The Ankota Healthcare Delivery Management Blog

Accountable Care Must Learn from Other Industries

Posted by Will Hicklen on Oct 15, 2012 4:01:00 PM

Boeing Ford Toyota

If you know Ankota, you know that since 2008 we've endeavored to develop technology to manage healthcare delivery and bring lessons to healthcare that are inspired by other industries. We often hold up global standouts such as Boeing and Toyota as examples from which healthcare must learn. If Boeing and Toyota can coordinate thousands of engineers around the globe, manage concept through design, manufacturing, and distribution, and service cars or aircraft for the entire lifecycle, then health care can learn from that model. Global manufacturing businesses like these have relied on very advanced coordination among providers for decades while being ever mindful of quality.

Consider further that these industries have progressed through multiple generations of technology to manage processes and optimize the use of staff, equipment, and resources. Think healthcare is too complex to manage this way? We don't-- and that inspires our development of technology every day. Boeing can tell you every single person who was involved in the design, manufacture, assembly and service of its aircraft. They've predicted material properties, failures, ride quality, and more based on quality measures of the parts, assemblies, human involvement and finished product. These companies leverage highly coordinated networks of organizations that, while otherwise unrelated, share common goals for quality and performance, on time delivery, and more. They have long employed progressive financial models that healthcare is only just beginning to explore with terms like shared savings, bundled payments, and more.

Think they haven't tackled the same business and process problems already?

Care Transitions and Discharge Planning? Think: Supply Chain Management. 

Avoidable Readmissions? Think: Peformance Management. Total Quality Management (TQM). 

Post Acute Care? Think: Supply Networks, Distribution & Service Networks.

Think: Healthcare Ecosystems 

This, by the way, is the future of healthcare delivery. Coordinated networks of providers performing services that are increasingly delivered outside of hospital settings, many under models like Accountable Care. As population health initiatives take hold and promise to take better care of patients by keeping them healthier and out of hospitals longer, networks of providers are already developing that intend to coordinate care for better results. Ankota's technology is used to organize providers into "ecosystems" which coordinate services and drive better outcomes at lower overall costs.

Much like Toyota's world-renown Toyota Production System (TPS), Ankota's approach to automation leverages Lean Manufacturing priniciples while maintaining the vital human element of control. Afterall, it's the lives of people that we're all trying to improve. 

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In a related Decision Health Hospital Impact article titled, "What Healthcare can Learn from the Car Industry," Dr. Frederick Southwick observes, "By modeling the healthcare delivery system after successful business practices, we can help prevent medical errors." He continues to relate key concepts of Toyota TPS to healthcare oranizations:

Set protocols: Define the work that needs to be done, how it should be done, and who is responsible for its completion. Standardize this practice for all healthcare staff and all potential diagnostic situations.

When a caregiver works with multiple physicians, they are required to learn different protocols to achieve the same goal. In the absence of a single best-practice protocol for each disorder, all processes in hospitals and clinics are random and ill-defined. When there is an error or a delay, there is no single protocol that can be modified, making lasting improvements impossible.

Identify and support customer-supplier relationships: At Toyota, the assembly line worker's most important customer is the person next in the assembly line. Physicians too often regard themselves as the customers and nurses as the suppliers of respect and ego gratification.

Following this example, physicians must identify themselves as the supplier and nurses and support staff as the customers. They need to listen closely to the concerns of bedside nurses who experience the dysfunctional delivery systems all day, every day, and then supply them with clear instructions for patient care.

Use the scientific method: Caregivers should be encouraged to implement changes by using iterative cycles of planning the change (plan), trying out the change (do), measuring the effects of the change (study), and then if deemed a true improvement, implementing the change on a broader scale (act).

Often administrators discourage adaptive change for fear of breaking a regulatory rule. A command-and-control administrative structure discourages front-line leadership and any sense of autonomy.

Those with higher administrative authority must reduce formality and flatten the power gradient, because hierarchical power structures deter open communication and increase the chance of errors. When errors do occur, the individual reporting the error should be supported emotionally, and in most cases punishment should be avoided. Those with administrative authority need to understand that most errors are the consequence of bad systems, not bad people.

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TPS to improve communication and prevent errors

Treat everyone with respect. Everyone has an important role to play in managing the care of our patients. Humility, friendliness and empathy go a long way in lowering the power gradient.

Become an effective team leader. Teamwork acknowledges the value of all members of the care team and encourages reciprocal communication, that is, every idea from a team member is a good idea. Teams reduce errors because you have many eyes, ears and brains focusing on the same problems. Great teams develop a team identity that gives everyone a sense of belonging and greatly increase job satisfaction.

Embrace a systems view of healthcare. Understand that in modern healthcare delivery, you as an individual will not be able to manage your patients alone. You will need to depend on fellow physicians to create shared protocols to create consistent ways of doing things.

By creating operating standards within your healthcare institution for specific diseases and problems, you will allow those working with you to be more efficient and reduce the likelihood of errors. This is not cookbook medicine, but rather the best approach for creating good habits that will free everyone to focus on events that are unexpected and which require high-level decision-making.

Frederick Southwick, M.D., is a Professor of Medicine at the University of Florida and manages New Quality and Safety Initiatives for the University of Florida and Shands Health Care System. He also is the author of Critically Ill: A 5 Point Plan to Cure Healthcare Delivery.

Read Dr. Southwick's entire article in Decision Health's Hospital Impact

Learn more about the Toyota Production System (TPS)

More about Toyota Production System on Wikipedia 

Learn more about Care Coordination technology and managing Care Transitions by contacting Ankota or using this fun orange button  

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Topics: Care Coordination, transitional care, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO, ACO Technology

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About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

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