Page 101 - Harvard Business Review (November-December, 2017)

while numerous health care organizations are mov-
ing in this direction, the majority are not making the
holistic changes needed for transformation. HEALTH CARE’S PRODUCTIVITY WOES

IMPROVING QUALITY Some industries use technology better than others, and labor productivity statistics
Historically, the adoption and management of health reflect that. In the case of U.S. health care, the industry has been growing faster
than the overall economy, but because the number of health care workers has been
care IT has been left to an organization’s chief infor-
mation officer and other technical personnel. This rapidly increasing and the use of information technology has lagged, productivity
growth has been minimal.
is a mistake. A number of organizations—including
Boston Medical Center, Geisinger Health System LABOR
in Pennsylvania, Intermountain, Mayo Clinic, and REAL INDUSTRY EMPLOYMENT PRODUCTIVITY
New York University (NYU) Langone Health—have INDUSTRY GROWTH (%) GROWTH (%) GROWTH (%)
shown that health care IT is effective only when all INFORMATION 4.8 –0.7 5.5
members of an organization work to unlock its po-
tential. (Full disclosure: One of us, Robert Huckman, FINANCE AND INSURANCE 3.1 0.6 2.5
has taught in executive education programs for two
organizations related to this article—Intermountain REAL ESTATE 2.3 0.7 1.6
Healthcare and Brigham and Women’s Hospital, RETAIL 2.1 0.5 1.6
which is owned by the same parent company as
Massachusetts General Hospital.) PROFESSIONAL AND BUSINESS SERVICES 2.8 1.7 1.1
Two key constituencies outside of technical per-
sonnel—senior leaders and clinicians—must play sig- HEALTH CARE 2.6 2.1 0.5
nificant roles. Leaders are crucial because they will EDUCATION 1.8 2.7 –0.9
have to enlist clinicians in the cause by persuading
them that the effective use of IT is central to delivering U.S. ECONOMY 2.2 0.8 1.4
higher quality. The urgent need to reduce health care
costs has led many leaders to become preoccupied NOTE PERCENTAGES ARE COMPOUND ANNUAL GROWTH RATES (CAGRS) FROM 1997 TO 2016. REAL INDUSTRY GROWTH IS
with that objective. The happy reality is that improv- THE INCREASE IN VALUE-ADDED GDP LESS INFLATION. LABOR PRODUCTIVITY GROWTH WAS APPROXIMATED AS THE REAL
INDUSTRY CAGR MINUS THE EMPLOYMENT CAGR.
ing clinical work processes can achieve both lower SOURCE AUTHORS’ ANALYSIS OF U.S. BUREAU OF ECONOMIC ANALYSIS AND BUREAU OF LABOR STATISTICS DATA
costs and higher quality, and we’ll discuss later what
it takes to use IT systems to do this.
The pledge to improve quality should be more than
words; it must be translated into visible practices.
Geisinger, for one, has done just that. It has made its NYU Langone Health has also backed up its words
IT system part of a broad strategy to establish a sur- about improvement with action. When Dr. Robert
gical “warranty”: If complications arise within 90 Grossman became the center’s CEO and the dean of
days of a surgical procedure, the patient bears no ad- NYU School of Medicine in 2007, his first major initia-
ditional cost to have the problem addressed. Starting tive was to merge the school’s disparate information
with coronary artery bypass grafting (CABG), a team systems into a single data warehouse for both the
of clinicians developed a five-stage protocol that be- hospital and the medical school. He stressed that the
gins at the time of diagnosis and extends through the reason was to evaluate the system’s quality perfor-
warranty period. The team initially identified 40 evi- mance against external benchmarks and to support
dence-based guidelines that, according to a case study changes in administrative and clinical workflows.
conducted by the Commonwealth Fund, were then The resulting information increased the willingness
embedded in the EHR system “through templates, or- of department chairs and administrators to challenge
der sets, and reminders,” driving up adherence from norms and to design and implement improvements.
59% to 100%. Furthermore, the integrated IT system For example, the need to establish data fields in the
improved communication among various clinical per- IT system forced discussions about the definition of
sonnel (including physicians and advanced-practice “excellence” and the best ways to assess the impact
nurses) to coordinate care for the patient. The results of frontline staff.
were significant: Postoperative mortality fell by two- In 2016, NYU Langone received multiple national
thirds, post-acute-care spending decreased by nearly quality awards and was ranked by U.S. News & World
50%, and the overall profitability of cardiac surgical Report among the top 10 hospitals in the United States,
services actually improved. Thanks to the success of alongside the likes of Mayo Clinic, Cleveland Clinic, and
the CABG program, the model was expanded to 14 Massachusetts General Hospital. The organization’s fi-
other clinical conditions as well as to primary care, nancial performance was similarly impressive: From
with a focus on the chronically ill. 2007 to 2015, patient revenues more than doubled.

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