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A ‘Starter Kit’ For Better Health Care DeliveryReengineering Health Care: A Manifesto For Radically Rethinking Health Care Delivery by Champy Jim Greenspun Harry Upper Saddle River (NJ) : Pearson Education, publishing as FT Press , 2010 227 pp.; $26.99

2011; Project HOPE; Volume: 30; Issue: 4 Linguagem: Inglês

10.1377/hlthaff.2011.0262

2694-233X

Karen Boudreau,

Healthcare Policy and Management

Book Review Health AffairsVol. 30, No. 4: Still Crossing The Quality Chasm A ‘Starter Kit’ For Better Health Care DeliveryKaren M. Boudreau Affiliations Karen M. Boudreau ( [email protected] ) is senior vice president of the Institute for Healthcare Improvement (IHI), in Cambridge, Massachusetts. She is medical director for the IHI Continuum Portfolio, which addresses the patient journey in health and chronic disease care, and she oversees national and international work on IHI’s Triple Aim (optimizing health, patient experience, and per capita health care costs), transitions in care, and strengthening and redesigning primary care. PUBLISHED:April 2011Free Accesshttps://doi.org/10.1377/hlthaff.2011.0262AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSOrganization of carePatient engagementPatient testingPhysician workforcePatient outcomesEfforts to reengineer US health care delivery are not new, but efforts in the past have been variably effective and sustainable. Now changing circumstances have created a new environment—and new efforts. With last year’s passage of health reform, along with the attention and funding associated with it, many organizations are looking for guidance on how to begin redesigning the system.Enter Jim Champy, an experienced business leader, manager, and enthusiastic champion of the reengineering concept ever since he began applying it to corporations and management. In this book he teams with physician Harry Greenspun, the chief medical officer for Dell, to offer a “manifesto for radically rethinking health care delivery.”Their book is no fervent call to arms. Instead, they invite readers to go on a well-chosen scenic tour, presenting engaging examples of successful delivery system redesigns and innovations.Champy and Greenspun opt to focus their travelogue and recommendations on three major areas: harnessing technology; redesigning processes; and remembering that people have the ability to accelerate or impede change. They believe that health care providers need to lead the change effort: “Reengineering must be done, and it must be done by clinicians. No angel of government, even under the auspices of ‘national health care reform,’ can reduce the cost and improve the quality of health care without the work and leadership of clinicians. It’s time for all clinicians—physicians, nurses, technicians, physician assistants, and pharmacists—to assume their rightful role in directing change.”Once that effort is under way, the authors argue, the needs of patients and families should be at the center of reengineering efforts. But they stop short of suggesting that patients and families be engaged directly in health care redesign efforts and in testing changes. Many, however, myself included, believe that more is needed than merely “educating the patient and offering clear choices,” the approach that Champy and Greenspun espouse. Reengineering efforts need to actively include patients in designing, testing, and improving health care delivery systems. Put another way, true patient-centered care—“nothing about me without me”—goes far beyond health care workers’ designing care that they think patients want and need.What these authors do well is to create an approachable series of stories of successful, and occasionally dramatic, redesign efforts. The examples come from a variety of health care settings, ranging from primary care/multispecialty group practices such as Atrius Health in Boston, to hospital systems such as MultiCare in Washington State and Methodist Hospital System in Houston, and direct-to-employer health care delivery systems such as Activate Healthcare in Indianapolis.The examples that Champy and Greenspun selected show what structured redesign processes can lead to. Among the results: adopting electronic health records in a carefully executed way; introducing shared medical appointments, in which a group of patients see the same doctor at the same time; methodically engaging physicians in considering innovative process designs; using personal stories and motivational data; and directly engaging employers in improving the health of their workforce.The stories the authors tell illustrate what is involved in coming to a meeting of the minds with key leadership and explain how an effective process can be created. They also detail organizational steps taken by the highly effective leaders being profiled and—especially helpful—the challenges they faced and missteps they made. Several chapters conclude with specific checklists and guidance to help achieve success. Written in a conversational style, Reengineering Health Care provides an introductory overview of many, although not all, key processes and capabilities required for the successful reengineering of organizations involved in health care. Think of it as a helpful starter kit. Champy and Greenspun’s compelling case for reengineering the way health care is delivered should inspire readers, especially those new to the improvement field, to believe in the promise of delivery system redesign. By beginning thoughtfully, then building on successes, the authors demonstrate the true challenges and potential of transformative improvement through the examples they choose. One critical message is understated, though. The success of the profiled organizations always depended on two essential factors: having visionary and engaged leaders, and having an organizational culture that was willing to embrace innovation and transformation. Neither factor alone would have been sufficient. And even when both were in place, leaders and organizations needed painstakingly to prepare and nurture both their organizational cultures and their capabilities to improve. Those motivated by reading this book can begin their own reengineering efforts by identifying the processes within their organizations that could be redesigned most successfully. Later the organizations will need to supplement their redesign journey with more-detailed methods and guidebooks, such as Six Sigma (the business management approach originally developed by Motorola), 1 the most recent edition of the multiauthor Improvement Guide: A Practical Approach to Enhancing Organizational Performance and its “Model for Improvement,” 2 and the five-step lean techniques from the Lean Enterprise Institute. 3All of these, although they use different routes and more-detailed methods, arrive at the same final destination found in Champy and Greenspun’s travelogue. The shared goals are a health care system that delivers a better care experience for patients, better patient outcomes, and better value for all; and an organization that has rediscovered the joy of providing health care. It will take a full bookshelf—and concerted effort—to get us there.NOTES1 Motorola University . What is Six Sigma? [Internet]. Schaumberg (IL) : Motorola Solutions ; [cited 2011 Mar 30 ] Available from: http://www.motorola.com/web/Business/_Moto_University/_Documents/_Static_Files/What_is_Six Sigma.pdf Google Scholar 2 Langley GL , Nolan KM , Norman CL , Provost LP . The improvement guide: a practical approach to enhancing organizational performance . 2nd ed . San Francisco (CA) : Jossey-Bass ; 2009 . Google Scholar 3 Lean Enterprise Institute . Principles of lean [Internet]. Cambridge (MA) : The Institute ; [cited 2011 Mar 30 ]. Available from: http://www.lean.org/WhatsLean/Principles.cfm Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 April 2011 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download