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Recommended posts: Management Improvement in Healthcare - Improving Hospitals Documentary - Going Lean in Health Care - USA Health Care Costs reach 15.3% of GDP
Related: Healthcare management improvement portal - healthcare improvement articles
This is the 1,000th post to the Curious Cat Management Improvement Blog. Here are some highlights:
Information Technology: Toyota IT Overview - “customizing the code, to its business processes, and not the other way around.”
PBS presents a very nice overview of the heath care systems in Japan, United Kingdom, Germany, Taiwan and Switzerland in: Sick Around the World. It is a just a surface view of the overall system but even so does a good job of providing more understanding of the options available to fix the failed system in the USA. The US system costs over 50% more than others and has worse outcome measures than the alternatives (and leaves many without any coverage). And while the alternatives are not perfect the defenders of the status quo make claims about the alternatives are not accurate.
Table combines data from my previous post, International Health Care System Performance, and the PBS website:
| Australia | Canada | Germany | Japan | Netherlands | New Zealand | Switzerland | Taiwan | UK | USA | |
| National health spending - Percent of GDP | 9.5% | 9.8% | 10.7% | 8.0% | 9.2% | 9.0% | 11.6% | 6.3% | 8.3% | 16.0% |
| Percent uninsured | 0 | 0 | <1 | <2 | 0 | 0 | 16 |
Switzerland, spending 11.6% of GDP on health care, is the 2nd most expensive in the world.
Related: USA Spent $2.1 Trillion on Health Care in 2006 - Measuring the Health of Nations (USA ranks 19th of 19 nations studied) - Drug Prices in the USA - USA Health Care Costs 16% of GDP (2006) - Deadly Diseases of Western Management - 5 Million Lives Campaign
In 2005 I posted about some of the problems with drug pricing. It is nice to find at least a couple of people at MIT that want to have MIT focus research on the public good instead of private profit. As I have mentioned too many universities now act like they are for-profit drug or research companies. That is wrong. Drug companies can do so, institutions with purported higher purposes should not be driven to place advancing science below profiting the institution.
The DDC also would serve as a mechanism for prioritizing drugs for development, noted Finkelstein. “It is a two-level program in which scientists and other experts would recommend to decision-makers which kinds of drugs to fund the most. This would insulate development decisions from the political winds,” he said.
I see their idea as one worth trying. Lets see how it works. Their book: Reasonable Rx - Solving the Drug Price Crisis by Stan Finkelstein and Peter Temin
Related: USA Spent $2.1 Trillion on Health Care in 2006 - Measuring the Health of Nations - Antibiotics Too Often Prescribed for Sinus Woes - $600 Million for Basic Biomedical Research - articles on improving the health care system
ValuMetrix Services provides some really nice lean six sigma case studies. Simple short but still with enough detail to actually provide some sense of what is going on.
While on the topic of online case studies let me plug the Curious Cat management improvement library. I think it is one of the more valuable resources for management improvement offered on the Curious Cat sites. Library shelves: health care articles, lean manufacturing articles, six sigma articles, newly added articles…
via: Daily Kaizen
Related: Curious Cat Management Search - Management Consulting, what does the web site show? - Lean Management Case Study
The percent of GDP spent on health care in the USA increased again in 2006 - to 16%. Health care spending reached a total of $2.1 trillion, or $7,026 per person in 2006, up from $6,649 per person in 2005.
Related: USA Healthcare Costs Now 16% of GDP - Measuring the Health of Nations - USA Paying More for Health Care
Measuring the Health of Nations: Updating an Earlier Analysis
Rankings: 1) France 2) Japan 3) Australia 4) Spain 5) Italy 6) Canada… 18) Portugal 19) USA. Maybe the United States is last but still not significantly behind?
It might seem like a stretch to compare the lowest ranked country to the average of the top 3, but, for all those that feel the USA is the best health care system it raises the questions of why they don’t think 100,000 annual deaths is a significant enough problem to lower their opinion of the current system. And remember the USA system costs something like twice as much as the average system: up to 16% of GNP in 2006.
I must say I would rather have the Toyota mindset shown by those talking about the USA health system instead of the claims of how the current USA health system is number 1. In Toyota’s horrible last year they still had a profit of about $14 billion (I believe something like 20 companies have every made that much). The United States health system sure has some things to point to positively but the system seems to be losing ground to the rest of the world more and more quickly while many cling to a belief it is the best system around.
Related: Evidence-based Management - posts on improving health care - Improving Hospital Performance - articles on improvement health care - Best Research University Rankings - Top 10 Manufacturing Countries - Dr. Deming’s Seven Deadly Diseases of Western Management
I am reading a fascinating book by Jessica Snyder Sachs: Good Germs, Bad Germs. From page 108:
This is a great example of a positive special cause. How would you identify this? First you would have to stratify the data. It also shows that sometimes looking at the who is important (the problem is just that we far too often look at who instead of the system so at times some get the idea that it is not ok to stratify data based on who - it is just be careful because we often do that when it is not the right approach and we can get fooled by random variation into thinking there is a cause - see the red bead experiment for an example); that it is possible to stratify the data by person to good effect.
