Why does health care need improvement science?

David M. Williams, PhD, Improvement Advisor, TrueSimple

For me, one of the things that we look for in improvement is to try to find an area where there’s some evidence that says that we can make a difference somewhere, and then we think, “Well, I can bring improvement science to that, and there’s a chance that we could significantly impact lives. We can reduce variation in a particular care area or raise the level of outcomes that exist.”

The ambulance industry is a great example. Right now, there’s evidence that supports that paramedics and ambulance systems can make a difference in things like stroke, in ST-elevation myocardial infarction (STEMI), potentially sepsis, trauma, out of hospital cardiac arrest. And in a number of cases, when we look at the data, there’s wide variation from community to community. You can walk across a border from one city to the next and see a change in the outcomes even though the systems for the most part have the same level of training, the same equipment, the same everything. It’s a process problem.

The challenge, I think, is that you’ve got all these great people that have a lot of will. They want to make a difference. They want to save lives, and they’re working really hard, but they may not have the direction on the right aims and the right drivers and have the right tools to be able to get them there.

So there’s some exciting best practices around the world of people who are starting to make differences in out-of-hospital cardiac arrests. They’re starting to identify deteriorating patients in the field. They’re looking at reducing the time from 911 call to STEMI intervention to under 90 minutes, which is much faster than the benchmark door to balloon time.

Where I get excited is this idea that you have these people who are working really hard. They want to make a difference in these areas that there’s evidence that supports they can, and improvement science may be able to “unstick” some of that variation that exists and enable people to really pursue making some significant differences on patients in the community.