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Management Blog Review 2012: Gemba Walkabout

Posted on January 9, 2013  Comments (0)

This is my second, of two, 2012 management blog review posts. In this post I look back at the last year on Mike Stoecklein’s Gemba Walkabout blog. Mike is the Director of Network Operations at Thedacare Center for Healthcare Value.

photo of Mike Stoecklein
  • In a very long post, Some thoughts on guiding principles, values & behaviors, he provides a sensibly explanation for one the real difficulties organization have making progress beyond a certain point (project success but failure to succeed in transforming the management system). “I’m not saying this approach (focus on tools, teams, events) is wrong, but I do think it is incomplete. I think we also need to work from right to left – to help people understand the guiding principles, to think about the kinds of systems they want and to use tools to design and redesign those systems. Dr. Shigeo Shingo said, ‘people need to know more than how, they need to know why’.
    …
    Most managers view their organization like an org chart, managed vertically. They assume that the organization can be divided into parts and the parts can be managed separately
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    It’s what they believe, and what they don’t know is that is is wrong – especially for a complex organization.
    If their thinking was based on the guiding principles (for instance “think systemically”) they would manage their organization differently. They would see their organization as as set up interdependent components working together toward a common aim.”
  • Reflections on My (Brief) Time with Dr. Deming – “The executives thought he was pleased. When they were done with their ‘show’ he thanked them for their time, but he wanted to know what ‘top management’ was doing. He pointed out that they were talking about improvements on the shop floor, which accounted for only about 3 percent of what was important.” When executives start to radical change what they work on the organization is starting to practice what Dr. Deming taught. Mike recorded a podcast with Mark Graban on working with Dr. Deming.
  • Standard Work and PDSA – “What I have noticed is that sometimes people insert another wedge (shown as black) in the diagram below. So, progress gets stopped because some seem to believe that standard work doesn’t get adjusted as you make improvement.” This is a brilliant graphic including the text standard work misued. The 2 biggest problem with “standard work” in practice is ignoring the standards and treating them as barriers to improvement. Standard work should be practiced and if that is a problem the standard work guidance should be changed.
image showing how failure to adjust standard work can block progress

During the year stay current with great posts twice a month via the Curious Cat Management Improvement Carnival.

Related: Management Blog Review 2012: Not Running a Hospital – 2011 Management Blog Roundup: Stats Made Easy – Standardized Work Instructions – Annual Management Blog Review: Software, Manufacturing and Leadership

Management Blog Review 2012: Not Running a Hospital

Posted on January 3, 2013  Comments (4)

Paul Levy started the Running a Hospital blog when he was the CEO of Beth Israel Deaconess Medical Center. Thankfully he has continued the blog, renamed to Not Running a Hospital, after leaving that position. Paul provides a huge number (the lowest number of posts in a month was 32) of valuable posts focused on health care, but worthwhile for everyone interested in improving the practice of management.

Image of cover of Goal Play!

In addition to his blog, during 2012 Paul published a wonderful book – Goal Play!: Leadership Lessons from the Soccer Field. In my first 2012 management blog review I take a look at Not Running a Hospital.

Some of the thoughtful posts by Paul in 2012:

  • How to get better at harming people less – “Imagine what we as a society would do if three 727s crashed three days in a row. We would shut down the airports and totally revamp our way of delivering passengers. But, the 100,000 people a year killed in hospitals are essentially ignored, and hospitals remain one of the major public health hazards in our country.”
  • Medtronic’s Lean Journey – “They knew they would have to think big, but then sweat the details. Over time they figured out how to collaborate.

    There were five stages in the process:

    1 — Define our operating standards, who we aspire to be.
    2 — Set a global expectation to accelerate improvement.
    3 — Develop the ability to assess current state.
    4 — Create ongoing mechanisms to learn and leverage to close gaps.
    5 — Continually check and adjust.”

  • Sarah Patterson informs about Lean – “Would like Va Mason org to operate like an aircraft carrier. How to run a complex business safety.

    Aircraft carrier = an airport on top of a nuclear power plant comprising a bunch of 19 year olds!

    Aircraft carrier needs complete alignment with the mission. If not done well, puts others at risk.

