What You Need to Know about Heart Attacks, Rocket Science, and Process Improvement

Friday’s New York Times article,  A Sea Change in Treating Heart Attacks, is a great example of dramatically improving results, not because of subject matter expertise, but because of attention to process. Heart attack death rates have dropped 38% in a decade. Several surgeons surrounding patient on operation table during their workAnd that number probably under reports the real success due to changing demographics and increasing numbers of diabetic, obese, and other high risk patients.

The improvement is not the result of new medical techniques. Doctors still remove blockages using a catheter, tiny balloon, and stent. What’s different is speed. The longer a blockage remains in place, the more damage is done to the heart and the more likely the patient is to die. Typical times between emergency calls and blockage removal have dropped from as much as two hours to under 60 minutes. At one hospital, that interval was cut from more than 150 minutes to 57. Some hospitals are now under 50 minutes. This is progress easily measured in lives saved.

In hindsight, the changes seem simple and obvious. So simple you may think there is nothing your business could learn from them. I challenge that. Here is what you can learn.

1. People were dying and too many health care providers were thinking “that’s just the way it goes.” 

The first critical step to improvement is deciding the status quo isn’t good enough. If change is important, you can’t tolerate attitudes of  “that’s just the way things go.” When employees say something like “we’ve never been able to change that,” you have to feel challenged, not acquiescent. The only framed certificate I saved from my corporate life was “Most likely to dispute recognized authority.” I received this for challenging the conclusions and opinions of experts from places like Harvard and Yale. It was the Yale-New Haven Hospital that had among the slowest times for treating heart attacks for years. How many recognized authorities in the health care profession just accepted the status quo before these improvements began? How many lives would have been saved if someone had challenged them sooner? Don’t let your employees trample opportunity and enthusiasm with often repeated and inaccurate assumptions.

2. Door to balloon time was the critical metric

The second critical step to improvement is to identify a key metric, preferably a simple, easily measured metric. In this case, it was D2B – door to balloon time. The shorter that interval, the greater the chance of survival. This metric is not only the critical interval, it is also easily measured, understood, and compared, all of which increased visibility, understanding, and healthy competition. Without a clear goal like D2B, improvement will be slow at best.

3. Attention to process, not rocket science, is often the difference maker

When you look at the changes that reduced D2B by as much as two thirds you won’t see anything very earth shattering:

  • Have the paramedics do an electrocardiogram upon arrival and transmit it to the hospital right away so the diagnosis beats the ambulance to the ER.
  • Establish a separate phone line  just for paramedic calls to prevent delays and make it obvious that a heart attack patient is en route.
  • Give ER doctors the authority to call a specialist directly without intervening consultations and referrals.
  • Page the entire heart attack team with a single call instead of calling each one individually.
  • Ensure the entire team is on call and within 30 minutes of the hospital when on call.
  • Replace intake forms with minimal data collection: name, birthdate, social security number.
  • Swarm the patient with a team that begins prep work immediately upon arrival and provides everything from defibrillators to shaving.
  • Keep treatment space open and stocked with everything you need to treat heart attacks.

You wouldn’t have to be a health care expert to propose these changes. You just need to look carefully at what is and isn’t happening and how speed is affected. Prior to hiring me, many of my best clients have asked about my expertise in their industry. My answer is always the same. They have plenty of experts in their industry. What they need is clarity and attention to process.

Dramatic improvements are within your reach if you:

  • Are clear about your objectives and how you can measure progress and success
  • Are willing and determined to challenge the status quo
  • Attend to the process from end to end

Where in your organization does the status quo need to be shaken up today?

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