Posted by: knightbird | May 31, 2011

This Sounds Harsh

As I continue to attempt fostering a performance improvement revolution in the Alaska Native Tribal Health System, I have tried to describe the current state. It came out like this:

The Alaska Tribal Health System (ATHS) is considered underfunded, is not well managed, is administratively top heavy and predominately practices reactive, symptom specific medicine. It is staffed by talented and well meaning people, but overall turnover is high. Coordination among the various components of the ATHS is poor. There are shortages of medical staff in some disciplines, particularly in rural Alaska. Technology is spreading, but at a very slow pace. Negative health outcomes for Alaska Natives have either been static, or are increasing. Costs of governance are extremely high given the plethora of system crises, and the substantial number of national and statewide meetings with multiple staff present.

At Chugachmiut, we accept that “Problems are Treasures” and have no problems describing a current state as we see it, factually and non-judgmentally. We happen to have a different lens than other organizations. Unless we recognize our faults, we cannot fix them. However, bringing this kind of assessment to non Lean managed organizations causes problems. Humans seem to place the best possible spin on what they are involved in. How do we present harsh assessments with the potential for improvement that lean represents?

The facts demonstrate that, for the most part, we do not have a good health system in the United States. Yes, we do amazing things in medicine—things that were not  possible just a decade or 2 ago. Yet the evidence is solid that we cause great harm through our medical care system. “To Err is Human,” released in 1999, estimated that as many as 98,000 Americans died as a result of medical errors. [i] The United States consistently ranks low among industrialized nations on a wide range of indicators, with at least one estimate that Doctors are the 3rd leading cause of death in the US. [ii] And behavioral sources of medical issues are barely acknowledged in our healthcare system. Most of our top health risk factors are behavioral, with 7 of the 9 leading causes of death consisting of significant behavioral components. [iii] Lean Healthcare practitioners estimate considerable gains available through adopting a lean culture. [iv]

I struggle constantly with how to present negative information to an audience that predictably reacts by rejecting it. Yet until we learn to accept that problems are all around us, the really incredible improvements in outcomes are not achievable.


[i] Kohn LT, Corrigan JM, Donaldson M, eds. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 1999.

[ii] Starfield, Barbara. Is US Healthcare Really the Best in the World? JAMA: The Journal of the American Medical Association, Vol. 284, No. 4. (26 July 2000), pp. 483-485.

[iii] Levant, Ronald F. Washington Update: 21st Century Psychology: Toward a Biopsychosocial Model. http://www.drronaldlevant.com/articles.html (2004)

[iv] Berwick, Donald M., “Crossing the boundary: changing mental models in the service of improvement,” International Journal for Quality in Health Care, Volume 10, Number 5: pp. 435-441, 436

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