Reflections on Eleven Years

Posted on Jan 10th, 2013 at 9:18am.

Eleven years ago when I founded The Reinertsen Group, I added the tagline “Creating Organizational Environments in Which Quality Can Thrive.” That has proved to be a reasonably durable statement, bothof our goal, and of our strategy. It seems more relevant than ever for health care leaders today, as they prepare to take their organizations fully into the era of value-driven, accountable care.It’s also especially pertinent to something that Bryan Sexton taught me this year, one of my top lessons from 2012 (see below).

While our tagline has been constant, other things have changed. This was my final year as a Senior Fellow with IHI. It has been an extraordinary privilege to work with IHI’s world-wide family of leaders and faculty, and I am grateful to Don Berwick and Maureen Bisognano for their invitation in 2001 to join their team. I have learned an enormous amount from working with the IHI team on projects, white papers, and programs such as Pursuing Perfection, the Executive Quality Academy, the 100K and 5M Lives Campaigns, the Seven Leadership Leverage Points, Boards on Board, Engaging Physicians in a Shared Quality Agenda, and the annual CEO Summit at the National Forum.

Another change I have noticed over some years is my steadily increasing emphasis on two dimensions of quality: safety and efficiency (cost). Other quality attributes such as effectiveness, timeliness, and patient-centeredness obviously can’t be cleanly dissected away from safety and cost, but these two stand out, and seem to take precedence in most of my interactions with clients. In the case of safety, I often describe it as a moral imperative, rather than one of several strategic options. Safety seems to be on a more fundamental plane than, say, service quality. As I often tell clients, “The patients whom you injurewill notcare whether or not you had valet parking.”

Cost has emerged as the other key dimension of quality because of our national fiscal crisis. The US has no choice: we must reduce our rate of growth of health care costs. As Victor Fuchs puts it: “If we solve our health care spending, practically all of our fiscal problems go away.If we don’t, then almost anything else we do will not solve our fiscal problems.” Cost control—not better access, not insurance reform, but real reduction in spending—will likely dominate health care policy for the next 10 years. The key for health care delivery leaders will be to maintain or improve other quality dimensions—such as safety—while simultaneously reducing costs.

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