    Aircraft carrier requires an incredible commitment to adoption of standard work. Relentless focus on training.
    …
    Create jobs that are doable. Train people to do them. Hold people accountable to them.
    …
    Adopted TPS=customer first, highest quality, obsession w/ safety, staff engagement, successful economic enterprise
    …
    Senior leader regular gemba rounds to view one aspect of standard work.”

    • Continue reading →

USA Spent $2.6 Trillion, $8,402 per person,17.9% of GDP on Medical Expenses in 2010

Posted on January 19, 2012  Comments (2)

Total health expenditures in the USA in 2010 reached $2.6 trillion, $8,402 per person or 17.9% percent of GDP. All these are all time highs. Every year, for decades, health care costs have taken a larger and larger portion of the economic value created in the USA.

In 2009 the USA Spent Record $2.5 Trillion, $8,086 per person 17.6% of GDP on Medical Care.

USA health care spending grew 3.9% in 2010 following an increase of 3.8% in 2009. While those are the two slowest rates of growth in the 51 year history of the National Health Expenditure Accounts, they still outpaced both inflation and GDP growth. So yet again the health system expenses are taking a bigger portion of overall spending. This has been going on so long that the USA spends double what many other rich countries do on healthcare with no better results.

As a result of failing to address this issue for decades the problem is huge and will likely take decades to bring back just to a level where the burden on those in the USA, due to their broken health care system, is equal to the burden of other rich countries. Over 2 decades ago the failure in the health care system reached epidemic proportions but little has been done to deal with the systemic failures. Dr. Deming pointed to excessive health care cost, back then, as one of 7 deadly diseases facing American business. The fact that every year costs have increased more than GDP growth and outcome measures are no better than other rich countries shows the performance has been very poor. The disease is doing even more harm today.

Some good things have been done over the years, most notably by Don Berwick while at the Institute for Healthcare Improvement. He was effectively thrown out of office by the politicians recently. The same politicians that have through decades of such foolish acts contributed more than any other group to the broken health care system that burdens the USA today. In the last 10 years a significant amount of good work has also been done in “lean healthcare”: applying lean thinking to healthcare. But it is similar to the quote that a “bad system will beat a good person.” With all the bad systemic issues the efforts, good as they are, in lean healthcare are mainly improving around the edges. Of course, “around the edges” of a $2.6 Trillion dollar system can still be extremely valuable and important.

Related: USA Heath Care System Needs Reform – USA Spends Record $2.3 trillion ($7,681 Per Person) on Health Care in 2008 – Systemic Health Care Failure: Small Business Coverage – Measuring the Health of Nations – How to improve the health care system performance – Management Improvement in Healthcare – USA Spent $2.2 Trillion, 16.2% of GDP, on Health Care in 2007

Continue reading →

More Reasons to Avoid Layoffs

Posted on February 11, 2010  Comments (1)

Lay Off the Layoffs by Jeffrey Pfeffer

As its former head of human resources once told me: “If people are your most important assets, why would you get rid of them?”
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In fact, there is a growing body of academic research suggesting that firms incur big costs when they cut workers. Some of these costs are obvious, such as the direct costs of severance and outplacement, and some are intuitive, such as the toll on morale and productivity as anxiety (“Will I be next?”) infects remaining workers.
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research paints a fairly consistent picture: layoffs don’t work. And for good reason. In Responsible Restructuring, University of Colorado professor Wayne Cascio lists the direct and indirect costs of layoffs: severance pay; paying out accrued vacation and sick pay; outplacement costs; higher unemployment-insurance taxes; the cost of rehiring employees when business improves; low morale and risk-averse survivors; potential lawsuits, sabotage, or even workplace violence from aggrieved employees or former employees; loss of institutional memory and knowledge; diminished trust in management; and reduced productivity.
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As bad as the effects of layoffs are on companies and the economy, perhaps the biggest damage is done to the people themselves. Here the consequences are, not surprisingly, devastating. Layoffs literally kill people. In the United States, when you lose your job, you lose your health insurance, unless you can afford to temporarily maintain it under the pricey COBRA provisions. Studies consistently show a connection between not having health insurance and individual mortality rates.

