Across the Chasm Aim 5: Health Care Must Be Efficient

Information for this feature story was obtained from the IHI Calls to Action series, Implementing the Quality Chasm Report.
Our fragmented health care system promotes not only wasted time, but also wasted effort, materials, medications, money, and trust. Improving quality means reducing waste of all kinds. That is why efficiency is one of the "Aims for Improvement" in the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, which describes the immense divide between what we know to be good health care and the health care that people actually receive.
"Efficiency versus quality — do we have to choose?" writes Thomas Nolan, PhD, a Senior Fellow at the Institute for Healthcare Improvement. "This question comes up frequently in all industries and now it's surfacing in health care. … We can have both, but we must challenge some of our assumptions and redesign the way we work." The health care system is inefficient in part because it is complex, and some health care professionals might call the idea of an "efficient health care system" an oxymoron or, worse, an impossible dream. But those willing to challenge assumptions and change fundamental elements of the health care system have brought tremendous rewards both to themselves and to their patients.
One basic design reform is matching the work to the worker. Allowing each member of the care team to focus on appropriate tasks reduces inefficiency and saves time. No longer should health care professionals spend so much time doing work they should not be doing such as nurses chasing lab results and doctors doing unnecessary paperwork. Some experts estimate that most physicians are productive only 50 percent of their time, partly because the system works against them.
Other examples of waste reduction are fairly obvious, like streamlining forms to reduce paperwork. Others are more unconventional and perhaps more controversial, like using email to follow up with patients when appropriate. Many are administrative — implementing open access scheduling, for example — while others are clinical — using group appointments for patients with similar conditions or concerns. Sometimes boosting efficiency is a matter of using existing resources in a more efficient way, as one hospital did by moving its telephone operators out of a central pool and placing them on care teams in the units so they could communicate with staff more easily: Patients became much more likely to make meaningful contact when they called.
All these changes are ways of working smarter, not harder, and all share the goal of reducing waste and increasing efficiency in order to serve patients better. Good use of time and resources simply makes more available for the work that truly matters: Taking care of patients.
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