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

Tag Archives: Value Stream

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.
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

Improving Patient Flow to Improve Wait Times

Dr. Mealy has shown us the link between a problem of access to a physician’s office, and a solution that comes from improving throughput in another location – the operating room. We don’t often make those connections without the help of systems thinking. Continue Reading

Start Your Lean Journey With a Sprint!

“A Lean journey is a marathon, not a sprint.” That’s what our Simpler Sensei reminded us of more than once back in 2010 when we embarked on our Lean journey with the 300 physicians of the Sutter Gould Medical Foundation. (Actually, done right, it’s more like a multi-year trek into the wilderness searching for enlightenment. … Continue Reading

Financial Impact of Physician Work-Life Balance

This posting is for the CFOs. Why should CFOs care about physician work-life balance? It’s common knowledge that physician burnout rates are increasing every year. It’s less common knowledge that satisfaction physicians with their work-life balance(WLB) is decreasing at a faster rate than burnout is increasing. In most professions satisfaction with WLB is increasing. Not… Continue Reading

Breakdown of Community

Breakdown of Community results from the first three drivers of burnout. When people are overloaded, lack control, and receive insufficient reward, they begin to act in ways that protect themselves as individuals. Individual self-protection leads to Breakdown of Community. Continue Reading

Fixing Frustrations at the Front Lines

Here is another in my series of vignettes about health care organizations that are reducing physician burnout, taken from our book Preventing Physician Burnout: Curing the Chaos and Returning Joy to Patient Care. Following my post on Sunday about burnout driver #3 – Insufficient Reward – I’m happy to share this example of Lean providing… Continue Reading

Physician Burnout Driver #3 – Insufficient Reward

Today’s posting takes a deep dive into the third driver of physician burnout – Insufficient Reward.  When most of us think about the reward we receive from work, we first think about compensation.  Most doctors are paid relatively well.  Pay is an extrinsic reward.  Many will argue that what they are paid is not worth… Continue Reading

Lack of Control

Today in my ongoing series on the six drivers of physician burnout we discuss burnout driver number two as identified by Maslach and Leiter in The Truth about Burnout – Lack of Control. In last Sunday’s post we discussed the first driver – Work Overload – which for physicians is exacerbated by a chaotic work environment… Continue Reading