From live chat on 7/29/09:

From live chat on 7/29/09:

"Your success at Southwest was in context of a single company with a compelling vision and culture. Health care with competing/conflicting interests is a different challenge. How can those entrenched silos be overcome to achieve high performance?"

Airlines actually have many of the same challenges that we find in healthcare -- fragmentation between pilots, flight attendants, mechanics and so on is similar to the fragmentation we find between doctors, nurses, therapists. Airlines are also in the middle of fairly complex supply networks. So my point is, what SWA has achieved is no small feat and is in fact relevant to the healthcare industry. I've shown in High Performance Healthcare that hospitals can achieve better outcomes for patients more efficiently by increasing relational coordination across functional and organization boundaries -- achieving this is not rocket science but it does require implementing a set of work practices that fundamentally change the way providers relate to each other.

"Healthcare has to ride mobile phones...an efficient and affordable solution, even if not 100% effective. I think Southwest is a cost and route optimized model. That applies only to those hospitals that have high overheads. Your views, Jody?"

SWA does optimize on costs and routes, certainly, but its lessons are not applicable only to hospitals with high overheads. Its success at achieving high reliability at low cost is driven by cross functional and cross organizational coordination – spanning across the boundaries that typically divide pilots, mechanics, ground crews and so on. Any organization whose core work processes are highly interdependent, uncertain and time constrained can push out its production possibilities frontier by increasing relational coordination. Both the SWA Way and High Performance Healthcare provide frameworks for how to do that...

"What features of the current health reforms being proposed do you think will be successful?"

My work focuses on managing organizations effectively, not on creating new policies -- but the two are obviously connected, especially in the healthcare industry! I show how our fragmented healthcare system stands to gain from increasing coordination across functions and across organizations. Many of these steps must be taken by healthcare leaders in partnership with their care providers, but there is clearly a supporting role for policy.

Some of the most promising features of current reform efforts in my view are
1) Funding IT upgrades that can improve the sharing of information among care providers and
2) Designing payments that incentivize and reward care providers for coordinating care across the continuum.

Neither of these policies will work on their own. It's still critical for healthcare leaders to partner with care providers to make the necessary internal changes. But these policies are steps in the right direction.

"I've been offering cash health services for 10 years. How do you think these services will be effected if the proposed government plan is approved?"

I don't know! Seems way beyond the scope of High Performance Healthcare.

"Jody, what do you mean when you say high performance healthcare?"

As I define in chapter 1 of the book, high performance healthcare is healthcare delivered with quality clinical outcomes, high levels of patient satisfaction, and without wasting resources.