Category Archives: Health care

Traveling for Health Care

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 CareChange Health CareHealth Care Crisis

USA Paying More for Health Care

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:

Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey

The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent. The average premium for family coverage in 2007 is $12,106, and workers on average now pay $3,281 out of their paychecks to cover their share of the cost of a family policy.

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 borrowingludicrasly overpaid senior executives). Continue reading

Lean Dentist Podcast

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 CareLean Health Care WorksPBS Documentary: Improving Hospitalsmanagement improvement podcasts

Health Care the Toyota Way

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

For example, doctors and nurses from SSM Health Care, a Midwest system, with 22,000 employees and the Pittsburgh Regional Health Initiative, a group of 40 competing hospitals, report how they did their best in the past, working overtime, while hospital conditions worsened. They were initially dubious and then delighted to learn systems thinking and Toyota methods to improve patient care dramatically and reduce unnecessary deaths, suffering, errors, infections and costs without additional resources or government regulations.

The Deming-Toyota-Baldrige method and systems thinking can improve schools, government agencies or any organization, even military invasions and occupations, because it offers new ways to look at the bigger picture. It allows an organization to be greater than the sum of its parts as the people in the system learn to work together more effectively.

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 Systemarticles on improving health careFixing Healthcare from the InsideChange Health Care

Lean Health Care Interview

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 careGoing Lean in Health CareDocumentary of improving hospitalsSimple Solutions That Worknon-value added steps

How to Avoid Kaizen

‘Disillusioned’ surgeon quits UK:

In the theatre anaesthetists at the James Paget Hospital prepared the next patient while he was operating on another. He said: “I found I was wasting time between operations so I came up with this solution. Now I don’t waste any time and I have no waiting lists.

“After I won my award, I met Tony Blair. He said he would send someone from the Department of Health and that happened only after six months. They came but nothing happened.

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:

“The reason for that is very simple – there are no incentives for surgeons to become more efficient. If we don’t have performance-related pay, why should we change?”

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 CareUK National Health System ManagementFixing the Health Care System from the InsideProblems with Bonuses

Comparative Performance of American Health Care

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care

The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance.

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 GDPHealth Care CrisisFixing Healthcare from the InsideHealth Care Spending in the United States and OECD Countries

Fixing Health Care – Andy Grove

Intel’s Andy Grove Pitches a Plan for Fixing Health Care

Call it fear of mortality, opportunism or altruism — Grove sees a major breakdown in a system that leaves nearly 50 million Americans uninsured and emergency rooms closing down in droves. There’s also a business case. Health care is a $200 trillion-a-year industry — as Grove notes, 20 times larger than the chip business — that’s only getting bigger as baby boomers enter their autumnal years.

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 GDPPBS Documentary on Improving HospitalsChange Health CareGoing Lean in Health CareManagement Improvement in Healthcare

Data Visualization Example

[I replaced the embedded video, since Google broke the original link with the way they shut down Google Video after buying YouTube]

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 for good additional material.

Related: Great ChartsOpen Access Education Materials

Errors in Thinking

photo of Jerome Groopman

The Doctor’s In, But Is He Listening?, text and podcast from NPR:

Jerome Groopman (photo) is a doctor who discovered that he needed a doctor. When his hand was hurt, he went to six prominent surgeons and got four different opinions about what was wrong. Groopman was advised to have unnecessary surgery and got a seemingly made-up diagnosis for a nonexistent condition. Groopman, who holds a chair in medicine at Harvard Medical School, eventually found a doctor who helped…

“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 DiagnosesWrite it DownThe Illusion of UnderstandingIllusions – Optical and Otherhealth care improvement posts

Read an exceprt [the broken link was removed] from the book: How Doctors Think by Jerome Groopman .