Why It Matters
Because health and health care need improvement.
Processing ...

Balancing Improvement and Cost Reduction: This Isn’t a “QI Project”

By Jameson Case | Monday, May 12, 2014
In this interview with IHI faculty member Lisa Schilling (pictured below), RN, MPH, National Vice President for Healthcare Performance Improvement at Kaiser Permanente (which you can also watch on video), she describes the keys to successfully improving quality while controlling costs. For more on quality improvement and cost reduction, attend IHI's new seminar, Applying Value Management to Health Care, on November 2–4, 2016.

Video: Lisa Schilling speaks about improving quality while controlling costs

Watch video with Lisa Schilling on YouTube

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.

first last

Average Content Rating
(0 user)
Please login to rate or comment on this content.
User Comments