Related: Five Managerial Fallacies Concerning Layoffs – Honda has Never had Layoffs and has been Profitable Every Year – The Trouble with Performance Reviews by Jeffrey Pfeffer – Cutting Hours Instead of People – Firing Workers Isn’t Fixing Problems

Hospital Providing Better Health Care While Reducing Costs

Posted on January 19, 2010  Comments (0)

Business Week has a good article on the strides one hospital has been able to make at reducing costs and improving quality. Hospitals: Radical Cost Surgery

Walk into Providence Regional Medical Center, in Everett, Wash., and you will see a hospital trying something different: It brings the equipment to the patient. In 2003, Providence opened one of the few “single stay” wards in the nation. After heart surgery, cardiac patients remain in one room throughout their recovery; only the gear and staff are in motion. As the patient’s condition stabilizes, the beeping machines of intensive care are removed and physical therapy equipment is added. Testing gear is wheeled to the patient, not the other way around. Patient satisfaction with the “single stay” ward has soared, and the average length of a hospital stay has dropped by a day or more.
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High quality at a low price. Every other industry strives for that combination, but a hospital that does both is all too rare. Providence and its cost-efficient brethren demonstrate that quality care can be delivered at an affordable price, provided hospitals can be persuaded to rethink decades-old practices.

The crazy world of hospital economics does not offer a lot of incentives to change. Both Medicare and private insurers reimburse on a piecework basis – known as fee-for-service – that encourages hospitals to treat more, prescribe more, and test more.
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Providence has also published data showing that infections, lengths of stay, and surgical complications have dropped since starting its own program.

But hospitalists are still controversial in many communities, because primary care physicians are wary of giving up control of their patients, along with their share of inpatient fees. Dr. Joanne C. Roberts, one of the first hospitalists at Providence, has not seen this conflict in Everett, possibly because most of the hospitalists and primary care doctors are associates at one large medical practice, Everett Clinic. That’s not true everywhere, she says. “In another community where I worked, independent doctors were pretty hostile. Everyone was trying to grab part of the money. That just doesn’t happen here.”
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In a study of 2,531 operations at Providence, Brevig reported that the incidence of transfusions was reduced to just 18% in 2007, from 43% in 2003, while the average patient stay was reduced by half a day. The changes have saved Providence an estimated $4.5 million.

Brevig has been proselytizing for his plasma practices at medical meetings, but to little avail. Only some 200 U.S. hospitals have a blood conservation program. Since patients are billed the cost of the plasma, doctors aren’t motivated to change their habits.

There are many more great examples of positive actions being taken in health care. But all you have to do is look at the overwhelming evidence of how amazingly poorly the health care system in the United States is doing to know that it is, overall, an enormous failure. For decades the enormous cost of supporting special interest groups that benefit from the current broken system have forced the rest of society to pay for their unwillingness to improve. We can no longer afford to accept the poor performance. We need to adopt the new ideas much more quickly and eliminate the taxes on the rest of society to support those that want to take an every increasing amount from society to support their outdated, failed policies.

Related: Community Medical Care Successes – CEOs Want Health-Care Reform – USA Spends Record $2.3 trillion ($7,681 Per Person) on Health Care in 2008 – Health Care: Lessons for the USA from Switzerland

Systemic Health Care Failure: Small Business Coverage

Posted on December 27, 2009  Comments (2)

There are many significant problems with the medical care system in the USA. It makes sense that a system that costs over 50% more than other countries and has no better outcomes, from all that extra spending, suffers from many failures. Coverage for small business is one of the problems we face now – When Health Insurers Dump Small Companies:

In June testimony before the Senate Commerce Committee, Potter said insurers “dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether – leaving workers uninsured.”
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Joy Mosley, COO of Biotest Laboratories, a 77-person medical testing company in Minneapolis, recently got such a “requote” from her insurer, Medica, after an employee was diagnosed with pancreatic cancer. Medica covered the million-dollar treatment, but then said the large claim warranted $156,000 in additional premiums – a 72% increase.
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Not all entrepreneurs are equally vulnerable. About a dozen states prohibit insurers from basing premiums for businesses with 50 or fewer employees on workers’ health status. But in roughly three-fourths of the country, so-called ratings bands allow for considerable flexibility in pricing. In states with loose ratings bands, such as Texas and Nevada, one small company can be charged nearly 70% more than another. In Pennsylvania and Virginia, there are no ratings restrictions. No matter what state you’re in, ratings bands don’t apply to companies with more than 50 employees.

