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W. Edwards Deming - Let's Not Miss the Quality Boat Twice

W Edwards Deming

I have a couple quotes from W. Edwards Deming, an American engineer, statistician, professor, author, lecturer, and management consultant, on the white board in my office that read "drive out fear" and "encourage effective two-way communication and other means so everyone in the company can be effective." I was intrigued by how many of my health care quality improvement co-workers commented on the quotes and in return, shared one of their own favorite Deming quotes. One co-worker shared "Inspection is waste"; another co-worker shared "A bad process will beat a good person every time." Another shared "In God we trust; all others must bring data" and "If you can't describe what you are doing as a process, you don't know what you are doing."

We take Deming seriously at HealthInsight. Deming has been given the title of "philosopher of quality" and championed the cause of "statistical process control." Deming was largely ignored by the production-focused United States during the 1960s and1970s. Deming took his quality message to the Japanese industrial leadership and the results produced placed him on a path to stardom in Japan. The Japanese automotive and electronic industries skyrocketed in sales due to higher quality products which were reliable over time. Most experts feel the United States missed the quality boat during this time frame as Unites States sales were down and their products did not last as long. Many industries in the United States have warmed to his quality message over time. In health care, the Institute for Healthcare Improvement (IHI), among others have championed many of Deming's ideas.

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Achieving Our “True North” Vision for Health Improvement

Compass

Just two weeks ago in the beautiful setting of Santa Fe, New Mexico, we met for our annual board retreat. The retreat included HealthInsight's four boards, senior staff, and the invited boards of three other health improvement organizations whom we count as partners. We came to learn, to share, to envision and to consider new plans and approaches.

Over the course of two days of meetings, something special and significant seemed to happen. Perhaps the best way to characterize the outcome of the retreat is that this group of almost 100 leaders-already highly engaged and committed to achieving better health outcomes for our communities-became even more committed; even more motivated to fully realize transformational change. The level of rapport and engagement was palpable and energizing!

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Three Good Things

Change Agents - Learning and Action Network

I recently had the great pleasure of serving as the regional host for a HealthInsight-sponsored learning and action network (LAN) event, "Be the Change: Strategies for Health Care Transformation".

I have been a HealthInsight employee for nearly two decades. Part of my reasoning for continuing to work for HealthInsight for all these years is that I am still able to learn and grow, and think about new possibilities to change the health care system.

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"Be the Change: Strategies for Health Care Transformation" HealthInsight's First Live Multi-state Event

Change Agents

As health care changes providers, clinics, hospitals and insurance companies have to be innovative, efficient and creative in their solutions to the problems facing the American health care system. As a Quality Innovation Network Quality Improvement Organization, HealthInsight has to be at the forefront of the change and offer innovative solutions to the way we help providers understand the changing landscape. Yesterday was a big step in the right direction.

HealthInsight, in Nevada, New Mexico and Utah along with Acumentra Health in Oregon, held our first four-state Change Agent learning and action network event; bringing together nearly 400 participants in five on-site locations and online. We used new technology to broadcast our plenary and breakout sessions live from Las Vegas, including a live chat that allowed online participants to ask questions and be a part of the conversation without being in the room. We used Twitter and the event hashtag #ChangeAgentsLAN to connect online and share thoughts, insights and quotes from speakers. On location in Las Vegas, Albuquerque, Portland, Salt Lake City and St. George, we combined the use of the technology with in-person interaction through group discussions, table-top exercises and get-to-know-you activities. Online participants shared their experience and thoughts through the chat enabling them to connect with the speakers and others attending virtually. The result was a successful event with robust conversations about the way health care is changing and the roles each of us will play moving forward.

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Celebrating 10 Years of National Health IT Week: A Look at How Far We’ve Come

Doctor with Laptop Computer

I recently caught up to an excellent blog post by Dr. John Halamka, Trajectory not Position, in which he reminds us of the significant progress that has been made in health information technology (HIT) in the past 10 years:

"My view is that we must believe in incremental progress, communicate broadly, and focus on our trajectory not our position."

"At age 53, my personal medical data is electronic. That was not true when I was 43."

