“What is unique about the strategies in the Checklist is that they not only improve outcomes, but simultaneously reduce costs. The business case for their adoption is compelling.”

-JAMA, July 18, 2012

Gary S. Kaplan, MD

A recent Journal of the American Medical Association (JAMA) article co-authored by Virginia Mason CEO Gary S. Kaplan, MD, offers a practical checklist enumerating 10 strategies “that have been found most effective in providing better care at lower costs within several major health care institutions. These strategies represent the leadership, culture, infrastructure, care delivery, and reliability components essential for delivering high-value care.”

The JAMA article is based on an Institute of Medicine (IOM) paper entitled, “A CEO Checklist for High-Value Health Care”. The article − Marshaling Leadership for High-Value Health Care: An Institute of Medicine Discussion Paper – was authored by Patricia Gabow, MD, CEO of Denver Health Foundation and George Halvorson Chairman and CEO of Kaiser Permanente, along with Dr. Kaplan.

The article states clearly that “what is unique about the strategies in the Checklist is that they not only improve outcomes, but simultaneously reduce costs. The business case for their adoption is compelling.”

The essence of the article identifies a series of foundational elements that constitute the CEO Checklist for High-Value Health Care:

Foundational Elements

• Governance priority — visible and determined leadership by CEO and board
• Culture of continuous improvement — commitment to ongoing, real-time learning

Infrastructure Fundamentals

• Information technology (IT) best practices — automated, reliable information to and from the point of care
• Evidence protocols — effective, efficient and consistent care
• Resource utilization — optimized use of personnel, physical space and other resources

Care Delivery Priorities

• Integrated care — right care, right setting, right providers, right teamwork
• Shared decision-making — patient-clinician collaboration on care plans
• Targeted services — tailored community and clinic interventions for resource-intensive patients

Reliability and Feedback

• Embedded safeguards — supports and prompts to reduce injury and infection
• Internal transparency — visible progress in performance, outcomes, and costs

The IOM paper was co-authored by Delos Cosgrove, Michael Fisher, Patricia Gabow, Gary Gottlieb, George Halvorson, Brent James, Gary Kaplan, Jonathan Perlin, Robert Petzel, Glenn Steele and John Toussaint. It includes concrete examples of successful work under each of the checklist categories. For example, one of the examples under culture of continuous improvement is the Virginia Mason work adapting the principles of the Toyota Production System to health care – “identifying and eliminating waste and inefficiency in the many processes of health care delivery.”

Under the evidence protocols category, the authors note the VM work embedding “evidence-based decision rules into the existing workflow of providers at the point of ordering an advanced imaging test to reduce variability. If the provider cannot specify an appropriate evidence based decision rule, the test cannot be ordered.”

The result was a significant decrease in imaging utilization – reducing “MRI rate for headache by 23.2 percent; lumbar MRI rate by 23.4 percent; and sinus CT rate by 26.8 percent.”

How does the CEO Checklist resonate with your experience as a leader?