It's 2AM, and a pager beeps you awake. A critically ill patient is on their way to the hospital, and they'll be there in ten minutes or so. You rub your eyes and waddle downstairs, nearly awake, to setup to assist this patient at this early hour. As you rub your eyes again, the patient wheels into the room for your (and the team's) care. You approach the patient, along with the team, just as you've been taught. You examine the patient, treat his difficulty breathing, and notice that the floor of the room is already red with an enlarging puddle of blood. The issue, here, is a large metal bar that has impaled the gentleman in the chest. And the blood? It slowly & relentlessly oozes onto the floor beneath his stretcher. He needs an operation, and he needs it now. You call for blood to transfuse the gentleman to keep him alive. At 2AM, it feels like it takes forever. In the mix of emotion and early morning, the blood seems to take an hour to get to the room. The patient is doing no better.
Whichever way this situation goes, whether this patient lives or dies, you are sure you need to address how long this took in the morning when the case is reviewed in the light of day. It was just too long. Things need to change, and perhaps the whole process used to give patients blood needs to be re-arranged in response to this case.
...and guess what. If you thought that, you'd be wrong. You'd also be well on your way to making the system worse and having patients require an even longer period to get blood. That's the issue with quality improvement and systems based practice. Responding to one case without data to understand the whole system actually makes things worse. Patients often have worse issues with how long it takes to get blood when you adjust a process without using data, and without using your data in a certain way. This is what I talk about: how what we feel can get us so far, and yet how we use data to see our system can get us much higher quality and better outcomes for our patients. My live trainings blend stories, data, and proven experience with quality improvement to help hospitals and practitioners better serve their patients. In those we focus on specific tools, tips, and techniques that let us use data to take our system from good to great. Interested in hearing more at an event or conference? Say hello beneath.
Hi I'm Dr. David Kashmer. I design and build high-quality healthcare systems using a data-driven approach. I share many specific tools, and their uses, in the recent Amazon best-seller, Volume to Value: Proven Methods for Achieving High Quality in Healthcare.
I have an embarrassing confession: I am a nerd. I can't help but dive deep into the rabbit holes that interest me. Because of this quirk, I have an MD, an MBA, and am a Lean Six Sigma Master Black Belt.
My passion in life is blending my business and operations experience with my love of Medicine to improve the quality and effectiveness of hospitals. I use data driven decisions to improve patient care. Here's one of my favorite examples:
A large hospital had issues with delivering great patient care to critically ill and injured patients. One way that the process wasn't going well included how the documentation about the patient's care (which other physicians wanted to use later in the care of the patient) just didn't measure up.
As usual, one of the most important steps included how to know just how amiss things were. They asked me to assist.
The team (10 of us) got together and estimated how to measure the waste that resulted from such poor documentation. We discovered that the costs of poor quality were large...not to mention the more important patient care issues!
The group built and validated a tool that helped us represent just how good the documentation was in each case reviewed. We tested the tool, and found how what we'd built was so reliable that two totally different reviewers who read the patient record independently would often score the record the same way. The hospital's team found a way to quantify just how well they were doing, and now they could see the issues.
The team made changes based on the newly collected data. They made it easier to document the patient care already delivered, and medical coders along with physician caregivers could see the obvious difference.
Now that the documentation had improved, the costs of poor quality like missed charges for patient care, and, more importantly, medical problems that had occurred owing to poorly documented medication allergies, disappeared. Now that the care delivered was documented, the patients did better and the hospital even recovered more than $320,000 that was previously lost to quality problems. The result may seem counterintuitive--in fact, it's typical.
The highest quality care is almost always the least expensive.
Get in touch beneath to hear some specifics on how the team made the improvements stick, and for tools, tips, & techniques to make meaningful quality improvements to healthcare systems. Here's what others have said about training with me recently...
"Dr. Kashmer's discussions of data acquisition pitfalls and the limitations of benchmarks is helping our organization better understand where we need to make real changes in our quality improvement process as we encounter real world problems that go beyond the available benchmarks. For example, our organization is attempting to improve standards for EMR charting and blood product delivery in our trauma bay. The recommendations which I have gleaned from Dr. Kashmer's programs are helping me to develop better processes which will improve efficiency and eliminate waste. His espoused techniques are making an enormous difference in how I can help my institution deal with problems in our trauma system. I cannot say enough about the positive impact his work has had on helping guide a focus on process improvement at my institution."
R. King, MD Trauma & Acute Care Surgeon, Surgical Critical Care Specialist
"The goal of our publication is to share practical solutions with hospital leaders, so I seek out experts who bring a fresh perspective to healthcare quality and management. I can tell you that Dr. Kashmer’s insights stand out for their uniqueness and clarity. While most hospitals have adopted a methodical approach to quality improvement, the PI process is still often dominated by team members’ emotional response to performance shortfalls. David shows providers how to move beyond ‘gut feeling’ by using rigorous data-driven techniques. He shows how to use data to identify the true drivers of poor quality, develop effective system-based interventions and ensure ongoing results. And our readers have responded enthusiastically to these insights and solutions. Over the last several months, the editorial content that Dr. Kashmer has helped us develop has generated thousands of page views and hundreds of downloads. His passion for healthcare quality—and his generosity in sharing his knowledge—are making a difference for many healthcare teams."
Robert Fojut, Publisher, Trauma System News
"Medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered. At any point, the reality is that we are sometimes as apt to harm as we are to heal.
David Kashmer helped train me and transformed our team's approach at a major teaching hospital simultaneously. He understands that the fundamental problem with the quality of American healthcare is that we’ve failed to view delivery of care as a science. He also warns that effective delivery ought not be ignored since it is just as critical as understanding disease biology and finding successful therapies.
In our ICU, dogmatic practices permeated through our system. Did every intubated patient need a daily chest X-ray and daily lab studies? Was a urinary catheter or central venous catheter required? Couldn't we just stock antibiotics and blood in a satellite pharmacy or blood bank closer to patient care in order to avoid delays?
Frequently dismissed by research funders, government, and academia, quality and delivery of healthcare has always been viewed as the Art of Medicine. That is a horrible mistake that is economically destructive and, most importantly, will cost patient lives.
Dr. Kashmer has demonstrated repeatedly that he has the essential skills and knowledge to gradually modify systems to enhance quality of healthcare. His efforts go beyond checklists and timeouts."
F. Madbak, MD Trauma & Acute Care Surgeon, Surgical Critical Care Specialist
"I reached out to Dr. Kashmer after reading one of his insightful blog entries on the Minitab website. His data-driven approach to healthcare process improvement is something I connected with very strongly. As a newly minted six sigma blackbelt, I had received the formal training, passed the exams, and completed a project and I was eager put my new education to further use in my new professional role. I expressed my goal of developing a simple way to present data and communicate what I had learned to executives and process owners – all engaged team members, essentially. He was kind enough to initiate a series of remote Webx sessions where we could have a discussion, look at some data, and bounce ideas off each other. I learned quite a bit through these helpful interactions – primarily the confidence and improved ability to analyze, interpret, and communicate process performance through data analysis. His practical approach has helped me on a current ED throughput project in which we are both reducing the arrival to provider time as well as the process variation. I highly recommend Dr. Kashmer as a healthcare leader and a quality improvement-driven physician who has an ability to boil down complex problems to practical applications and share them in a straightforward manner. He’s a refreshing authoritative voice and an effective and valuable knowledge expert in our growing field of process improvement."
Z. Robison, Director, Process Improvement, Piedmont Health
"Listening to David speak about healthcare & Lean leaves you nodding your head in agreement."
J. Panco, Sr. Specialist, Standards & Training, PeaceHealth