Thursday, May 17, 2012

Focus and Leverage Part 112

As promised in my last blog posting, I’m going to start a series of postings on continuous improvement in the healthcare field.  I’m also going to be sharing excerpts from a remarkable new book entitled, Performance Improvement for Healthcare – Leading Change with Lean, Six Sigma and Constraints Management written by Bahadir Inozu, PH. D., Dan Chauncey, Vickie Kamataris and Charles Mount.  These four authors have combined their writing talents, knowledge and experience base to create what I’m convinced with become a classic.  I hope you like this series and even more, I hope you will seek out this book and share all it has to offer. I think the best way to begin this series of posting is to share some quotes directly from the opening chapter of this book. 

 “Even though we are at the forefront of the most advanced ability to heal, a great many people are deprived of the best of care either because they cannot afford it or because they are otherwise denied access to treatment. This book is not about the social aspects of that state but about what every healthcare leader and his or her organization can do to make healthcare more available, more affordable, with better outcomes . . . and yes, if desired, more profitable.”

“The United States spends more on healthcare than any other nation in the world, yet 50.7 million people in the United States have no health coverage. In 2008, $7,681 was spent for every U.S. resident on healthcare, some $2.3 trillion, as reported by the Centers for Medicare and Medicaid Services, yet the average life expectancy in the United States is shorter than that in many developed and developing nations. In a study of the healthcare systems of seven industrialized countries, the Commonwealth Fund ranked the U.S. healthcare system as the most costly, spending almost twice as much per capita than average.  How can this be?”

“The healthcare system in the United States is in shambles. Emergency departments are overflowing with the uninsured. There is a shortage of primary care providers driven by lifestyle and reimbursement pressures and a rush to specialize. The Affordable Care Act could extend health insurance coverage to 32 million uninsured U.S. citizens.  There are fears that there won’t be enough doctors to treat the newly insured because the United States could face a deficit of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. Like doctors, nurses have been working more overtime and take care of more and more patients, leading to the exit of experienced nurses from the profession because of burnout and exhaustion. Forty percent of practicing nurses are 50 years old or older. In the journal Health Affairs, Rother and Lavizzo-Mourey project that within the next 15 years, the U.S. nursing shortage will reach a shortfall of 260,000 registered nurses. Dedicated physicians and nurses are already working against impossible odds to achieve improbable results. How will care be provided to this expanding population of patients?  The answer is not by working harder.”

“The United States has more modern hospitals, more skilled physicians, more specialists, and more professional nurses than any other nation in the world. Most of the advances in healthcare technology, pharmacology, and medical science have originated in the United States. Applicants to medical schools in the United States compete with applicants from other nations seeking the world’s best medical education. The American Recovery and Reinvestment Act (ARRA) of 2009 allocated about $30 billion to develop a national health information technology (IT) infrastructure. Yet the expected return on investment in technology, unlike advances in pharmacology and medical science, has not been fully realized. In the book Curing Health Care: New Strategies for Quality Improvement, Dr. Donald Berwick and colleagues wrote, “[T]ens of billions of dollars have gone into IT systems in healthcare, . . . but patients and care providers have very little to show for it.”  The answer is not by spending more.”

“If working harder and spending more is not the answer, what is? Healthcare systems are full of waste and experience an enormous amount of variation and many preventable mistakes. Furthermore, constraints and bottlenecks need careful management to get the most value for the money spent. The ailments of healthcare today are comorbid. Hence a direct, concentrated triage of the system is needed.”

“Other afflicted industries have found effective remedies for similar challenges. While acknowledging the uniqueness of humans and the complexity of healthcare delivery, three industrially based methodologies have been applied successfully in healthcare systems worldwide to achieve dramatic results. These are:
 
1.      Lean—a systematic approach to eliminate waste
2.    Six Sigma—a rigorous, data-driven process to reduce variation and eradicate defects
 
3.    Constraints Management—a breakthrough methodology to focus efforts and manage a system’s bottlenecks and other constraints.”

And so this is the prelude for a series of postings I want to deliver on one of the most important problems facing our country today…..how to make healthcare more affordable.  As stated in the beginning of this posting, I will not be delving into the social and political aspects of this subject simply because this is a subject that equally impacts Republicans, Democrats and Independents all over this great country.  My focus will simply be one of relating, through the eyes of these authors, how we can improve the “state of the business” so to speak in the healthcare industry which is the primary reason this book was written.

Bob Sproull

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