The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Organizational Fibrillation: Studying the Cause of Organizational Malaise

By Robert Sutter/Monday, September 16, 2013
Robert Sutter imageWhen I ask my clients how their performance improvement system is working, they often respond that it’s not working well, and they can't seem to make progress on performance improvement projects. Upon further discussion, it becomes clear that these organizations are afflicted with organizational fibrillation with respect to performance improvement.

When the heart is afflicted with fibrillation, the muscle fibers contract rapidly at their own pace and not in coordination with other muscle fibers. As a result the amount of blood pumped to the body is reduced. In other words, there is a lot of heart activity, but reduced heart output.

Many healthcare organizations are in same state with respect to their performance improvement system; there is a lot of activity, but minimal results. This is typically characterized by more performance improvement projects and other projects, such as tasks, being conducted simultaneously than can be supported by the performance improvement project leaders. Hence, they exist in a state of organizational fibrillation.

The causal factors associated with this condition are the lack of two important components of an effective performance improvement system:
1.    A supportive organizational infrastructure
2.    A systematic approach to performance improvement.

Joseph Juran said it best, "All improvement happens project by project and in no other way." This is the beacon guiding the implementation of an effective performance improvement system and the treatment of organizational fibrillation. It means that the key to improving organizational performance is to successfully execute as many performance improvement projects within a given time frame as possible. In order to achieve this, objective organizational defibrillation is required.

Robert Sutter, RN MBA MHA

Asking the Right Questions about the Necessity of a Cesarean Birth

By Michael R. Udwin/Thursday, July 11, 2013
Michael R. Udwin imageThe HealthLeaders Media article "C-Section Rate Reductions Panned" rightly applauds the drop in cesarean births prior to 39 weeks yet is unable to completely explain why such deliveries have continued to rise after 39 weeks. As suggested in the article, concern about large babies and the over-use of induction may be contributing to this phenomenon. Like so many other challenges facing the healthcare community, the key to changing outcomes rests in asking the right questions. Yes, this does sound like a cliché. But surprisingly, it is not happening often enough.

Those with access to healthcare data are in a unique position to pose and answer the right questions. Such queries could explore the indications for the surgery? How many cases started as inductions? And are these inductions “necessary?”

It is instructive and perhaps not coincidental that early elective deliveries declined as hospital rates were publicly published. This suggests that providers are indeed sensitive to patient perceptions and concerns. With this in mind, it is up to both doctor and expectant parent to not just pose the above questions but also adjust behavior based on the answers.

It is a common refrain in hospitals, “mothers come to have a healthy baby, not to have a natural delivery.” This is indeed true, but it does not preclude ideally doing both whenever possible.

Michael R. Udwin, MD, FACOG
National Medical Director