Keys to Process Improvement

"We need new American models [for healthcare]," she said. "We decided to become one of those models. The critical role of leadership in this journey is that we have to create the vision, find the path, learn and teach the path, create a structure, walk the path, measure performance and provide feedback, and create transparency."

She and her team have learned that transparency is perhaps the key to the successes the organization has achieved over the past several years in performance improvement, but Gabow said the business realities of operating a safety-net hospital gave them a sense of urgency that got them started along the process improvement path much sooner than others.

They started by consulting with recognized leaders in efficiency from other industries and learning how they achieved their success. In most cases, it came from constant reassessment and goal-setting involving process improvement. Denver Health process improvement staff visited Federal Express in Memphis, and Dell Computer in Round Rock, TX, among other site visits, to learn.

"Our patients aren't packages," she said. "But we realized that if we knew as much about our patients as FedEx does about their packages, we'd be delivering great care."

Denver Health provides care for 170,000 people, about one in three of those who live in Denver. More than 37% of the city's babies are born there, and 40% of its children get their care there. During the recent recession, the system went from providing $362 million in uncompensated care in 2009 to $388 million in 2010. It was projecting a number in excess of $400 million for 2011.