A Valentine for Dr. Brent James

There is no doubt that Brent James, MD, MStat, Chief Quality Officer and Executive Director of the Institute for Health Care Delivery Research at Intermountain Healthcare, is one of a handful of this Country’s leaders in healthcare quality.

According to the introduction of an interview conducted by Bob Wachter, arguably our leader in patient safety, Dr. James “has probably educated more leaders in health care quality and systems change than anyone else in the United States.”

Here are just four of Dr. James’s positions that I admire and endorse:

1. Speak “the language of the natives” when introducing a quality improvement program; avoid the use of jargon.  By taking this tack, you reduce the barrier to acceptance of the quality methods and the fear that there’s a huge body of knowledge that must be learned before making progress.
2. Have a clear aim for the project.  This comes from Dr. Deming.  We, at Twin Peaks Group, also preach the importance of clear, concise, objectives so that we can easily determine whether they’ve been attained and so they can be attained before the participants run out of enthusiasm and energy.
3. Plan for managing change from the very start of an improvement project.  Any significant improvement modifies the way that people perform their work.  But, since we all prefer to do things the same old way, it’s essential to plan for winning support and sustaining the gains before embarking on a project.
4. Include the financial impact along with the process impact.  In Dr. James’s words “include cost outcomes in parallel with the clinical outcomes.”  As he correctly points out, this is essential to get the organizational resources behind the programs to improve quality.  As consultants, we’re naturally very aware of the importance of this step.

No Valentine is perfect: Dr. James and I probably disagree regarding the financial benefit to a hospital  of many quality improvement projects , such as those which have reduced infections.

The benefit is conventionally estimated as the sum of variable costs (e.g. materials and supplies), which are relatively small, and the loaded cost of the clinicians and others who deliver value to the patient.  The latter costs, as recently pointed out in “The fixed cost dilemma: what counts when counting cost reduction efforts?”, are fixed or vary very slowly with the number of patients. Consequently, the financial benefit to hospitals of many healthcare quality improvement programs is not as large as often thought.

Fortunately, there are payers out there who are willing to support virtuous behavior, sending additional patients the way of well-deserving hospitals; a perfect payer Valentine to a provider.