By Jake Luty, MD

Clinical Hospitalist, Faculty Lead of the OHSU HQSC

Disclaimer: I’ve never been on a crew team. I have, however, been in a raft going down thrashing whitewater, part of a team of people who all of a sudden found themselves frantically rowing, trying to get from start to finish without anyone being thrown off the boat. No matter the level of turbulence, both situations strike me as an apt collective metaphor for healthcare improvement teams (of course this metaphor is not new as many sites & sources have clearly laid out this case more eloquently that I).

In an October 2013 Harvard Business Review case study, Michael Porter and Thomas Lee, MD outline a strategy to address the value gap in healthcare - that our system is designed to produce unacceptably low quality at unacceptably high cost. This gap is well articulated in the seminal work from the Institute of Medicine, Crossing the Quality Chasm, wherein they outline strategies to make our care safe, timely, effective, equitable, efficient, and patient-centered (STEEEP for short) – a must read for anyone starting to wrap their minds around improving healthcare. Bridging the gap, Porter and Lee contend, will require agreeing on the goal(s) and then, an integrated strategy for ‘value transformation.’

Their first point (Defining the Goal) is subtle – it accounts for roughly 5% of their article – but it is in many ways the most important. Just like the rowers in the raft (or racers in the ‘shell’), setting the direction emerges as a key first step in a safe and effective journey (so much so that each sport usually includes a member whose sole focus is setting direction and facilitating team mechanics to guide along this shared path). In healthcare improvement, an initiative’s team manager typically starts by guiding the team in the definition of the problem as related to the team’s shared purpose. This shared purpose usually derives from an organization’s interpretation of the ‘STEEEP’ paradigm as it relates to the care gaps most pressing for the population served by that healthcare organization. At OHSU, this is the executive leadership, who defines a common framework to which the direction other managers’ ‘rowing’ is set. Especially in an institution as geographically dispersed as OHSU, setting a common direction via accessible mental models (houses and the like) becomes the first step in integrating everyone’s efforts toward impactful and sustainable improvement. Without adept leaders touting a clear shared direction, racers can find themselves inadvertently working against each other.   

The second of Porter and Lee’s points (Strategy for Transformation) can, should be, and is regularly debated by many, so the fine points are not a focus for this post. Rather, it is interesting how the mechanics of a crew team overlap with the central point of the rest of the review – that healthcare teams’ efforts need to be integrated if we are to accomplish the ‘STEEEP’ aims set out in Crossing the Quality Chasm. More so, they cap their model with the key point that efforts ought to be facilitated by an enabling information technology (IT) platform. These are like the ‘tactics’ of a row team, scripted moves in unison that propel the boat with maximal efficiency. Improvement teams with enabling IT platforms enjoy similar boosts in coordination and effectiveness (websites, online networks, dashboards, etc.). That is the aim of this website and many of the other recent changes in the HQSC – to try out new platforms for coordination around a common goal. To better ‘row’ as an integrated unit.

Expect to see developments in the OHSU HQSC’s IT platforms, especially as they relate to newly developed conceptual models for OHSU’s strategic vision (houses etc.), in the coming months. Our hope is that they help us steer our efforts to ford the quality gap in a way similar to an elite Olympic Rowing team, or at least a bit less like a turbulent rafting team, at times rowing in opposition and at others being flung from the boat entirely.

If you have suggestions about how the OHSU HQSC could do better in our efforts to enable integrated action, or have a reaction/resource/story that you think would inform us on this topic, please start a dialogue in the comments section below.