"At age 22, my daughter has never encountered a paper-based record as an adult. She has always had access to 100% of her healthcare data on her iPhone. That was certainly not the case for me."

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Patient and Family Engagement Council – One Year Later

Group Session

It's been just over a year since I wrote a blog about how HealthInsight Nevada was taking on establishing our own Patient and Family Engagement Council (PFAC). Because we are so proud of our progress, I wanted to provide an update. The hard part was getting started. Now, even though we are only five months into having actual PFAC meetings, it is starting to feel like a sustainable effort.

After much helpful advice from Joan Gallegos and Juliana Preston, our HealthInsight colleagues in Utah, we began our venture. First, we established a core group of staff to represent HealthInsight Nevada. Then we spent a few months going through the Patient and Family Centered Care Partners Gateways Program presented by Libby Hoy. For those that don't know about this, it is a course of five webinar sessions working with a small number of organizations (there were three in our cohort) with Libby's curriculum, homework assignments and feedback. It really provided focus for our group and forced some decisions to be made early.

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R-E-S-P-E-C-T—“Find Out What It Means to Me”

"R-E-S-P-E-C-T find out what it means to me," are words most everyone has heard and probably sang along to at one point in their life. The popular song by Aretha Franklin, is just one of many songs that touts the need for respect.

Because HealthInsight lists "Respect" as one of its "Values in Action" that govern our relationships with one another and the communities we serve, and because of the importance of respecting each other in the workplace, I thought the topic was important enough to remind everyone what respect is, and how respect is demonstrated in and around the workplace.

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Lightning Safety in the Mountains and Beyond

Storm Clouds - Photo by Melissa J. White

There goes that thunder again! Something rare in the Southwest, thunder storms and the associated lightning became common this summer in New Mexico. It seemed every time my sister and I went hiking in the Sandia Mountains, especially above 10,000 feet, we encountered a late afternoon thunderstorm with lightning over our heads. Even though we had checked the forecast before leaving, the storms kept sneaking up on us.

What should we do? There is no sturdy shelter here unless you are near the tramway and the ski area. On one occasion, we headed into the trees and got out of the high meadow we were crossing. Although still risky, we were less exposed than being on the ridgeline or under a lone tree in the meadow. Lightning strikes the tallest object and being out in the open, and we didn't want to be the tallest object.

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Co-pays, and Discounts, and Cash Prices, Oh My!

Tablets

At HealthInsight we have an initiative, funded by Cambia Foundation, to develop a curriculum to equip newly-insured people with tools to assist them as they navigate the health care system. As someone who has received formal health care system and policy education, and one who has worked in the system for nearly 20 years, I was confident that I was an expert on utilizing and maximizing the system for my family and me. My confidence was crushed the moment I needed to fill my son's acne prescriptions.

I am on a high-deductible health plan, which is complimented by a health savings account (contributed to by both me and my employer). At the first doctor's appointment, I was more than $1,000 away from my deductible--when in-network care and prescriptions would be covered at 100 percent. My son's pediatrician was aware that I would be paying out of pocket, so he wrote prescriptions for what he thought would be the most inexpensive. When I went to pick them up from the pharmacy, the total was $312.73 for a topical antibiotic and a tube of generic Retin-A. I was shocked, but the pharmacist reassured me that I could probably stretch them out beyond a month. I caved and bought the medication.

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Building Our Skill Set for the Future

Meeting

HealthInsight operates in a demanding environment promoting improvements to a complex health care system and in the overall health of our communities. The providers we have served for decades are facing difficult challenges, including adapting to changing demands of consumers, an increased burden of disease and health care reforms that are altering both the payment for and design of their work. In this blog I've captured ideas from staff across HealthInsight as we consider how to evolve our skill set to continue to serve communities in our mission to improve health and health care.

In the past we concentrated our learning in key areas of leverage, such as applying lessons from the aviation and nuclear industries to health care processes and patient safety; using technology (initially Palm Pilots) to bring clinical decision support to the front line and focus on effective use of electronic health records (EHR) and other health information technology (HIT); promoting transparency of information on quality of care; and analyzing processes and using data to understand the dynamics of gaps in care. While those areas remain important, we want to know: Are there others?

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