International Quality Symposium.

Field experts meet in Palermo to show how better care at lower costs is feasible.

Improving patient care while saving money: this will be the topic of the 2nd Annual International Quality Symposium organized by ISMETT and UPMC, held today in Palermo at Palazzo dei Normanni. An ambitious though crucial goal of cutting wastes without hindering patient care but, on the contrary, improving the offered services. The method, known as Lean Six Sigma, was developed in the industrial business to eliminate waste and reduce errors in processes and activities. In recent years, however, efforts have been made to transfer Lean Six Sigma in health care and this will be the main focus of the Symposium.

The Lean Six Sigma method is well-known in the United States. “At Virginia Mason Institute, we have been implementing this method for the past two decades in all departments: from administration to surgery units and emergency rooms,” says Henry Otero, one of the world’s leading experts who has travelled to Palermo to teach this method. “We have reached some extremely interesting outcomes: eliminating distracting elements so that nurses can spend 90% of their time at the patient’s bedside, improving the clinical path for physicians, nurses and staff to complete their daily tasks on time, reducing patient waiting times at the ER, eliminating defects in post-op thromboembolism prophylaxis implementing error correction strategies. The most important outcome is to constantly and continuously improve patient satisfaction.”

Eliminating waste also has a positive impact on the quality of patient care. “Although we have never directly measured such data, the improvement in patients’ health is evident from reduced readmission rates and infection prevention,” says Eric Bakow (UPMC). “For example, within the scope of the Prescription for Wellness program, patients willing to quit smoking, lose weight, or improve their diabetes therapy can be referred by their physician to a clinical coach. Thanks to Lean Six Sigma projects, the number of patients referred to this program has significantly increased: this data can be interpreted as an important advantage for the patients’ health.”

Does Mr. Bakow think this model can be enforced in Italy? “I approached projects in Italy assuming that data-driven decision-making processes will become the normal standard, and that our patients will benefit from this entire process. At the end of the day, this is the reason we’re here today.”

According to data of the WHO, between 20% and 40% of health care expenditure worldwide represents a waste caused by an inefficient use of the resources. Although according to a study carried out by Bloomberg in 2018 the Italian NHS ranked fourth in the world for efficiency, there is still space to improve, as we know very well: from long waiting times to wrong diagnoses, incorrect prescriptions and medical errors. The key topic is listening to patients: “When we started, we thought we knew what patients wanted and what they needed,” says Dr. Otero. “Then we understood we were wrong. Today we include patients in all stages of process design and in our shared decision-making model. I believe health care can only be truly innovated by organizations that include patients as equal partners.”

Some of these approaches to improve efficacy and efficiency are already in place at ISMETT. During the Symposium one of the top three Lean projects submitted by ISMETT employees will be awarded. The three selected projects focus respectively on an antifungal stewardship program on appropriate prescription, consumption, and costs of anti-mycotic drugs; appropriate prescription of urine culture tests; digital management of the radiology storeroom. All projects identify and eliminate tasks with added value, streamlining processes and improving efficiency.

Errors are in fact often not caused by doing too little, but by doing too much. This was highlighted by the Choosing Wisely project that has arrived in Italy and that Sicily has recently embraced. The mission of Choosing Wisely, supported by the scientific societies, is to avoid unnecessary and unsupported diagnosis and care that affect the health of citizens and have a negative impact on economy.