Lean Healthcare: We Got The Money-Now What?

I want to start things off by saying that I come to the table not only bringing a problem, but also the solution. Most of us are skeptics and are concerned that the money recently handed out will not be used to improve the patient care in our healthcare system. Even with the best intentions, the money may get diverted to areas, which may have little impact on the real systemic healthcare problems. As you read this article, you will discover there is a way to ensure that the changes and investments of the dollars have the desired outcome on healthcare. It only requires passion and a solid strategic plan for implementation.

Over the last few weeks, there has been a great deal of press and conversation about Canadian Healthcare. The politicians are dividing up a pot of newly found money for healthcare and the public is wondering why the waiting lists for many of the critical care areas are so long. It appears the healthcare system is broken down.

Growing up in Canada, the one differentiator between Canada and the rest of the world was our fantastic healthcare, which served all Canadians. We were the envy of all countries. Today, the envy has turned to smirks and sometimes laughter created by the dissatisfaction and frustration of the present healthcare service that is received.

Canadian Healthcare Facts

I caught the end of a talk show the other day and within the span of 20 minutes I heard some astounding healthcare facts:

Canadians in the Ottawa and Regina area can wait between 50 and 70 weeks for an MRI
Doctors who work in hospitals make on average only $95, 000 per year
Midwives make 4 times as much as Obstetricians when delivering a baby
A cook in a hospital makes approximately 50% more than a cook in the private industry
The number of healthcare administrators making more than $100,000 per year has tripled since 1996
» There are 55,000 administrators in healthcare – more than the number of actual healthcare providers

Lean Healthcare Potential Solutions

If these facts are even partially correct then I must agree the ‘system’ is either broke or on the verge of breaking.

As with any problem there are several options:

Do nothing – doing nothing is just not an option for any of us
Privatize parts or all of the system – privatization may be the answer if the current environment can’t be fixed or parts can’t be fixed. This option brings in emotional as well as practical issues and challenges. Most Canadians expect equal access to all levels of medical treatment and the amount of money in your bank account should not be the main factor in determining who gets treatment and who doesn’t.
Pour a ton of money into all areas to compensate for the present problems – point improvements – pouring money into parts of a broken system without a proper understanding of the entire system and the interconnectivity of each part will only sub-optimize the results and more than likely hide the problems. And while we are hiding the problems they will of course get worse and be tougher to solve down the road when they surface again (which will definitely happen). Initially, everyone will feel good that they are fixing the concerns and improving the service but this feeling of accomplishment will soon start to turn to frustration again and the money will be used up.
The ‘Right’ Choice – Focus our energies on understanding the current ‘systems’ and determining how to implement a proper plan that will create better service to the patient while making it faster and less costly – understand the potential of the current system and transform it to maximize it’s effectiveness so we don’t buy unnecessary equipment and assets. We need to remove the existing ‘waste’ by following a Plan that gives’ system’ improvements that will impact the patient/client.
Lean Healthcare The Method
If we don’t do this, then ‘how do we know how much more equipment we need, how much more space and people we need?’ By understanding our Current State and removing the ‘waste’ to create the desired or Future State, we will be able to make very effective decisions on doing what is right. We won’t waste our time on doing ‘point’ improvements (we call it ‘Exciting Chaos’) that do little or nothing to improve the service to the patient and has little impact on improving the quality and costs.

Map the current state of the entire ‘system’ (end to end including information/communication through the actual hands-on activities), identify all the value and non-value activities, determine the present Turnaround Times TAT, determine the present costs and quality issues. Once that is complete (takes normally a day), then design a Future State (6 months out) which removes the pure waste in the system (takes a day or two), develop and detailed Implementation Plan (two days max) that outlines the tools, the people and the sequence of events to remove the waste for the entire system.
Lean Healthcare Results

This Plan will tell us where we need to spend the $$ and effort and will maximize the impact to the patient and the budgets of the organizations. Then, and only then, will we be able to accurately determine what equipment purchases and building requirements are needed. Then execute the Implementation Plan and get immediate results. Without an Implementation Plan the moneys will be wasted and just mask the problems so that we have to go after even more $$ n the coming years. The results we have experienced are greater than 50% improvement (within 6 months) using the existing assets.

