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

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