Now for my final conclusions, let me first review the principles and, tools covered in this course that will allow you to create a patient centered health care delivery system. And remember you can go back repeatedly and watch the individual videos. Please feel free to use the nonproprietary forms on the course weds- website. I also recommend that you read several of the books and articles on your reference list to further consolidate your learning and most important I recommend that you repeatedly apply these tools to great standardized work in your health system. As you recall, I drew a simplified TPS or Lean House in our introduction. And now that you have completed the course we can formalize our Patient-centered health care Delivery system, PhDs House and create a more formal figure. PhDs consists of two pillars. The first, continue improvement guided by plan, do study act- study X cycles. As the abbreviation PhDs emphasizes these improvements should be guided by the input of those working on the frontlines. Who have been trained in the scientific method. The second pillar is mutual respect and transparency. Everyone works together and everyone shares the problems they are encountering. These important principles were emphasized in our discussion of teamwork and huddles in our first course. These tw- these two pillars hold up the roof wafer represents value added care for patients. Everything we do in our patient centered delivery system should be of true value to our patients. In other words value added. The foundation of this system is waste reduction and we have introduced you to the power of 5s. We have also focused on diagnostic waste and the importance of creating illness scripts grouping diagnostic possibilities into three pretest probability tiers and using Bayes Theorem to judiciously order diagnostic tests. The floor of the house and the platform for all improvement is standardized work. We have strongly emphasize the importance of creating standardized work because without it, there can be no improvement. Within the house, we've introduced you to the tools that enable you to effectively design and continually improve standardized work. Value streams that allow visualization of lead cycle and most important tack time allowing you to deeply understand the current state. We've shown you how process mapping and rapid improvement of events can be used to eliminate bottlenecks and remove wasteful procedures identified by value stream mapping. By adjusting work output to meet that variable demands so common in health care delivery, you now understand how to level workflow. We have been- you have been introduced to the A3 form that is very helpful for summarizing the current state, ideal state, the rationale and plans for implementation and you have learned how to use the Paredo chart which can help to set the priorities for your improvement. We reviewed the different levels of Error Proofing and showed how high level error proofing can reliably prevent errors from reaching patients. Finally, you were introduced to visual controls and shown how they can be used to reduce errors and to minor work progress. These proven tools and principles work together to create a comprehensive and highly effective system that can dramatically improve the efficiency, quality and safety of patient care. When fully implemented this system can achieve a four fold increase in productivity and simultaneously reduce errors by ninety 99%. In the introduction to our first course fixing health care delivery, you watched Don Berwick former CEO of the Institute of Health Care Improvement and former director of the Center for Medicare and Medicaid Services. CMS describe the institute of Medicine's definition of the ideal health system. Let's watch this IHI video again. One of the most important things that happened in that report was it- it gave names to the dimensions of quality. If you're buying a car there are dimensions of quality safety, fuel, efficiency, comfort, fun and driving, durability and so on. What we're used to that. What- what what are the dimensions of goodness in health care? And the Institute of Medicine crossing the quality chasm report gave us six dimensions and said these should be the areas for health care to improve on. It also summarized a lot of the research literature on the current levels or performance for those six areas and here the six areas. The first one is safety. Back to the report from a year and a half earlier. To err is human. Safety means we're not harming people with our care. We're not adding to the burden of illness. A safe healthcare system reduces hazards and risks from the care itself safety. The second dimension they called effectiveness and that was a term that sort of was meant to up- to mean matching science to care. So if science says that this drug can help in this disease then we use that drug. And if science says this can't help, we don't use it. So avoiding overuse of things that don't help and assuring use of things that do help, avoiding under use that's effectiveness. Lining up science with care. There are big problems in effectiveness. The Rand Corporation famously and published a study a few years ago which showed that of the needed effective care that Americans should get when they track 7000 people over- over two years. Those people who had all sorts of things ranging from just well care to serious chronic illness. Those 7000 people failed to get 45% of the care that would have helped them. So that's effectiveness. The third dimension is patient centeredness and this is a pretty subversive goal. That means people should be in control of their own care. They should make decisions about what affects them. We say nothing about me without me. It's putting the patient in the center of the care system and giving them power and control over their own lives and their own care. The fourth dimension is timeliness which means avoiding delays. People are quite familiar with waiting rooms. You know we wait a long time to get into- to see the doctor in the emergency room or waiting for an appointment. In all other industries timeliness is an important dimension of quality you don't want to wait everywhere while nor do you in health care. So timeliness is reduction of needless delay, some delays in instrumental you want to wait to see what happens. But there's a lot of non-instrumental very costly delay. The fifth dimension is efficiency which means avoiding waste. We throw out so much in health care. We give things that can't help. We duplicate procedures and tests. We lose records. We lose the ideas of the workforce by not inviting them to join an invention. So efficiency is a big word it means stop wasting stuff. We're very very wasteful in health care. The last dimension which some people think should be the first is equity and that means closing the gap. In justice and health care, basically. Right now the biggest predictor of your health status in our country remains your race. You know someone's race, you know much more about their future and health and in almost anything else I could tell you about them. A black baby born in inner city Baltimore this year is has a life expectancy of a male. It's seven or eight years less than a white baby. That's a quality dimension to equity. So safety, effectiveness, patient centeredness, timeliness, efficiency and equity. That- those are the names of the dimensions of quality that the Institute of Medicine says we should work on. By applying our patient centered health care delivery system, you can achieve all the goals of steep described by Dr. Berwick. First of all safe, standardized work, air proofing, vision controls, all improve reliability and thereby reduce errors and improve safety. Timely, value stream and process mapping create more time efficient processes. Efficient, waste reduction, value stream and process mapping continually improve efficiency. Effective, when it comes to patient care standardize work assures that every diagnostic and treatment plan is based on the latest scientific and clinical evidence. Equitable, standardized work assures that all patients with the same disease receive- receive the same effective treatments. Patient centered, as the name of this system applies, PhDs is designed to continually improve every process to provide the highest value for each patient. I'm very excited to share my vision of an ideal health system and I look forward to hearing from you about your successes and your challenges. I hope you will stay in touch and join me on fixing health care delivery PhDs Facebook group page and share your ideas on Twitter. You now have the tools to eliminate the conditions. That Martians Steve and I encountered and to remove the challenges to patients all over the world face when they become ill. You have the skills to create a patient centered health care delivery system. So get out there and make a difference. Thank you.
