Dr. Jay Bishoff to Speak About Trimming Waste in Healthcare at HAS 16
Spend 30 minutes talking with Dr. Jay Bishoff, and it’s guaranteed you’ll be motivated to improve your work, improve yourself, and improve pretty much everything around you because his enthusiasm and energy on the topic of improvement are completely infectious. Dr. Bishoff is delivering a keynote presentation at the 2016 Healthcare Analytics Summit, and his fervor is sure to show when he talks about a topic similar to what made him one of the most popular speakers at last year’s Summit: quality improvement and taking waste out of healthcare.
One Healthcare Improvement Journey
“My boss told me I had to take his course,” Dr. Bishoff says. “I didn’t know who he was and didn’t know what quality improvement was. I was blown away by his intelligence, his research, and his dedication. Dr. James left surgical oncology to chase something that he thought was the future of medicine. This lent a lot of enthusiasm and excitement to my career.”
Dr. Bishoff was recruited to lead the Urological Institute at Intermountain in 2008. Then he was asked to help with the robotics program and other initiatives around quality improvement. This is how he developed the skillset required for his position in reducing waste, a role that must always consider the why behind everything.
“We need to give people the understanding of why we are doing a new program or new initiative,” Dr. Bishoff says. “It’s easy to spend a lot of time planning and developing a great initiative and then suddenly launching it. But people on the frontline may be wondering where it came from and why it’s important.”
Rather than focusing on the staggering statistics that define healthcare waste (he says everybody already knows them), Dr. Bishoff says we need to figure out what is and what isn’t waste.
“We don’t always know who are the biggest perpetrators of healthcare waste. We estimate that 50 percent of cost in healthcare is waste, but we don’t always know where it is. There are some general areas, ORs for example, where we can make a quick dent. Intermountain has saved a lot of money there.”
For those who feel discouraged when thinking about how far behind their organizations are with quality improvement, take heart. Dr. Bishoff will talk about the philosophy behind what brought Intermountain this far and how important it is to start today. Healthcare organizations just need to take the first step with improving quality.
“It’s important to not get too concerned about making a mistake or irritating people. This is what prevents quality improvement from launching,” Dr. Bishoff says. “Get started by picking something particularly frustrating, costly, or wasteful. Then take the ‘ready-fire-aim’ approach. You have to jump in with quality improvement efforts when you’re about 60 percent in agreement, and then adjust as you go.”
The Quality Improvement Imperative in Value-Based Care
The ‘ready-fire-aim’ idea is even more validated in value-based healthcare, where providers only have a fixed amount to treat disease. For example, a physician might have $10,000 to treat prostate cancer and, after that money is consumed, he is on his own. It quickly becomes obvious that the physician should have been figuring out the best way to treat prostate cancer several years ago, and by doing so, he would already be seeing that automatic, associated cost decrease.
At Intermountain, Dr. Bishoff says, “We have found enormous variation, from $400 up to $1,800, in our costs for laparoscopic cholecystectomies, even though our surgeons have been getting similar outcomes. So we looked at the data, shared it openly, and soon everyone dropped their costs of this procedure.”
This has led to some tough conversations with the higher-cost surgeons about how they can reduce expenses. If they aren’t willing to cooperate, then they simply aren’t allowed to do the procedure in the hospital because the hospital doesn’t want to lose money. More and more, physicians are being challenged to increase quality and help reduce costs.
“The medical profession is being compelled, for the first time, to look at all areas that are simply wasteful and inefficient,” says Dr. Bishoff. “It is being compelled to look at quality outcomes, now that Medicare will pay for performance. Before, high infection or complication rates were worrisome, but nobody lost money over them. Now that’s changing, so patients are going to start getting get the best health care because we are starting to ask what can be done to prevent complications and improve outcomes.”
Concepts of Process Improvement
In his presentation, Dr. Bishoff will allude to what Ed Catmull taught us last year at the Healthcare Analytics Summit. Catmull talked about how he and his people were in charge of reinvigorating Pixar after it was acquired by Disney. The tendency, when a big improvement like this is mandated, is to get rid of people, but Catmull took a different approach because he realized it was processes that needed fixing.
Dr. Bishoff recounts another simple story to illustrate a point about process improvement. “When I was on a trip in Texas recently, there was a sign on a door at my hotel that read ‘This door to always remain closed.’ But the door was always open. Every process we have is perfectly designed to get the results that we’re getting. The hotel could have put a hinge on the door that automatically closed it. They could have locked it, or they could have decided that the door being closed wasn’t that important. But they got the exact results they designed for.”
It may seem more complicated, but the full cycle of a quality improvement program can be summarized in these simple steps:
- Explain the why behind any process improvement effort.
- Training may be needed to articulate the why, even for those who see and understand the problems.
- Pick something to improve and get started. Don’t overcomplicate this step.
- Gather data on the process being improved.
- Get everybody who’s involved in the process involved in the process improvement. Then diagram the people and processes.
- Develop leverage points where interventions can be inserted and from which changes in data can be measured.
- Adjust, measure the data again, and then move on to the next thing.
Join Health Catalyst and Dr. Jay Bishoff as he presents his keynote speech on Wednesday, September 7, during the 2016 Healthcare Analytics Summit in Salt Lake City.