Cutting Variation to Boost Patient Outcomes

Moreton Lecturer links robust protocols to better results.cutting variation

The Monday morning council session at AMCLC 2013 wrapped up with the much-anticipated Moreton Lecture, given by Brent C. James, MD, Mstat, executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare in Salt Lake City. James presented the lecture "Value, Variation, and Patient-Centered Care: Building Radiology's Future."

James pinpointed variation as a main driver in poor patient outcomes and increasing health-care costs. Meanwhile, implementing and fine-tuning protocols has been linked to better care for patients and greater efficiency in the health-care system. With this in mind, James's institution set out to establish protocols and track data across all of its facilities. And the effort got results: "Over a period of time, we saw massive reduction in variation," said James. "And on average, it greatly reduced the cost of care."

His team found that when a task is completed the same way every time, error rates fall because complexity is reduced. Fewer mistakes result in better care and more favorable outcomes for patients. In addition, well-understood protocols bring greater efficiency, which leads to significant cost savings. If all of this seems obvious, James won't disagree. The ideas are based on common sense and solid evidence. "You can apply the scientific method to systematically improve," said James. "Regardless of where you start, you will end up with the best demonstrated care practices."

A founding tenet of James's approach was the caveat that no two patients are the same. Therefore, the protocols had flexibility built in, and physicians were empowered to adapt as necessary. "It's not that we allow or even encourage [flexibility]," said James. "We demand that we modify a shared baseline protocol based on a patient need."

As James reflected on the results of these efforts, he said, "We count our successes in lives," acknowledging that behind the metrics are real patients. "And that's the tip of the iceberg. For every life saved, suffering is reduced and functioning is improved in hundreds of [other] lives."

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