Can KM help improve healthcare outcomes as well as reduce medical costs?
Over the past few months as the US House and Senate have been debating the health care bill I’ve been thinking about the role that KM can play in helping reduce health care costs as well as increase the health outcomes.
As I’ve read articles on the topic and listened to reports from news organizations such as NPR several examples of hospitals using what I would term effective KM have stood out for me - although in none of the cases do they actually refer to KM…instead they talk about sharing and use of good or best practices.
- The first is Geisinger Medical Group in Pennsylvania
- The second is Mass General
- The third is a Surgeon, Dr Gawande, and his team at Harvard
In each of these cases what the hospital and staff have done is (1) examine what they are doing, (2) codify their process and (3) create a check list based on their current processes and what they perceive as good practices. They are then able to observe the results from both medical outcome and a cost perspective. In all cases this simple KM process…of taking tacit knowledge, making it explicit and then using it as a check list…has resulted in positive outcomes.
What I’d like to do is to take a brief look at each of these and ask…as KM practitioners what can we learn from what they are doing…and can we help extend these practices in order to help improve our healthcare system?
The first example – Geisinger…
In an issue of Time Magazine this past fall Geisinger Medical Group was highlighted in an article titled “A healthy way to pay doctors.”
The article talks about how Geisinger Medical Group in Pennsylvania has significantly reduced costs, improved patient health outcomes, and attracted and retained top quality doctor’s through the use of some fairly straight forward KM practices. An example of what they have done is in surgery.
The first thing he and his team did was take 20 general steps all surgeons follow throughout a bypass episode and try to sharpen them in a way that would remove as much chance and variability as possible, going so far as to spell out the specific drugs and dosages doctors would use. The result was an expanded 40-step list that some surgeons balked at initially, deriding what they called “cookbook medicine.” Once doctors began following the expanded checklist, however, they grew to like it. After the first 200 operations — a total of 8,000 steps — there had been just four steps not followed precisely, for a 99.95% compliance rate. A total of 320 bypasses have now been performed under the new rules. “There are fewer complications. Patients are going home sooner. There’s less post-op bleeding and less intubation in the operating room,” says Casale. What’s more, the reduced complication rate has cut the per-patient cost by about $2,000.
The article goes on to talk about how Geisinger Doctors have done similar things for hip-replacements, bariatric and cataract surgeries and kidney treatment. And the results from both a cost perspective…and a health outcome perspective.
As I read the article and thought about what the teams had done it was apparent that they are applying some very simple KM techniques – what many KM practitioners would probably consider KM 1.0. But these simple techniques were having a powerful impact.
I’ll look at a couple other examples from Mass General and Dr Gawande and his team at Harvard in the next part of the blog.
Uncategorized | Allan Crawford | 06 January 2010 |
