Healthcare: A Forever Improvement Journey

1. Do we still need to improve healthcare?

Ans: The answer is straightforward: Yes, we still need to! Also, improving healthcare is a never-ending journey. This is not just a slogan. It is the reality…

Good care happens where the patient receives it. It is about providing every patient – no matter who they are - with the best, evidence-based care that we have, without harming them in any way, whilst being focused on their needs and meeting their expectations, and in a way that is seamless, at the lowest possible cost, and does not waste their time, or create a negative experience…

But haven’t we done that already? Yes, we have. So, the question is: why do we still need to improve healthcare? There are many reasons why we still need to. In this thought piece, I will address some of them and what that means for us.

State-of-the-art medicine is continually evolving. This changes what we do, creates new horizons with potentially new actions, options, and questions - all these need to be factored into the processes of care delivery. Patient needs and expectations, as well as our health workforce are also continuously evolving. These factors change what may have been the previous optimal care delivery designs. The answer is a simple one: care delivery processes need to be continually revised in ways that enable the implementation of the continually evolving evidence-based care that meets the needs and expectations of our patients in the most efficient, and contextually appropriate ways. This is not a one-time event, but a journey of continually improving. It is not only about doing one’s work, but also about continually improving one’s work.

2. So, the next set of questions that come up are the following: How do we do that? And how do we know which processes need to be updated?

Ans: How do we improve care delivery processes given any of these changes? This requires a review of changes in the content of the care we need to provide and a re-alignment of the processes of care delivery to enable its reliable implementation. We also need to monitor our predictions that the care delivery process changes produced the effect we anticipated them to. Based on these results, we may need to adjust, discard, or institute these changes. Underlying all this work is the key idea that if we continue to do what we are doing we will continue to get the results that we are getting. If we want better results, we should be doing something different that enables us to get the better results that we are seeking. At the heart of improving care is changing either what we do or how we do it, but more likely, a combination of both. At the heart of improvement is change. However, not every change is necessarily an improvement. Some changes may not yield improvement. Others may make things worse. The way to know is to measure the result we are interested in before we make changes, while we are testing different changes, and act upon the results that we see until we get the result that we are seeking. The best people to work on this are the people involved in delivering the care as well as those receiving the care. We have come a long way on our journey in improving healthcare. We have learned many things through experience. One of the key learnings has been the power of shared learning. Wherever we have more than one entity interested in making the same improvement, orchestrating a shared learning and improvement environment has proven to be essential. In this type of collaborative environment, they all work together, share with each other, learn from each other, and teach each other, as they conduct their improvements. The result is invariably better results which they can achieve faster.

3. Which care delivery processes need to be updated?

Ans: Unfortunately for the most part this is being done on an ad hoc basis. We wait until an issue arises, then we act. This has the cost of running into unnecessary problems as well as missing opportunities. These missed opportunities are often lives that could have been saved, or patients whose suffering could have been alleviated. A better way to do this is to set up systems by which we anticipate what processes need to be improved at what time. The inputs for such systems come from a variety of sources. These include updates to guidelines, patient input, and health worker input. It sounds like a lot of work. However, is this work not already being done? Clinicians are aware of updates to their clinical guidelines, and we do ask our patients regularly for their input. Health workers are not shy about pointing out what can be improved.

4. Can we put all these together and use them as inputs for deciding on the next priorities for improvement?

Ans: It is a critical role of leadership to do this and proactively manage the next set of priorities for improvement. This is also where improvement strategy becomes a key component of organizational leadership.

Improving healthcare is a never-ending journey, requiring leadership and strategic direction, with awareness to the evolving nature of healthcare, and continually commissioning and supporting teams to improve clinical and organizational priorities.

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About Dr. M. Rashad Massoud, MD, MPH, FACP

Dr. M. Rashad Massoud is a globally recognized leader in improving healthcare and strengthening systems to deliver better outcomes, efficiency, and sustainability. He is an inaugural member of the Quality & Safety Academy of the International Society for Quality (ISQua). Dr. M. Rashad Massoud has worked with over 100 countries. He is fluent in Arabic, English, and Russian. Dr. M. Rashad Massoud has strong cross-cultural competencies.

Dr. M. Rashad Massoud is former visiting faculty of Harvard T. H. Chan School of Public Health. Dr. M. Rashad Massoud is a senior Vice President and Chief Program Officer at Americares overseeing the organization’s health programs worldwide including in the United States, Emergency Response, and distribution of $1.25 billion in medicine and supplies to over 90 countries. Dr. M. Rashad Massoud was a Chief Medical and Quality Officer and Senior Vice President of the Quality and Performance Institute at University Research Co., LLC where he was Director of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project – $210 million over 7 years in 46 countries, and the USAID Healthcare Improvement (HCI) Project – $150 million over 6 years in 38 countries. He is the Chief Executive Officer of Rashad Massoud Associates, LLC. and recently has been empanelled with Vmarsh Healthcare to service clients worldwide with their healthcare needs based on Vmarsh and his combined capabilities.