Intermountain Adopts 'Toyota Model' of Quality Improvement

Intermountain Health Care in Salt Lake City is building the next generation of electronic medical record by taking lessons from quality-improvement programs in other industries.

Over the next four years, Intermountain will embed coding into encounter notes, but first, clinicians need a working problem list, says Brent James, M.D., executive director of Intermountain's Institute for Health Care Delivery Research and a member of the Institute of Medicine's Committee on Quality of Health Care in America.

The health system will do so by building its documentation system around tasks in the work processes of its clinicians and administrative staff. "Another name for the task list is an order set," James explains. And order sets are a foundation for computerized physician order entry.

At the heart of decision-support systems at Intermountain's flagship LDS Hospital is a protocol, specifically a knowledge engine, says James, who has a master's in statistics, in addition to his medical degree. "Knowledge management took off to the point that it became an indispensable part of IT," he says. "Protocols are the bread and butter of quality improvement."

According to James, "We think we've got a system that will eliminate all chart abstraction."

That is a strategy right out of the playbook of aluminum manufacturing giant Alcoa, identifies every work process in advance of deploying a new IT system. "IT was aligned to processes," James explains. "It's critical, but ultimately it's only a tool," he says of IT in healthcare.

James has had several meetings met with former Alcoa chairman and former U.S. Treasury Secretary Paul O'Neill, who now heads a business coalition on healthcare improvement in the Pittsburgh area. Intermountain also is learning from the Six Sigma quality-improvement efforts at General Electric and lean manufacturing techniques from Motorola.

"Six Sigma is a form of QI," says James, who sat down for an exclusive interview at last week's National Forum on Quality Improvement in Health Care, the 17th annual conference of the Cambridge, Mass.-based Institute for Healthcar Improvement.

In automating quality, Intermountain also has begun to examine Toyota Motor Co., often viewed as the gold standard in manufacturing quality because the Japanese automaker manages its knowledge processes, James says.

Intermountain has added bar codes to hospital supplies to automate the supply chain, allowing the hospital system to implement a bedrock principle of lean management, namely just-in-time delivery.

Also, the hospital can predict staffing needs by looking at the patient list, so Intermountain can schedule only the nursing and support workforce it needs in each department rather than having to guess, James says.
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