Quality controls cost

Post date: November 12, 2013 by Steve Mattson

Quality controls cost. Period. Quality and cost are two sides of the same coin, and many players within the patient care value stream influence both. When we work to understand their roles and the leverage points available to them, we increase the chance for successful collaboration and improved value for patients and families:

Healthcare delivery relies on thousands of interlinked processes—both clinical and administrative—that extend from a patient’s call for an appointment to the final settlement of their bill.  And we know that waste exists within every step of the healthcare process.

Healthcare wastes can be categorized in different ways. For purposes of this discussion, let’s break them down into quality waste and efficiency waste:

  1. Quality waste: Physicians and other providers work hard to follow clinical guidelines and other “best practices” (when they exist). Nevertheless, clinical services are often overused, underused, and misused, all of which results in lower quality and higher costs:

    Overuse: doing more than is necessary to effectively diagnose or treat a patient.

    Underuse: failing to follow evidence-based protocols or other accepted clinical standards.

    Misuse: following known clinical standards but doing so in a reckless or negligent manner.

    As in other industries, the cost of poor quality in healthcare is estimated to add upwards of 50% to the total bill. But as physicians and other providers successfully reduce unnecessary practice variation and implement data-driven, evidence-based protocols, we see improvements in quality, affordability, and the amount of time available to practice the “art of medicine.”

  2. Inefficiency waste: Inefficiency waste (including rework, waiting, wasted motion, excess handling, and more) is present in every step of every value stream, increasing the cost of the many inputs to the care process. Even as clinical quality stays constant or improves, inefficiency waste adds cost and eats away at value.

    Inefficiency waste is the primary target for kaizen. When we relentlessly focus on value by mapping patient value streams and perfecting processes, we can provide consistently safer, higher-quality care at a lower cost.

In the end, the total cost of care is a function of both what we do and how we do it. To reduce costs, quality must be improved, and we’re all accountable. By working together across disciplines, departments, and roles, we can improve the accessibility, appropriateness, and affordability of care for all.