Just from an insurance perspective the companies are not providing what is needed. They are quick to say you can’t have healthy people remain uncovered and wait to buy insurance once for example, “their house is on fire” (they are sick). They are right. Well you also can’t have the insurance company cancel coverage during the fire and have a system that works.
Continue reading →

Video Overview of the PDSA Cycle

Posted on December 20, 2009  Comments (2)

Robert Lloyd, PhD From the IHI Open School‘s, presents a nice overview of the PDSA Cycle (plan-do-study-act). The webcast includes an example of using PDSA to improve the discharge process for a hospital.

As I have said many times the keys to success are to turn the PDSA cycle rapidly, predict the results in advance, and analyze the results to continually improve. the Improvement Handbook is an excellent resource.

The IHI Open School is a great resource and exactly the type of thing organizations with a mission to improve performance should be doing. Provide resources online that are easy for people to access and then apply in their organization. See more management webcasts.

Related: Tom Nolan on PDSA – Saving Lives: US Health Care Improvement – 5 Million Lives Campaign

Blame the Road – Not the Person

Posted on August 19, 2009  Comments (4)

The system is responsible for 90, 92, 94, 97% of problems – W. Edwards Deming. Fix the system, don’t blame the people. When you seek system fixes you approach situations differently than if you search for people to blame.

By the way, I am often asked about the data supporting Deming’s contention that the system was responsible for 97% of the problems. This statement was not based on a set of data but on Dr. Deming’s decades of experience. And he increased the percentage over time – as he learned more.

Roads that are designed to kill

Half blamed the runner, saying she should not have been running in the street at that hour. Half blamed the driver, for not paying close enough attention. Not a single writer blamed the road.
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Your streets are designed to kill people.
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Vision Zero started about 30 years ago, when traffic safety researcher Claes Tingvall got the idea that we didn’t have to accept road traffic deaths as a fact of life. Tingvall and his colleagues said that these deaths were not “accidents’’ but were predictable and preventable. And they set out to prove it.

One of the ways they began to protect people was to put barriers down the center of two-lane roads. They showed that this could be done cheaply. When Mylar – a strong polyester film – is supported by closely spaced plastic poles, it can keep cars from crossing the median. When the Swedes used this type of center barrier to separate the traffic going in opposite directions, they effectively prevented head-on collisions and the death rate on these roads fell by 70 percent to 80 percent.

Global health research shows more improvements can save lives. For example, Ghana put in rumble strips – small bumps spaced closely together – across all the roads leading into the capital city of Accra, reducing fatalities by 35 percent. Research has shown that speed bumps on roads are one of the “best buys” in all of global health.
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Most people think we are doing all that can be done to keep our roads safe. They are wrong. Road traffic injuries kill more than a million people a year worldwide, including 40,000 a year in the United States.

Is a situation killing 40,000 people in the USA a year a health care issue? It sure seems to me it would be. It probably isn’t a disease management issue though (some might try to say bad roads are a disease but I wouldn’t say that). I think this is one, of many examples, that shows that we have a disease and injury management system not a health care system (in addition to illustrating systems thinking, effective root cause analysis, PDSA, innovation, respect for people…).

