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

Tag Archives: Leadership

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.
People Centric Leadership

How much do you know about People Centric Leadership? I’ve learned a lot about it in the three-plus years I’ve been a part of Simpler Consulting. Three years ago, as a newbie to Simpler, I was sent to the Association for Manufacturing Excellence (AME) annual meeting. Having led the first 5 years of Sutter Gould… Continue Reading

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

Toxic Workplaces

Why do we tolerate toxic workplaces? Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaire’s disease spreading through it’s HVAC system, or cryptosporidium in its water supply? When there is a unusual smell associated with headaches and nausea in a surgical unit or emergency department, do… 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

Everything Has to Change

“If you want things to stay the same around here, everything has to change.” Richard Carr, an HR expert and Simpler colleague, shared this quote from The Leopard, written by Giuseppe Tomasi di Lampedusa. As described in this Wikipedia post, as the mid-19th Century Italian historical novel progresses, a prince is forced to choose between… Continue Reading