Redesigning Clinical Workflows to Return Joy to Patient Care
The Iron Triangle of Healthcare

Tag Archives: Engagement

The Iron Triangle of Healthcare

Have you heard of the Iron Triangle of Healthcare? It’s more familiar expression is “Quality, access, and cost: Pick any two.” The baseline assumption in the Iron Triangle is that in healthcare, due to limited resources, we can’t improve quality, increase access, and reduce cost simultaneously. One of the three has to suffer in order to improve the other two.

On a recently posted Red Hot Healthcare podcast, Dr. Steve Ambrose discusses disruption in healthcare with Dr. Stephen Klasko, President and CEO of the Jefferson Health System. They talk about the Iron Triangle, a concept that first was introduced by Dr. William Kissick in 1994.  Dr. Klasko has actively promoted disruption of traditional care delivery. He explains that way to improve all three components of the Iron Triangle is through innovation and disruption of current health care delivery.

Disruptive Innovation in Healthcare

Dr. K has initiated a number of such disruptions, including

  • merging with community health systems in a way that does not put them in a position of less power,
  • developing a simulation center to test physicians’ procedural skills to ensure ongoing competency,
  • doing neurosurgery post-op visits using telehealth and sparing patients the significant inconveniences of coming to a medical school clinic for a 10 minute appointment.

I think he’s right, well partly right. My concern with most disruption in healthcare is that it is implemented into our currently dysfunctional workflows without adequate understanding of the full impact on health care workers, particularly doctors and nurses. Don’t get me wrong, I’m pro-disruption and innovation. We absolutely need to innovate care delivery.

Overcoming the Iron Triangle

There is another way to improve all three components of the Iron Triangle – Lean. Lean done right empowers front line clinicians (doctors and nurses) to:

  • remove waste and improve practice efficiency (cost)
  • hardwire quality and safety procedures (quality), and
  • increase capacity with current levels of resources (access)

Combined together, disruptive innovation and Lean can synergize to produce results greater than the simple sum of the two.

We can achieve the Quadruple Aim and thwart the constraints of the Iron Triangle.  Healthcare leaders who understand this, and pursue both innovation and Lean in their organizations, will succeed while others struggle to survive.

Are you pursuing disruptive innovation and Lean in your organization?

  • If so, please share a comment about how it’s going and what you’ve learned.
  • If not, please share why not. I suspect you have some good reasons. I’d like to understand why so few organizations are pursuing such change.
Management Malpractice

Have you witnessed cases of management malpractice? Hold on, don’t answer just yet. Before you answer “Yes” or “No”, you need to have a definition of the term. I define management malpractice along the same lines as medical malpractice. As a doctor, if I do something that harms a person under my care, and I… Continue Reading

Are you in a supporting or reporting relationship?

What is your reporting relationship at work? Do you have people that report up to you? Do you report up to someone else? You likely answered “yes” to one or both of these questions. (If you didn’t, you must own your own business as a sole proprietor.) The nature of these reporting relationships is important.… Continue Reading

Eliminate frustrations to prevent physician burnout

Does your work to reduce physician burnout include work to eliminate frustrations? This week I was working with a health system that is committed to reducing physician burnout. I had a number of meetings, including one with the medical group dyad leadership team. This team includes physician leaders and their administrative partners at the manager,… Continue Reading

Sharpening the Saw to Prevent Burnout

I hear it all the time, “Doctors don’t have time for huddles or improvement events!” Really??? Have you heard the story of “Sharpening the Saw“? It stresses the importance of taking the time to ensure your tools are at working as well as possible, so that you can be most effective in your work. It’s… Continue Reading

Explaining Lean in Healthcare

One of the more frequent challenges I have is succinctly explaining Lean in Healthcare. May people are either unfamiliar with it, or worse, have had a bad experience with “Lean” – usually done the wrong way. This latter issue is such a problem that in our book, Preventing Physician Burnout, my co-author Diane Shannon and… Continue Reading

The Front Lines of Care – What’s Keeping Leaders Away?

Why don’t leaders spend much time at the front lines of care (FLOC)? Why don’t they Go to the Gemba? In this post I’m not asking a rhetorical question to tee up a few paragraphs of my thoughts on the subject. I’d like you to share your thoughts, because it’s something that many of us… Continue Reading

Want Physician Engagement? Engage with Physicians!

“How’s your physician engagement?” I’m directing this question to hospital and health system leaders, because they often as for someone like me to help them with it. I’ve been asked many times by the C-suite to help them get their doctors engaged in Lean or other forms of process improvement. What I commonly find is… Continue Reading

Resilience or Redesign: What Are You Doing About Burnout?

A question for healthcare executives – are you addressing physician burnout by investing in resilience or redesign? Same question for physicians – are you addressing burnout for you and your colleagues by investing in resilience or redesign? While most work on physician burnout still focuses on resilience, there is an increasing, and much needed, focus… Continue Reading

The Lean Lifestyle, Personally and Professionally

There are surprising similarities between getting Lean personally (losing weight) and getting Lean organizationally. Both are hard to get started, take a while to show significant results, and require personal change sustained over time. The benefits of both are also significant. Continue Reading

Executives – The Missing Stakeholders in Preventing Burnout

The National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, but there is one missing stakeholder.  Last Friday, July 14th, NAM hosted it’s its first public meeting on establishing clinician well-being as a national priority. The inaugural sponsors include nearly many medical specialty societies, the major insurance companies, the American Associations… Continue Reading