Management House is a best practices site advocating higher standards in American healthcare.

Raising Standards in American Healthcare

"There are two kinds of organizations.
Those that have a standards process,
and those that will."

—Alex Trotman, former Ford CEO

Stumbling Standards. Current examples of "less than best" approaches in American healthcare.

The JCAHO Joke. Where's the leadership? Is this standards group really getting the job done? It's no joke when either inadequate standards, or non enforcement of standards, result in the death of a loved one. The agency does not operate in the way in which true standards groups perform.

Management Malpractice. The core problem is lack of aggressive management action.

Professional Practice Standards—Are your profession's standards set appropriately high? Are they enforced? These are the criteria to judge a profession's maturity in dealing with the standards issue. Many health professions are unable to point to a defined standards setting group. Malpractice and lawsuits will result.

Organizational Management—Every department follows the rule that best practices are found in everything practiced in that department, and that all protocols and technology have been standardized around best practices and best tools.

Management Malpractice—the Core Problem

The root cause of America's hospital problems is how these organizations are managed. Mismanagement is the core issue. That isn't what gets blamed of course. Defenders point to bad reimbursement formulas, overregulation, competition, technological wrenching, but it's all smoke. True, these factors don't help, but the central problem is that healthcare managers simply do a poor job of managing. They are not, by and large, masters of the management craft but are malpracticing, not following the disciplines of their profession. This isn't about working hard, which they do most earnestly. It's about the need to learn how to work right and be effective. (Read Raising Standards in American Healthcare for the full presentation of the problem)

The problems of American health care stem primarily from an obsolete approach to management that produces poor performance outcomes. Too low standards are the root cause of healthcare's customer unhappiness, erratic quality, no-end-in-sight costs, and low morale and worker turnover. American healthcare leaders are running the risk of projecting blame on external forces and resource scarcity, rather than looking at how they manage.

The good news is that healthcare's problems can be overcome by a radically new management approach. The concepts of Operational Excellence and Strategic Standardization are already producing best-in-class performance—a way out of the crisis is at hand. The approach that has brought national award-winning Customer Satisfaction ratings and Top 100 hospital status to numerous healthcare organizations. The model has been field tested and it works. It is both valid (true) and reliable (it is repeatable in case after case).

There are always one or two major components missing in the performance of the malpractitioner:

Lack of personal standards. He (she) lacks values centeredness. These are the crooks who wind up in the fraud cases, play with the books, and not knowing how to create solid numbers wind up doing creative accounting. Thankfully the legal profession usually comes along to escort these sorry amateurs out the door.

Lack of business standards. More often the problem is that the organization's leaders do not follow a standards approach to managing. Because they do not set out to meet established standards, or to create them when not provided by the industry (more on that big problem for hospitals later), or to set breakthrough standards, they muddle around, hoping things will get better. They usually don't.

Dx & Tx

Diagnosis: Standards in American healthcare are too low in four primary areas. What evidence is there of that? Consider the following

Customer Satisfaction—just ask the trial attorneys
Quality—4% of admissions are injured or killed, 100,000 deaths per year
Economics—Costs out of control; leading cause of personal bankruptcy
People—One of the highest turnover rates of American industries

Treatment: The cure is a business strategy we term Operational Excellence. The strategy is to produce the following at extremely high levels and can be stated as BHAGs (big hairy audacious goals) in 8 words (must be memorizable by entire organization or you don't have a strategy):

High Satisfaction
High Quality
Low Cost
Best People

At what level should the organization attain these goals? There's the problem.

Management standards in the industry are abysmally low, not approximating best run companies outside the industry. Hospitals run to find out what Disney or Marriott do (and should)—why aren't Disney and Marriott running to their local hospital to see the standard?
Clinical standards are minimal. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) is still mired in a "minimal standards" mindset lest their paying hospital customers feel annoyed by the pressure to do better. This conflict of interest between the commercial interests of JCAHO and blowing the whistle on its customers has influenced the group's decisions for years, a "scandal" according to JCAHO's many critics. It would be fair to say that the organization is neither a tough standards setter nor a tough enforcer. It plays softball, not hardball, and the industry languishes.

Let's be clear: Management's job is to install best bractices throughout the organization, both clinically and managerially, in every department, in every nook and cranny. No more sloppy forms, no more prescription errors, no more sloppy hiring, no more malpracticing doctors granted privileges, no more dirty halls. If this sounds in error to you, if you just don't get it, then realize you are part of the problem. On the other hand, if you can hear the trumpets and see the flag waving, you may be one of the new generation of leaders who are going to take us to the mountaintop.