The following 20 pages in the book are littered with very interesting details many of which tie to thinking systemically and the perils of optimizing part of the system (both when considering the system to be one person and also when viewing it as society).
I have recently taken to reading more and more about viruses, bacteria, cells, microbiology etc.: it is fascinating stuff.
Related: Science Books by topic - Data Can’t Lie - Understanding Data
This does a great job of explaining what you need to know clearly. While this presentation for Azithromycin doesn’t prevent a mistake it sure makes it much more likely that the process can be completed successfully. We need more effort in creating such clear instructions.
Visual clarity is more important than lots of words. Applying that concept is not as easy as it sounds but it is a very important idea for instructions to end use and instructions for processes in your organization. Expecting people to read much is just setting yourself up for failure when they don’t bother (you should consider psychology, and how people will actually use your instructions not how you want them to).
via: Prescription UI
Related: Using Design to Reduce Medical Errors - Visual Instructions Example - Visual Work Instructions - Standardized Work Instructions - Health Care Pictographs - 5s - Edward Tufte’s: Envisioning Information
Great article on The Checklist - If something so simple can transform intensive care, what else can it do? by Atul Gawande
Related: Why Isn’t Work Standard? - Visual Work Instructions - posts on quality tools - European Blackout not Human Error-Not
From my post on the Curious Cat Investing and Economics blog: My guess is that traveling for health care is going to increase greatly in the future. Health costs in the USA are enormous. Costs in Europe are different - often in wait time (or costs to avoid waiting) but another option is available - travel. Countries would be very wise to focus on building up this industry in my opinion. The economic benefits could be huge.
The market is huge and growing. And the rich countries do not appear to be doing very well - especially the USA. The country needs to invest in a rigorous system to ensure world class medical care. It is almost certain the first attack will be attempts to frighten customers by saying your country is unsafe…
On this management improvement blog I continue to encourage the USA to improve the health care system. And some great strides are being made. But, Dr. Deming named the excessive health care costs a deadly disease decades ago and it is much worse today. So much so that the odds of avoiding a huge increase in overseas travel for health care is very unlikely in my opinion - even if we make better progress than I expect toward improving the USA health care system. It is an macro-economic problem and not one easily solved in 5 years or 10 years. The results (as long as countries step in to fill the market need - as has been happening) is people will travel to get health care.
Related: USA Paying More for Health Care - Change Health Care - Health Care Crisis
The USA health care system is well known as by the most costly in the world. Most also agree the system provides far from the best results - perhaps great results could justify such high prices but that is not the case (though some still argue this point). Decades ago W. Edwards Deming targeted high health care costs as a deadly disease of the US economy decades ago and the problem has just gotten worse almost every single year since. In the last few year the “good news” is that while health care costs are still rising above the rate of inflation above the growth in the economy the rate of the increases were declining. From the Kaiser Foundation news release:
Luckily some good work is being done but so much more is needed. Seeing figures like these should make people understand this system is broken and needs to be fixed. This has been a known seriously problem for quite a long time. It is very difficult for an economy to sustain such large negative factor in economic performance. Luckily the USA has a strong enough economy to sustain a large negative impact from the health care system (it is also able to overcome: a huge amount of government and consumer borrowing - ludicrasly overpaid senior executives). (more…)
This podcast by Mark Graban with Dr. Sami Bahri, “The World’s First Lean Dentist” is well worth listening to. It offers a wonderful example of how to apply lean ideas (I really appreciate how obvious the focus on learning and thinking has been key to becoming a lean organization). Dr. Bahri does a great job of explaining how he learned and applied lean thinking with a big focus on one patient flow. He worked with Deming’s ideas and TQM… before, in 1993, he really focused on lean thinking in 1993.
It is easier to see this, I believe, when it is not as easy to just copy what some other organization is doing. Trying to copy is never a good idea. Learning the concepts and then applying them to your situation is what is needed. Seeing what others do can be helpful, but you must learn and then adapt the ideas to your organization - copying is not a good idea. Then practicing continuous improvement and use the PDSA improvement cycle.
Related: Going Lean in Health Care - Lean Health Care Works - PBS Documentary: Improving Hospitals - management improvement podcasts
Clare Crawford-Mason produced the 1980 NBC news white paper on W. Edwards Deming that sparked a movement to improve management. She produced the Deming library tapes to help reach those taking steps to improve management and looking for more help. Last year she teamed up with Lloyd Dobbins on a new documentary - Good News - How Hospitals Heal Themselves.
