Dr. Brent James and Continuous Quality Improvement at Intermountain Healthcare

There is an absolutely wonderful article on Intermountain Healthcare’s approach to healthcare delivery by David Leonhardt in yesterday’s New York Times Magazine, which you can read here. We have mentioned Intermountain Healthcare in this blog before, and my colleagues and I interviewed one of Intermountain’s leaders for our weekly publication earlier in the year, so the details of Intermountain’s approach were not new to us, but the author presents a thoughtful consideration of other points of view, highlighting the difficulties of convincing doctors to adopt Intermountain’s approach.

Spearheaded by Dr. Brent James, Intermountain approaches quality in healthcare delivery much the same way that Toyota approaches quality manufacturing. It seeks to reduce variation in the way that its doctors treat patients who present with the same medical condition and then continuously refines its treatment protocols in a drive to improve patient outcomes. One criticism of this approach is that, unlike automobiles, each patient is unique, so a one-size-fits-all approach may result in some patients receiving sub-optimal care. Intermountain, however, recognizes that some patients may require deviations from the standard protocol. In Intermountain’s view, it is in precisely the ability to identify those cases that a physician’s experience and training are the most valuable. As Dr. John Wennberg and his colleagues at Dartmouth have repeatedly shown, however, unwarranted variations in physician treatment practices go a long way in explaining the high cost and poor quality of healthcare delivered in much of the US healthcare system.

One of the keys to Intermountain’s approach is being able to measure results, which is made possible by its electronic medical record (EMR) system. That is one reason why the Obama administration has placed so much emphasis on initiatives to have hospitals and physicians adopt EMRs. Adopting EMRs without changing the way medicine is practiced will not improve quality, but being able to track outcomes through EMRs could be a very important step, providing the foundation of evidence to help convince doctors to adopt best practices.