Posts Tagged healthcare

Hidden Healthcare Capacity — learn from lean manufacturing

conveyorbeltHealthcare in the past has shunned “conveyor-belt” surgery, “cookie cutter” treatments and “cookbook medicine”.  But, the disdain for efficiency, as honed by manufacturing, has put the spotlight on medicine and surgery as very inefficient with a huge hidden or wasted capacity.  Patients and healthcare providers are asking for the training of more healthcare professionals — they can’t manage the wave of baby-boomers needing care or the influx of new patients using the methods of the past.   So, let’s not use the methods of the past, it’s time to learn from industry, from Toyota, from Ford.
The key principle is “lean” —  definition of Lean, as developed by the National Institute of Standards and Technology Manufacturing Extension Partnership’s Lean Network:

“A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection.” 

Here is a translation for healthcare:

“A systematic approach to identifying and eliminating waste through continuous improvement, providing health care as needed by the patient in pursuit of perfection.”

 Here are the 8 “wastes” to be eliminated, as might be applied to a medical office:

  • Overproduction — From a medical office standpoint this is excess staff at certain times — indicated by an appointment schedule that is not full.  Staffing must be adjusted to patient load.
  • Waiting — Patients waiting for appointments, providers waiting for test results.  Ideally the when patient arrives  the provider is ready to begin.  Needs to be monitored with visual controls all the time.  Solving patient problems on the phone prevents clogging the system with unnecessary visits and reduces excess inventory.
  • Transportation — equipment (like gowns and syringes) need to be at the point of use not transported around the office.
  • Non-Value-Added-Processing (reworking) — having to review patient data because the problem was not resolved initially.  Sometimes multiple workers collecting the same information (very common when patients are admitted to the hospital) And, excessive medical documentation, a common problem with speech to text systems.
  • Excess Inventory —  No room in the appointment schedule because it is all filled up, patients want to be seen but no staff are available.  Represents a failure to hire adequate providers and staff.  Larger organizations are better able to make staff flexible, like sending them to a branch office if several staff are missing due to vacations or illness.
  • Defects (do it right the first time) — Following evidence based guidelines and using checklists reduces error in treatment and diagnosis.  Errors may result in legal action.  But, less severe errors end up requiring correction or at least explanation.
  • Excess Motion (poor workflow and documentation) A huge problem.  If offices don’t have labs, x-ray, a pharmacy, physical therapy, and commonly needed specialists it causes wasted patient and staff time.
  • Underutilized People — offices don’t often let nurses or scheduling departments make common sense changes.  Small offices fail to hire computer consultants or patient educators.

Much of the waste currently is due to lack of scale for many providers — they just don’t have big enough facilities.  Also, on a larger scale many towns have excess capacity in certain specialties.  Like supporting one neurosurgeon when all the neurosurgery should be done at a regional center to keep the providers busy and competent.  Likewise, not every hospital should be a high level trauma center.  Not every town or hospital needs a cancer treatment center.

Simply treating more patients over the phone is probably the greatest method to find hidden capacity.  If a visit is just to consider a blood sugar record that can be done without an office visit.  The second best efficiency boost is to incorporate NPs and PAs as team members.  Third, a high functioning computer record helps to prevent reworking and reduces excess motion.  Above all, constant monitoring of efficiency and quality with continuous improvement is essential.

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5% of Patients, 50% of Cost — where to focus

EmergencySocialThe U.S. spends more than other countries for health care but the outcome is not as good as other countries.  Why?  Many feel it is a failure to respond to the statistic that 5% of patients consume 50% of health care spending.  And, those 5% are often at the bottom of the socioeconomic ladder — either they started at the bottom or drifted to the bottom because of health problems.  See the recent article in Manage Care Magazine.

The health care solutions for the top 95% don’t work for the bottom 5% — because the 5% are not well educated, have unreliable transportation, no phone, smoke cigarettes, and only have part-time jobs.  No matter how much research is done on new drugs and surgical robots if a patient does not have transportation to a health care provider it is money down the drain.