Related: Find the Root Cause Instead of the Person to Blame – Traffic Congestion and a Non-Solution – Checklists Save Lives – Saving Lives: US Health Care Improvement – The Economic Benefits of Walkable Communities – SWAT Raid Signs of Systemic Failures – System Improvement to Respond to the Dynamics of Crowd Disasters – The Leading Causes of Death

Community Medical Care Successes

Posted on June 18, 2009  Comments (1)

The Cost Conundrum by Atul Gawande, New Yorker (The Power of a Checklist was published there in 2007 by the same author)

For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.
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I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said. Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. [actually the Deming Chain Reaction] Continue reading →

CEOs Want Health-Care Reform

Posted on May 28, 2009  Comments (5)

Decades ago Dr. Deming emphasized the deadly disease of excessive health care costs in the USA. Since then, year after year, the situation has become worse (reaching $2.2 trillion in spending in 2007 – 16.2% of GDP). During that time senior executives has put forth very little serious effort (in comparison to the huge cost) to fix this problem. Finally, in the last few years, more and more senior executives are actively moving to address the ever worsening crisis (including, Howard Schultz, CEO at Starbucks).

They seem to be realizing that hoping the problem will just fix itself is not a great strategy. Finally senior executives are realizing they need to have the government address the systemic failures. Those executives need to keep up their efforts because those seeking to retain the system that doesn’t work, because they personally benefit from it, have been doing a great job of preventing progress for decades. Until a critical mass of senior executives demand change from Washington the chance of improving the relative performance of the USA health system in comparison to other countries is very bleak (we have just been getting more expensive and less effective [relative to other countries] over time).

CEOs Secretly Want Health-Care Reform

Carl T. Camden, CEO of Kelly Services (KELYA). Managing insurance for his vast, geographically dispersed workforce of temporary workers is horrendously expensive, he complains: “My health-care costs total more than my profits.”
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But in private, “CEOs overwhelmingly want out of this business,” says Benjamin Sasse, an Assistant Secretary of Health & Human Services under President George W. Bush who’s now an assistant professor at the University of Texas at Austin. “They just do not want to be seen as more willing to dump [benefits] than their competitors are.” Sasse says many CEOs he has talked with would even pay a new tax if it got them out of the insurance business.

Related: Many Experts Say Health-Care System Inefficient, Wasteful – Articles on Improving the Healthcare system – Applying Disruptive Thinking to the Healthcare Crisis – Our Failed Health-care System
Continue reading →

USA Spent $2.2 Trillion or $7,421 Per Person on Health Care in 2007

Posted on March 16, 2009  Comments (0)

Health spending in the United States grew 6.1 percent in 2007, to $2.2 trillion or $7,421 per person.
For comparison the total GDP per person in China is $6,100. This continues the trend of health care spending taking an every increasing portion of the economic output (the economy grew by 4.8 percent in 2007). This brings health care spending to 16.2% of GDP (which is yet another, in a string of record high percentages of GDP spent on health care). In 2003 the total health care spending was 15.3 of GDP.

With the exception of prescription drugs (which grew at 1.4% in 2007, compared to the 3.5% in 2006), spending for most other health care services grew at about the same rate or faster than in 2006. Hospital spending, which accounts for about 30 percent of total health care spending, grew 7.3 percent in 2007, compared to 6.9 percent in 2006.

Spending growth for both nursing home and home health services accelerated in 2007 (4.8% v. 4.0%). Spending growth for freestanding home health care services increased to 11.3 percent. Total health care spending by public programs, such as Medicare and Medicaid, grew 6.4% in 2007 v. 8.2% in 2006. In comparison, health care spending by private sources grew 5.8% compared to 5.4%.

Private health insurance premiums grew 6.0 percent in 2007, the same rate as in 2006. Out-of-pocket spending grew 5.3 percent in 2007, an acceleration from 3.3 percent growth in 2006. Out-of-pocket spending accounted for 12.0 percent of national health spending in 2007. This share has been steadily declining both recently and over the long-run; in 1998, it accounted for 14.7 percent of health spending and, in 1968, out-of-pocket spending accounted for 34.8 percent of all health spending.

The costs for health services and supplies for 2007 were distributed among businesses (25%), households (31%), other private sponsors (4%), and governments (40%).

Decades ago Dr. Deming included excessive health care costs as one of the seven deadly diseases of western management. We have only seen the problem get worse. Finally it seems that a significant number of people are in agreement that the system is broken. Still, admitting the system is broken is not the same as agreeing on how to fix it. The way forward to workable solutions still seems very difficult.

Full press release from the United States Department of Health and Human Services.

