A. Recognizing the importance of process improvement

Healthcare leaders must recognize the significant potential of process improvement to increase value in healthcare.

In his keynote address, Berwick drew upon the work of quality management expert Noriaki Kano, who described three forms of improvement. Berwick referred to these as Kano 1, 2, and 3. Kano 1 is “defect reduction.” Kano 2 involves removing unnecessary cost from production, while fully meeting the needs of customers. Kano 3 adds new features and products and addresses the consumer appeal of a given project. Berwick noted that Kano 2 improvement merits special attention from the healthcare industry at this time, even while it continues to pursue, as it must, the other two types.

Fig 2.1: Opportunities for Innovation

Insight 2A - opportunities for innovation

“A Kano 2 improvement is quite different and not at all understood in healthcare,” said Berwick. “That is, reduce the cost of production without hurting the customer… by making production simpler, taking a step out, doing something with different materials… figuring out a way to do the same thing—or even something better—for the customer, while reducing your cost of production. Then you can use the money or return it. That’s the kind of Kano 2 improvement we need in healthcare.”

The survey echoed Berwick’s sentiment. While it exposed a surprising lack of confidence in the innovative power of traditional areas of focus, such as “basic medical research” and “pharmaceuticals,” it also revealed an intriguing confidence in an area of innovation typically associated with non-healthcare industries: process improvement. When asked to rank eleven areas of innovation by their potential impact over the next five years, participants identified “process improvements in care delivery” as the number one opportunity for both improving quality and controlling the cost of care, with approximately 60 percent expressing “very high” or “somewhat high” confidence in its power.

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