Q&A with Joseph Guarisco

Dr. Joseph Guarisco is chairman of the Department of Emergency Medicine and the system chief of emergency services for Ochsner Health System in New Orleans. He will be giving his keynote presentation at the Healthcare Systems Process Improvement Conference on Sunday, March 3, 2013, from 3:15 p.m. to 4:30 p.m.

What is the most pervasive issue or challenge in health systems management today?

I’m pretty fortunate at Ochsner because we have incredible depth of leadership development here. We meet regularly. We have a fairly tight network, and we try to stay on top of healthcare issues. But all of us will experience increasing financial troubles unless we figure out how to do more about waste reduction, how to do more than we’re doing with less. And so it’s a big topic. It’s something we talk about almost every day. … The question is have we priced ourselves out of good healthcare. And my angle with [my presentation] would be to figure out how SHS could help us. That’s how I originally came to SHS because I thought, “Here’s where the engineers are.”

So I think it’s engineering waste out of the system so that we can do more. I look around at emergency medicine in the country and everyone’s spinning hard, working as hard as they can, and we still can’t deliver on quality and service like we think because we’ve priced ourselves out of delivering good quality and good service. And the answer comes from re-engineering how we do our work. And to me that’s the hottest topic. We’re on top of that right now. It’s almost a buzzword in waste reduction. But it’s really about lean and about more efficiency. And that’s what I’ve been doing here. That’s why we’ve redesigned our EDs, and that’s what we go around the country doing. Waste reduction is a big issue.

Based on all the awards you and your group have received, it looks like you’ve had a lot of success with these methods.

We are – we’ve had lots of success. [Hurricane] Katrina kind of caused us to double-up and focus even more on this because we were one of only a few hospitals left standing in New Orleans, and we really had a huge supply/demand imbalance and had to figure out how to do more than we were doing faster and more efficiently. So we’re on it. In fact, [we were just talking about how to continue] to tweak what we’re doing to meet demand. We’re the fastest growing healthcare system in the South right now, and the challenge is just continuing to figure out how to do as much as we can.

What do you plan to discuss in your keynote presentation?

SHS was the first major group that came back to New Orleans after Katrina, the first ones in early 2006, and I remember that someone took a risk on the city and said we’re going to go back there and we’re going to have our conference there. So I was thinking about tying in my orientation with SHS and IIE and how, from that, I was able to network with some really key people at Banner, [and] we put together a game-changing approach to how people deliver care in emergency departments from a single SHS [conference presentation]. It came out of this burning platform to do something more after Katrina. So there’s a tie-in to my experience with the organization and what we’ve done in a small way and how to take that into a larger concept of bigger scope.

The American public has had enough. They’re not going to pay a dime more for healthcare. Yet we’re still stretching to deliver on service and quality. Whether it’s airlines, whether it’s Starbucks, whether it’s GE or Best Buy, there are a lot of people delivering really great service. And if we’re going to get to the same standards of quality and service that lots of other industry has gotten to, and yet there’s not a dime more to be found, where’s that going to come from? It’s got to come from IIE and SHS, people like that who understand how to produce more efficiently. I’d like to inspire them on that level.

We’re going to have to figure this out. The old traditional thing where patients got in their cars and drove to the hospital and waited in line to register and waited to see their doctor and the doctor saw them physically … That’s got to go. We’re going to have to figure out technological ways to [deliver care]. How do we actually take care of 10 diabetics at one time virtually and re-engineer conceptually exactly what is a visit? Unless we do that, there’s just no way the old thing works anymore.

There’s too much variance. We’re on a path to reduce variance, in terms of treatment, and again a lot of this comes from engineering and standardizing work flows and approaches. All that variance has to leave. In the old days when physicians could practice in any kind of way they wanted and any kind of fashion without regard to the impact on cost and quality and service – that’s just not there anymore. It’s really an engineering solution.

What would you like attendees to take away from your presentation?

What I would want them to leave with is a sense of urgency that we have reached a critical point in healthcare where unless we begin to re-engineer how we deliver care … those who don’t aren’t going to make it. And the work of doing that is really in the sphere of IIE and organizations like that. So my goal would be to create that sense of urgency, create the sense of opportunity and that they’re in a unique position to do that work. I think that’s where the answers are coming. A whole bunch of purely medical things are important out there, but the real game changer in healthcare is the work that the society can do in key positions in healthcare. I’d like for them to leave with the sense of importance, the opportunity, the urgency, and with some practical insights into what’s been done and what’s being done along those lines.

We have now 10 engineers on staff here at Ochsner purely because of my chance opportunity to go to the SHS conference. I left there and we put a program together because I was so inspired by the opportunities. So I’d like to leave them with those things. I’d like to leave them inspired. They may not know it, but [the SHS Conference] in 2006 and the work that’s been done as a result of that has changed the way emergency medicine is practiced around the nation. They may not know the impact they’ve already had.

For more information about Guarisco and the other conference keynote speaker, go to the Keynote Speakers Web page.

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