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Management Articles
Improving the Health Care System Articles
An Idealized Design of the U.S. Healthcare System by Russell L. Ackoff et. al.
"A consortium consisting of representative stakeholders in the National Healthcare (so-called) System has produced a "true" redesign of that system."
Lean Six Sigma in Healthcare by Henk de Koning, John Verver, Jaap van den Heuvel, Soren Bisgaard and Ronald Does
"This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach."
Saving Lives by US News and World Report
8 part story on United States Hospitals with a heavy emphasis on the Institute of Healthcare Improvement (Don Berwick) an organization we have long supported. An ambitious initiative called the 100K Lives Campaign" with a goal is to save 100,000 hospital patients by June 2006.
Going Lean in Health Care by James P. Womack et. al.
"Lean principles hold the promise of reducing or eliminating wasted time, money, and energy in health care, creating a system that is efficient, effective, and truly responsive to the needs of patients ? the 'customers' at the heart of it all."
Lean Health Care? It Works! by Patricia Panchak
"A group of Iowa manufacturing executives has already taken Jimmerson's recommendation a few steps further: They're teaming up with their health-care providers, showing them the benefits, educating them on the principles and practices, and helping them to implement lean."
Quality Health Care by Blan Godfrey
"Some of the earlier successes were truly remarkable. The Leicester Royal Infirmary in the United Kingdom, a winner of Hewlett-Packard's Golden Helix Award, reduced a 40-day neurological test procedure to one day, with an associated 40-percent reduction in administrative costs. Other hospitals have reduced lengths of stay by nearly half for some procedures, reduced emergency room waiting times by 70 percent and eliminated 67 percent of the time it takes for physical examinations."
What's Making Us Sick Is an Epidemic of Diagnoses by Dr. Welch, Dr. Schwartz and Dr. Woloshin
"The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses." See curiouscat's comments on this article.
IHI's Collaborative Model for Achieving Breakthrough Improvement by
"Key changes are then implemented in a cyclical fashion: teams thoroughly
plan to test the change, taking into account cultural and organizational
characteristics; they do the work to make the change in their standard
procedures, tracking their progress using quantitative measures; they
closely study the results of their work for insight on how to do better;
and they act to make the successful changes permanent or to adjust
the changes that need more work. This process continues serially over
time and refinement is added with each cycle; these are known as
Plan-Do-Study-Act (PDSA) cycles of learning"
Design of Experiments: An Overview and Application Example by John S. Kim and James W. Kalb
"DOE techniques are not new to the health-care industry. Medical researchers have long understood the importance of carefully designed experiments. These techniques, however, have not been applied as rigorously in the product and design phases as in the clinical evaluation phase of product development."
From the production line to the Nation Health Service by Peter Day
BBC podcast with Daniel Jones, David Fillingham, Miss Carol Makin, Professor John Seddon, Dr John Bibby and Kate Silvester. Discusses efforts to adopt lean thinking practices in the UK National Health System.
Toyota production system has the cure for the industry's ills by Norman Faull
Results included: "a 70 percent reduction in the number of steps needed to complete most tasks; a 40 percent reduction in the floor space needed; up to 90 percent reductions in the time taken for the department to do its job - and all achieved with less staff and limited capital investment."
Reduce Inventory and Need for Expedited Deliveries by ValuMetrix
"The Lean team conducted a step-by-step analysis of the procurement process. After identifying causes of waste and inefficient ordering, it rearranged the supply room, making the most frequently used items more accessible. It instituted a color-coded inventory management system with all necessary information centralized on convenient reorder cards. A monitoring process is helping to identify opportunities for further gains."
Better Patient Care Using Lean Thinking by ValuMetrix
"Lean is not just about better ROI; it's actually fundamentally about better patient care....the end result is, if you improve quality your costs will go
down. If you focus on patient quality and safety, you just can't go wrong. The idea is, you do the right thing with regard to quality and the costs will take care of themselves..."
To build a better hospital, Virginia Mason takes lessons from Toyota plants by Cherie Black
"Virginia Mason said overall benefits include an 85 percent reduction in how long patients wait to get lab results back, and lowering inventory costs by $1 million. They've redesigned facilities to make patient and staff work flow more productive. The hospital reduced overtime and temporary labor expenses by $500,000 in one year and increased productivity by 93 percent."
Patient Transfers: Learning from Motor Racing and Aviation by Oxford University
"We visited the Ferrari motor racing team to examine their pit-stops and worked with experts in aviation safety on briefings and teamwork. We translated their practices to the unique demands of healthcare, and redesigned the transfer process by focusing on leadership, communication, tasks, checklists, and anticipation. Studies before and after introduction of the new process showed reductions in errors and the duration of the handover, with the chances of multiple errors which are the most serious substantially reduced."
A Disruptive Solution for Health Care by Clayton Christensen and Jason Hwang
"by specifically targeting these customers who have been excluded from the traditional marketplace, disruptive business models can first establish a foothold outside the normal competitive space before moving in to compete against the incumbent firms... Similarly, we expect health IT to make its initial impact not via a nationwide, interoperable system based on open standards, but rather in the nonconsuming periphery of the health-care provider value network." See video
Webcast Interview with Former ThedaCare CEO by Dr. Toussaint
"we believe there's at least a trillion dollars of waste in the present delivery system in the United States, at least a trillion dollars. Now we could get that trillion out guess what we could pay for we could pay for an insurance plan for everybody right.
...
approximate 80% it -- and care delivery only 7% -- and it is in health care or health insurance administration. So we're just not we're not focused on the right thing in terms of trying to figure out how we gonna reform."
Design of Experiments: An Overview and Application Example by John S. Kim and James W. Kalb
"Carefully planned, statistically designed experiments offer clear advantages over traditional one-factor-at-a-time alternatives. These techniques are particularly useful tools for process validation, where the effects of various factors on the process must be determined. Not only is the DOE concept easily understood, the factorial experiment designs are easy to construct, efficient, and capable of determining interaction effects. Results are easy to interpret and lead to statistically justified conclusions."
Keen to Be Lean by Josh Hyatt - CFO Magazine
"Lean techniques have helped Denver Health's doctors see more patients - mainly by eliminating paperwork and rearranging offices so that the physicians don't have to do as much walking. In just one clinic, such moves have generated an extra $520,000 in revenue since 2007...
Lean provides a lens through which companies can study different processes across various departments with the goal of reducing costs and improving quality... Burnette calculates that lean has saved Denver Health, which has a $750 million budget, a total of $28.6 million..."
A Hospital That Slashes Costs and Delivers High-quality Care by Catherine Arnst
"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."
How Toyota Can Save Your Life At The Hospital by Mark Graban
"Spending money hasn't worked so far. While the united States far outspends other countries ($4500 per capita, while Switzerland is a distant second at about $3000 per capita), our life expectancy trails Japan (which spends about $2000 per capita), Switzerland, and other countries including Canada, France, Luxembourg, and even Malta. Spending more, whether it's in manufacturing, education, or healthcare does not necessarily lead to higher quality or better results."
USA Spent Record $2.3 trillion ($7,681 Per Person) on Health Care in 2008 by John Hunter
Health spending in the United States grew 4.4% in 2008, to $2.3 trillion or $7,681 per person... For comparison the total GDP per person in China is $5,970 (the closest total country per capita GDP, to the health care spending per capita in the USA, is Thailand at $7,703 - World Bank data). The average spending by OECD countries (Europe/USA/Japan&) was $2,966 per person in 2007 (the USA was at $7,290). In 2007 Canada spent $3,895; France $3,601; UK $2,992; Japan $2,581.
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