Better Questions, Wiser Answers by Clare Crawford-Mason
One thing more. The doctors and nurses in the successful hospitals frankly say the patient has been lost amidst new technology, regulations, reimbursements, etc. They say the Toyota approach allows the medical staff to spend more time with patients and deliver more effective care. So the solution is not computers or information. It is a new way of seeing and thinking.
I agree. Related: blog posts on the Toyota Production System - articles on improving health care - Fixing Healthcare from the Inside - Change Health Care
Nice short interview of Professor of Emergency Medicine, Matthew Cooke, on lean health care in the UK (via the lean blog). He mentions that applying lean thinking to health care gets rid of wasted time for patient, eliminates errors (by reducing opportunities for error) and staff spends more of their time on direct patient care.
Related: articles on improving the management of health care - Going Lean in Health Care - Documentary of improving hospitals - Simple Solutions That Work - non-value added steps
‘Disillusioned’ surgeon quits UK:
Giving awards can serve to highlight the behavior leadership want to encourage (especially when trying to encourage new behavior the leader often has to make it visible what they value). Taking 6 months for someone to show up and then nothing happening really sends a message on what is valued. Shows of support only are valuable if backed up with actual support. When someone would ask Dr. Deming, I tried to get my organization to do what they should but I did x and y and z… but I can’t make any progress what should I do. He often said: quit. Go work for an organization that will do the right thing. This Doctor adopted that strategy. By the way if you actually go the the article you will see the Doctor says:
Hmm, well I don’t agree with that at all. Oh well, that is the challenge of looking at management ideas in practice, I often see good points mixed in with things I don’t agree with. Via: Doctor who cut waiting times to zero quits - NHS shocker
Related: Change Health Care - UK National Health System Management - Fixing the Health Care System from the Inside - Problems with Bonuses
This study compared only 6 countries and focused more on survey results than I think is best for comparing country health care systems but it is another study pointing to the systemic failure of the USA health system (high costs and poor systemic results). These high health care costs must be born by companies doing business in the USA (given the setup in the USA where health care is tied to employment) burdening them in competition against companies producing (good or services) outside the USA. The poor performance creates huge problems for those living in the USA: not just limited to health outcomes but significantly negatively impacting economic well being as well.
Related: USA Healthcare Costs Now 16% of GDP - Health Care Crisis - Fixing Healthcare from the Inside - Health Care Spending in the United States and OECD Countries
Intel’s Andy Grove Pitches a Plan for Fixing Health Care
Exactly right, the system is broken. The huge costs drag down the entire economy and it needs to be fixed.
Related: USA Healthcare Costs Now 16% of GDP - PBS Documentary on Improving Hospitals - Change Health Care - Going Lean in Health Care - Management Improvement in Healthcare
In Myths About the Developing World, Hans Rosling shows some great graphics to display data on health care outcomes. This is one of the talks from the great TED conference that we have mentioned before. They really have some great webcasts available on their site.
The presentation also gives a concrete example of faulty knowledge (people thinking things which are not so - related to theory of knowledge). He also makes good points on stratifying data at the 14 minute mark. See gapminder.org for good additional material.
Related: Great Charts - Open Access Education Materials
The Doctor’s In, But Is He Listening?, text and podcast from NPR:
“Usually doctors are right, but conservatively about 15 percent of all people are misdiagnosed. Some experts think it’s as high as 20 to 25 percent,” Groopman tells Steve Inskeep. “And in half of those cases, there is serious injury or even death to the patient.”
…
Errors in thinking: We use shortcuts. Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind [of] what’s wrong. And too often, we make what’s called an anchoring mistake - we fix on that snap judgment.
An understanding of theory of knowledge is helpful to counteract errors in thinking. How we think is not perfect, and an understanding the weaknesses and faulty conclusions we are susceptible to making is helpful. That can help avoid jumping to conclusions that are faulty and to design systems that counteract such behavior.
Related: Epidemic of Diagnoses - Write it Down - The Illusion of Understanding - Illusions - Optical and Other - health care improvement posts
Read an exceprt from the book: How Doctors Think by Jerome Groopman .
In trials in Wales and Manchester, says Moon, patients not only recovered faster but noticed less smell and felt less pain from their rotting flesh when maggots were allowed to eat it. “Maggots are highly precise,” she says. “Unlike surgeons, they remove only the rotting tissue. Surgeons have to cut out healthy tissue to clear the wound, thereby creating a larger wound and more bleeding.”
I can believe we would avoid such a simple solution even it is more effective (the health care system seems perfectly capable of avoiding simple effective solutions to me). I hope we pursue scientific study of the most effective solutions - even if they don’t fit with the current way of thinking. It seems to me the health care system needs to find creative and cost effective solutions.
Related: USA Health Care System Costs Reach 16% of GDP - Lean UK Hospitals - Management Improvement in Healthcare - Maggot Therapy Project - Maggots make medical comeback
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