Related: Many Experts Say Health-Care System Inefficient, Wasteful – International Health Care System Performance – USA Paying More for Health Care – Health Insurance Premiums Soar Again – PBS Documentary on Improving Hospitals

ER Checklist

Posted on March 13, 2009  Comments (1)

The popular ER TV show highlighted the importance of using checklists in surgery yesterday.

Such powerful quality tools, like the checklist, are just waiting to be used. But far too many fail to use these simple improvement tools. And in health care those failures are potentially critical.

Related: Checklists Save Lives – The Power of a Checklist – management improvement dictionary – Articles on Improving the Health Care System

Applying Disruptive Thinking to the Healthcare Crisis

Posted on February 19, 2009  Comments (3)

The Innovator’s Prescription: A Disruptive Solution to the Healthcare Crisis

Christensen spies symptoms of such disruptions bubbling up in the healthcare industry, such as molecular diagnostics, imaging technologies and high bandwidth telecom, and business model innovations. Integrated health systems like Kaiser Permanente have a leg up in deploying and optimizing these disruptive technologies.

The push for widespread healthcare reform must come from employers, who in spite of their declared intent to cut healthcare costs also know “they profit when their employees are healthy and productive.” Affordable healthcare, he concludes, “doesn’t come by expecting high end, expensive institutions or expensive caregivers to become cheap, but by bringing technology to lower cost providers and venues of care, so they can become more capable.”

Clayton Christensen is the rare management thinker that I feel real provides profound insights into thinking about management. There are many other good management thinkers that offer valuable idea, just most of them (in my opinion) really are presenting material in ways that offer managers a good way to take action on all the long known good management ideas that we fail to adopt successful for decades.
Continue reading →

Checklists Save Lives

Posted on January 17, 2009  Comments (3)

photo of surgery room

Checklists are a simple quality tool that have been used widely for decades. Pilots use them, without fail, to save lives. Some surgeons have been using them and the evidence is mounting that checklists can save many more lives if more in health care use them. Studies Show Surgeons Could Save Lives, $20B by Using Checklists

Eight hospitals reduced the number of deaths from surgery by more than 40% by using a checklist that helps doctors and nurses avoid errors, according to a report released online today in the New England Journal of Medicine.

If all hospitals used the same checklist, they could save tens of thousands of lives and $20 billion in medical costs each year, says author Atul Gawande, a surgeon and associate professor at the Harvard School of Public Health.
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In his study, which was funded by the World Health Organization, hospitals reduced their rate of death after surgery from 1.5% to 0.8%. They also trimmed the number of complications from 11% to 7%.

The study shows that an operation’s success depends far more on teamwork and clear communication than the brilliance of individual doctors, says co-author Alex Haynes, also of Harvard. And that’s good news, he says, because it means hospitals everywhere can improve.

Researchers modeled the checklist, which takes only two minutes to go through, after ones used by the aviation industry, which has dramatically reduced the number of crashes in recent years.

This is more great evidence of the value of applying simple management tools that are already well known. The idea that improvement takes brand new breakthrough ideas is just plain wrong.

Related: Using Books to Ignite Improvement – The Power of a Checklist – New, Different, Better – Management Improvement History and Health Care – Open Source Management Terms – Fast Company Interview with Jeff Immelt

The Ergonomics of Innovation

Posted on September 22, 2008  Comments (0)

The Ergonomics of Innovation by Hayagreeva Rao and Robert Sutton

the IHI case teaches us that innovations spread quickly when organizations focus relentlessly on selecting and spreading ideas in ways that ease the burden of thought and action for everyone involved. This mind-set differs from the one that burdens most organizations, where innovation
is seen as difficult, expensive, and protracted. The IHI staff’s ergonomics-of-innovation mind-set focused on making things easier and cheaper for everyone, including the staff itself.
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IHI focused on small things that had a big impact without placing a big load on hospital staffs (reducing the number of infections, for example, hinged on frequent and thorough hand washing). In this way, the organization adopted what Karl Weick calls a “small wins” strategy.
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Berwick and his team believed that simply asking hospital staffs to “try harder” to save lives wasn’t enough; people need concrete, easily learned and implemented tools.