Face the facts:  Sweden spends more money on social services than health care.  The result:  infant mortality rate in Sweden is 1/6 th of the rate in the U.S.   Overall, Sweden spends less on health care and delivers much better results.

Here are the 2009 statistics from the Organization for Economic Cooperation and Development (OECD):



Countries with much higher health care quality (like the UK and France) spend at least twice the amount per person for social service as in the U.S.  The fragmented U.S. healthcare system fails to FOCUS on obvious problems — social service seems to be a lens to sharpen that focus.  It’s easy to see the return on investment for the system when social service provides transportation, navigation through difficult medical situations, health education, home vaccinations, and frequent contacts with pregnant women when needed.  Health care without social service is like building a house without one of the walls — looks great from one side only!

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What Can You Do For Healthcare?

jfkAsk not what healthcare can do for you .. ask what you can do for healthcare.  The US healthcare system is in trouble — doctors don’t listen to patients and charge too much, there is an increasing shortage of healthcare providers, waiting lists are longer, hospitals often give patients infections rather than prevent them, insurance companies extract high profit and they pay CEOs millions of dollars without much patient benefit.

Yet in this environment patients ask for more engagement with providers (meaning more face time), ask for more informed choices (meaning more education),  ask for lower price  insurance (meaning congressional action), and ask for shorter waiting times (meaning expanding the healthcare workforce).  ASK…ASK…ASK.

There is no question the US system needs change and there is no question people are not getting the attention they need.

So what can people do?  Perhaps you have some answers to the question.  Here are a few suggestions:

  • volunteer to help others figure out medical bills
  • volunteer to help in doctors’ offices pass out educational materials
  • be outspoken if healthcare workers fail to use alcohol hand gel before visits
  • volunteer to be on quality assurance committees in doctors offices and in hospitals
  • volunteer to do Internet searches to find health information for friends and relatives
  • volunteer to take people who don’t drive to health care appointments
  • don’t go to doctor appointments unprepared — have your records and test results in hand.
  • send messages to your congressmen any time you experience long waiting times, high drug costs, complexity of health insurance, or high prices of medical devices.  If you don’t get results don’t vote for them again.

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U.S. Health Care Report Card — failing grade

age lt 50 cause of death

The above graph is from a recent publication of the Institute of Medicine entitled  “U.S. Health in International Perspective: Shorter Lives, Poorer Health (2013)”.  The graph depicts the causes of death for males less than 50 years old.    Compared to other wealthy countries the U.S. life-expectancy ranks 17th for men and 16th for women  According to the report “The tragedy is not that the U.S. is losing a contest with other countries, but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”  Several causes were cited  including lack of insurance, lack of access to primary care, high poverty rate, poor diet, lack of exercise and use of firearms in acts of violence.

Although the report is blunt enough the bottom line is we have good doctors, good nurses, good medications, good equipment, good hospitals, and good clinics but we have poor management of our health care system.   The equation is:

Good Providers + Bad Management = Bad Health Care

You may ask:  what is health care management?  In a word a “PLAN” or simply coordination of action — we truly do not have a health care system.  We have a variety of types of insurance, government programs and fee for service (i.e. no money no service).  Even the very wealthy get poor health care because of a lack of quality management.   Some States do much better than others.  If Minnesota was a country it would rank near the top.  If Louisiana was a country it would be a third world country ranked near the bottom.

One of the big political concerns is cost.  We pay more for health care than any other country.  One third of our cost is attributed to waste (i.e. paperwork).  When a system is poorly coordinated the cost is high.  So, why would any country spend more money on such a system?

The above report is just another in a long series of bad reports on U.S. health care.  Although the Affordable Care Act (Obama Care) is helpful it will never move life expectancy to the top of the list.

There are lots of solutions.  But, they all require planning and system thinking.  Trying to solve one problem at a time to evolve a better system will take about as long as human evolution.  Perhaps in a million years we will have evolved beyond illness — yes, that’s the plan.

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