1. Systems Transformation in Healthcare: Academic Perspectives
Jim Begun
James A. Hamilton Term Professor and Chair
Department of Healthcare Management
Carlson School of Management
June 25, 2002

2. Academic-Practice Consensus on Extent of the Problem I
Serious, widespread underuse, misuse, and overuse of health services
-- To Err Is Human, The Quality Chasm

3. Selected Health Care Quality Problems as Defects/Million
Health Care Quality Problem Defects per Million Sigma Level
79% of eligible heart attack survivors , <1
fail to receive beta blockers
58% of patients with depression not ,
detected or treated adequately
21% of ambulatory antibiotics are for colds ,
1% of hospitalized patients injured by ,
negligence
Deaths caused by anesthesia during surgery
Source: Chassin 1998

4. Academic-Practice Consensus on Extent of the Problem II
Won’t improve on autopilot. Looming problems:
Aging population
Chronic care burden
Information overload
Financial fragility of organizations
Rising costs, workforce shortages, . . .

5. The “Transformation” Experience in Health Care
“the only constant in health care is the anxious anticipation of change that never actually occurs” -- Kleinke 2001
“health care may be the most entrenched, change-averse industry in the United States” --Christensen et al. 2000

6. Why So Hard to “Transform”?
Professional autonomy
10,000 healthcare systems
Community vs. Care vs. Cure vs. Control
Provider-centered, not patient-centered
unique level and nature of complexity

7. Promising Signs from Academe I
Rapid Growth of Quality Research
Evidence-based medicine
Funding priority
Profession of health services research

8. Source: Chassin 1998

9. “The United States has poured enormous resources into practitioner training and very little into improving processes in the systems within which those practitioners work, and it is time to redress that balance.”
--Jencks et al. 2000

10. Promising Signs from Academe II
Widespread Acceptance of Systems Thinking and Conceptual Models of Transformational Change
Long-term
Multi-level
Rooted in vision, leadership, and culture
Incorporating measurement, monitoring, feedback, reward

11. Examples of Multi-level Frameworks
Individual
Group
Organization
Larger System
Patients and community
Microsystem
Organization
Environment/Society
Recognizes interdependence, need for alignment

12. Keys to Transformational Change in Health Care
Leadership
Organizational Culture
Team Development
Information Technology
Source: Ferlie and Shortell 2001

13. Organizational Dimensions of Transformational Change
Strategic Cultural Technical Structural
No Yes Yes Yes No signif. results
Yes No Yes Yes Small, temp. results
Yes Yes No Yes Frustration
Yes Yes Yes No No learning
Yes Yes Yes Yes Lasting impact
Source: Shortell et al. 1998

14. Examples of Empirical Support for Models
3,000 CABG patients in 16 hospitals – participative culture
Nine hospital study of total hip and total knee replacement – coordination
Increased beta blocker use after myocardial infarction – shared goals, administrative support, data feedback
Specialty differences in diabetic treatment – well organized care settings
Source: Shortell 2002

15. Academic Challenges Leadership of curriculum; activating students
Better enabling tools (information technology, evidence-based knowledge, methods of analysis)
Better enabling models (that work well in systems that are complex, ambiguous, with distributed control and multiple conflicting goals [= health care])