
Why is it essential to focus on quality improvement while simultaneously working
on cost reduction?
We
all know how much of the national gross domestic product in the United States
is spent on health care and it’s unnecessary to spend that much. The industry
has grown so much and we’ve done great things to heal people, but now we need
to rebalance and engage people in their own health. We need to engage
communities. And we need to reduce the cost of care so we can reinvest in areas
like schools, communities, employer-based settings and other places where
people spend most of their time. People typically only access health care in
any given year a very small amount of the time, but they spend about 5,000
waking hours caring for themselves. So it matters more that we in the health
care community know what is happening around them every day in their lives, so we
can better support them and make an impact on their health. Shouldn't our
collective goal be to help individuals thrive in their lifetime?
Q:
What does a successful collaboration between finance and quality improvement teams
look like?
What
we’ve learned in our collaboration with IHI over two years is that finance and
quality should be on the same team. At Kaiser Permanente, we train finance
people as Improvement Advisors, and finance staff, quality staff,
physicians, and others work together and actually see the journey of the
patient, put a dollar value to that, see what the cost of that journey is, and
then work together to improve and define the financial value of that
improvement. We’ve learned that when we do that, we not only reduce cost, but
we tremendously improve quality.