Current Resources

Resources currently available in our Products Listings that can help in implementing higher standards in your organization:

Raising Standards in American Healthcare. This book is the full exposition of the problem and how to cure it. (info)

Best Practice Toolsets. 6 best practice manuals used in achieving Operational Excellence. (info)

	For Uncommon Leaders.... Raising Standards, Driving Change, and Creating New American Hospitals
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		Raising Standards in American Healthcare "There are two kinds of organizations. Those that have a standards process, and those that will." —Alex Trotman, former Ford CEO Stumbling Standards. Current examples of "less than best" approaches in American healthcare. The JCAHO Joke. Where's the leadership? Is this standards group really getting the job done? It's no joke when either inadequate standards, or non enforcement of standards, result in the death of a loved one. The agency does not operate in the way in which true standards groups perform. Management Malpractice. The core problem is lack of aggressive management action. Professional Practice Standards—Are your profession's standards set appropriately high? Are they enforced? These are the criteria to judge a profession's maturity in dealing with the standards issue. Many health professions are unable to point to a defined standards setting group. Malpractice and lawsuits will result. Organizational Management—Every department follows the rule that best practices are found in everything practiced in that department, and that all protocols and technology have been standardized around best practices and best tools. Management Malpractice—the Core Problem The root cause of America's hospital problems is how these organizations are managed. Mismanagement is the core issue. That isn't what gets blamed of course. Defenders point to bad reimbursement formulas, overregulation, competition, technological wrenching, but it's all smoke. True, these factors don't help, but the central problem is that healthcare managers simply do a poor job of managing. They are not, by and large, masters of the management craft but are malpracticing, not following the disciplines of their profession. This isn't about working hard, which they do most earnestly. It's about the need to learn how to work right and be effective. (Read Raising Standards in American Healthcare for the full presentation of the problem) The problems of American health care stem primarily from an obsolete approach to management that produces poor performance outcomes. Too low standards are the root cause of healthcare's customer unhappiness, erratic quality, no-end-in-sight costs, and low morale and worker turnover. American healthcare leaders are running the risk of projecting blame on external forces and resource scarcity, rather than looking at how they manage. The good news is that healthcare's problems can be overcome by a radically new management approach. The concepts of Operational Excellence and Strategic Standardization are already producing best-in-class performance—a way out of the crisis is at hand. The approach that has brought national award-winning Customer Satisfaction ratings and Top 100 hospital status to numerous healthcare organizations. The model has been field tested and it works. It is both valid (true) and reliable (it is repeatable in case after case). There are always one or two major components missing in the performance of the malpractitioner: Lack of personal standards. He (she) lacks values centeredness. These are the crooks who wind up in the fraud cases, play with the books, and not knowing how to create solid numbers wind up doing creative accounting. Thankfully the legal profession usually comes along to escort these sorry amateurs out the door. Lack of business standards. More often the problem is that the organization's leaders do not follow a standards approach to managing. Because they do not set out to meet established standards, or to create them when not provided by the industry (more on that big problem for hospitals later), or to set breakthrough standards, they muddle around, hoping things will get better. They usually don't. Dx & Tx Diagnosis: Standards in American healthcare are too low in four primary areas. What evidence is there of that? Consider the following Customer Satisfaction—just ask the trial attorneys Quality—4% of admissions are injured or killed, 100,000 deaths per year Economics—Costs out of control; leading cause of personal bankruptcy People—One of the highest turnover rates of American industries Treatment: The cure is a business strategy we term Operational Excellence. The strategy is to produce the following at extremely high levels and can be stated as BHAGs (big hairy audacious goals) in 8 words (must be memorizable by entire organization or you don't have a strategy): High Satisfaction High Quality Low Cost Best People At what level should the organization attain these goals? There's the problem. Management standards in the industry are abysmally low, not approximating best run companies outside the industry. Hospitals run to find out what Disney or Marriott do (and should)—why aren't Disney and Marriott running to their local hospital to see the standard? Clinical standards are minimal. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) is still mired in a "minimal standards" mindset lest their paying hospital customers feel annoyed by the pressure to do better. This conflict of interest between the commercial interests of JCAHO and blowing the whistle on its customers has influenced the group's decisions for years, a "scandal" according to JCAHO's many critics. It would be fair to say that the organization is neither a tough standards setter nor a tough enforcer. It plays softball, not hardball, and the industry languishes. Let's be clear: Management's job is to install best bractices throughout the organization, both clinically and managerially, in every department, in every nook and cranny. No more sloppy forms, no more prescription errors, no more sloppy hiring, no more malpracticing doctors granted privileges, no more dirty halls. If this sounds in error to you, if you just don't get it, then realize you are part of the problem. On the other hand, if you can hear the trumpets and see the flag waving, you may be one of the new generation of leaders who are going to take us to the mountaintop. Current Resources Resources currently available in our Products Listings that can help in implementing higher standards in your organization: Raising Standards in American Healthcare. This book is the full exposition of the problem and how to cure it. (info) Best Practice Toolsets. 6 best practice manuals used in achieving Operational Excellence. (info)
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