Related: Saving Lives: US Health Care Improvement – 5 Million Lives Campaign – PBS Documentary: Improving Hospitals – Hospital Reform – IHI on CBS – Articles on Improving Health Care Performance – Drug Prices in the USA – posts on innovation

Our Failed Health-care System

Posted on September 10, 2008  Comments (0)

The bad idea behind our failed health-care system by Malcolm Gladwell

One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system.
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Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average.
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Health Savings Accounts represent the final, irrevocable step in the actuarial direction. If you are preoccupied with moral hazard, then you want people to pay for care with their own money, and, when you do that, the sick inevitably end up paying more than the healthy. And when you make people choose an insurance plan that fits their individual needs, those with significant medical problems will choose expensive health plans that cover lots of things, while those with few health problems will choose cheaper, bare-bones plans.
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In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.

This is another article with an interesting take on the problems with the broken health care system in the USA. I don’t totally agree with the conclusion. I think the failure of the system and refusal to make substantial change have multiple causes including: smart lobbyists paying politicians lots of money to support their interest in keeping the current system, people being fearful about change, false perceptions about the system performance (thankfully an understanding of the poor performance is becoming more widespread recently), that the system works least poorly for the wealthy who have more influence than those without insurance, that the benefits of spending huge amounts today are going to specific companies and people and thus are available for buying political support (not just paying politicians but also funding marketing campaigns, experts to provide journalists the position of those in favor of the existing system…) while the benefits of changing are much more distributed. Luckily companies are increasingly – decades after Deming noted this health care costs are a huge problem for companies in the USA – focusing on the need for improving what is often one of the largest expenses for companies. The issue many fail to understand is how much the excessive costs of health care in the USA harm the ability of companies in the USA to compete – many even fail to appreciate the human cost of tens of millions of people without health insurance.

Related: Drug Prices in the USA – Measuring the Health of Nations – Overview of 5 Nations Health Care Systems – Fixing Health Care – Improving the Health Care System

Management Improvement Carnival #40

Posted on August 1, 2008  Comments (1)

Mark Graban is hosting the Management Improvement Carnival #40. Mark recently authored a new book, Lean Hospitals. Health care highlights from this carnival include:

  • Hospital Error – Heparin in the news again (The Lean Thinker Blog): “I am reasonably certain that the two workers who went on “voluntary leave” (yeah, right) will absorb more than their share of blame as the system solves the problem by asking the “Five Who?” questions.”
  • Management 101, 201, 301, and 401 (Paul Levy – Running a Hospital): “The only role of management is to create an environment where people left to their own devices and unsupervised are most likely to engage in behavior that advances the goals of the organization.”
  • Why I Work In Healthcare (Lee Fried – Daily Kaizen): “Great people that were trying to work in a broken system.”
  • Competing Podcast Interview with Mark Graban (Dwight Bowen – Lean Thinking Network): “Most everyone has been aware of the increasing costs of healthcare – the general public is recently becoming more aware of the patient safety and quality risks they face in a hospital. And these are all problems that can be addressed with Lean.”
  • 5S, Poka-Yoke, and Visual Controls (Bryan Lund – TWI Blog): “I need a visual control to tell me if the standard is met, in order to avoid mistakes or failure.”

Related: previous management carnivals – Curious Cat health care article library – Curious Cat Management Improvement blog Health Care posts – improving health care links

Post Number 1,000

Posted on April 29, 2008  Comments (1)

This is the 1,000th post to the Curious Cat Management Improvement Blog. Here are some highlights:

Overview of 5 Nations Health Care Systems

Posted on April 16, 2008  Comments (7)

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

Drug Price Crisis

Posted on March 18, 2008  Comments (3)

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.

Solving the drug price crisis

The mounting U.S. drug price crisis can be contained and eventually reversed by separating drug discovery from drug marketing and by establishing a non-profit company to oversee funding for new medicines, according to two MIT experts on the pharmaceutical industry.
…
Following the utility model, Finkelstein and Temin propose establishing an independent, public, non-profit Drug Development Corporation (DDC), which would act as an intermediary between the two new industry segments — just as the electric grid acts as an intermediary between energy generators and distributors.

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

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