From Airplanes To Doctors’ Offices: Improving Population Health Outcomes

Eric Just, Health Catalyst

Eric Just is vice president of technology at Salt Lake City-based Health Catalyst, a data warehousing and analytics company.

Great variation exists in our healthcare system

January 29, 2015

To consider how to improve population health outcomes, let’s start in an unlikely place—an airplane. If you’ve ever flown on an airliner, chances are good that you’ve browsed through the inflight magazine. If so, you’ve likely seen one of the ads for New York Magazine‘s “Best Doctors in New York.”

These ads—a staple of inflight magazines—speak volumes. They implicitly acknowledge that great variation exists in our healthcare system. When a loved one goes in for cancer treatment or surgery, we ask questions like, “Who’s your doctor? Where did she train and with whom?” We ask these questions because we want to know that our loved one is getting the best treatment possible in a healthcare market full of variation. We want to know that the individual physician caring for our loved one has the best credentials possible.

In that same vein, when we go to the doctor’s office, we don’t see ads that look like this.

Why don’t we see advertisements touting individual pilots as the “best” of this or that? After all, you trusted the pilot when you climbed aboard that aircraft and read the inflight magazine. However, I doubt you asked, “Who is my pilot? Where did she get her training? How many flight hours has she logged?”

The reason for the existence of ads for individual doctors and the lack of ads for individual pilots is simple—the airline industry operates a system of standardized production. This means that the airlines have built a system standardized by protocols, flight checklists, and routine maintenance schedules in order to create a consistently safe experience for the public. These protocols ensure that all pilots operate according to the same best practices. There is not a lot of room for individual variation among pilots.

This system of production represents one end of a spectrum of consistency and standardization. The other end of the spectrum is a craftsmanship mentality, in which a handful of masters train apprentices. The masters share their experiences with their apprentices, and the apprentices that train under the best masters eventually become the best masters.

Today’s healthcare industry is operating much closer to a system of craftsmanship than a system of production. Unfortunately, this system propagates variation and inconsistent processes in healthcare. The industry is making a lot of progress toward standardization of best practices, but we’re not there yet. We have to ask those questions about whom a doctor trained with or where she trained—because it matters!

Improving Population Health Outcomes Systematically

It is largely because of our system of craftsmanship that population health outcomes are not consistent across the nation. One of our favorite quotes here at Health Catalyst comes from Dr Paul Batalden: “Every system is perfectly designed to get the results it gets.”

Currently, most healthcare systems are perfectly designed to deliver variable results. To have consistent, high-quality outcomes, we need to transform the industry into a system of production.

Sounds too good to be true? It’s not. Consistent, high-quality outcomes is a fully attainable goal if the following three critical areas—the content system, deployment system and analytics system—are implemented and working together by healthcare systems.

The Content System

Healthcare organizations that want to standardize care to best practices must implement a content system. Putting a content system in place means determining what the standard of care should be. It means defining your care processes (for example, cardiac rehab, or sepsis) and determining what best practices should be followed for that care process. It means applying knowledge assets, like best-practice order sets, to important decision points along the care process.

In the example of sepsis, an essential factor is early identification of the condition. So we might start by defining those things that we need to measure consistently to identify sepsis quickly—things like temperature, heart rate, respiratory rate, and so forth. As we move forward, we’ll want to tackle sepsis treatment itself and determine the best-practice protocol for the condition, such as the appropriate antibiotics to use. Another category we would consider for sepsis is stratifying groups of sepsis patients. How would we define or categorise patients who exhibit the beginning stages of sepsis? How would we describe a patient with severe sepsis? What is the appropriate protocol for each of these groups?

The Deployment SystemHealthcare organisations must also establish a deployment system to work hand-in-hand with the content system. The content system determines what the standard of care should be; the deployment system complements that by setting up the organisational structures that will successfully push the standard of care across the organisation to reduce variation. It ensures that the standard process is used consistently across the enterprise.