Note: We are working with a world-renowned healthcare provider and hospital in the U.S. and their waiting list for an MRI is 2 to 5 days and they want to get better.

It is a simple process. The politicians have done their job of dividing up the money, so let’s not waste this opportunity to make everyone of those dollars have the desired impact and result in ‘doing more with less and doing it faster and better’!

Let’s choose the best option and become the envy of the world again and more importantly start saving more lives! It’s our choice to make, let’s not throw the opportunity away.

Remember in order to get a better result; we have to stop doing the same things we did that got us in this predicament in the first place!

Larry Coté is well known for his penetrating analysis and creative energy. He was with the Lean Enterprise Institute in Boston for almost two years as C.O.O./E.V.P. He was the Founder and President of the Lean Enterprise Institute Canada.

Over the years, Larry has worked with 100’s of companies at various stages of their Lean journey in many different business sectors. Larry has expertise in Toyota Production System concepts, diagnostics and assessment of Lean readiness. He works with the corporate leaders to develop effective plans for transforming organizations using Lean and adapting it to their particular culture.

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Four Tips for Protecting Your Healthcare Information

Think your healthcare information is always confidential? Unfortunately, it ain’t necessarily so.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) introduced some important privacy protections for your personal and healthcare information, which, in HIPAA language, is called Protected Health Information, or PHI.

Among the HIPAA protections is a series of requirements that allow your healthcare providers to share your PHI — without — your authorization. They include all of the following circumstances:

— Uses and disclosures required by law

— Uses and disclosures for public health activities

— Disclosures about victims of abuse, neglect, or domestic violence

— Uses and disclosures for health oversight activities

— Disclosures for law enforcement purposes

— Uses and disclosures for coroners and medical examiners

— Uses and disclosures for cadaveric organ, eye, or tissue donation purposes

— Uses and disclosures for research involving minimal risk

— Uses and disclosures to avert a serious threat to health or safety

— Disclosures for Workers Compensation

Should your healthcare provider disclose your PHI for one of the above reasons, he or she is required to document, or “account” for the disclosure. You have the right to receive that accounting so that you will know to whom, if anyone, your healthcare provider has disclosed your PHI. You can exercise that right any time you want by simply asking your provider for an accounting of the disclosures of your PHI.

However, compliance with disclosure accounting is spotty, at best. Many healthcare staff and providers do not really know or understand how or why they can, or should, disclose your PHI. So, some of them do not account for such disclosures.

You may not necessarily know whether or not your PHI has been disclosed — your authorization is not required for these types of disclosures, and providers’ offices may not be compliant with the disclosure accounting rules.

More important, though, is the fact that once your provider does disclose your PHI, whether they account for the disclosure or not, whoever receives your PHI may or may not be required to comply with the HIPAA privacy rules.

For example, Sue Smith (named changed to protect the individual’s privacy) suffered a death in her family. Because of the circumstances, her family member’s PHI was provided to law enforcement. Fortunately, the healthcare provider followed the HIPAA privacy rules and accounted for the disclosures. But, her family member’s PHI was subsequently released to the press, including Social Security Number, date of birth, and diagnoses.

How the press got the information is a subject for the courts. The point is that the information was not protected once disclosed by the healthcare provider.

Your healthcare information may not be safe once disclosed by your provider, either.

What can you do to help ensure that you and your family’s protected healthcare information really is protected and remains confidential?

First: should you or your family member ever be involved in any circumstance, mentioned above, in which your healthcare provider discloses your PHI, exercise your right for an accounting of the disclosure by your healthcare provider.

Next, if no accounting is provided to you in writing within 30 days, file a complaint with your healthcare provider’s HIPAA Privacy Officer (all healthcare providers are required to have one), and if necessary, file a complaint directly with Health and Human Services’ Office of Civil Rights.

Then, make certain that you follow the chain of custody: who got the information, and what they did with it. Make sure that all of your requests for this information are in writing, and follow-up with phone calls.

Finally, always keep a log of your requests; you may need it.

The HIPAA privacy rules were designed to keep your protected health information confidential while it is in the custody of your healthcare provider. Once it is disclosed to other organizations that are not engaged in healthcare, it is no longer protected by HIPAA. It is up to you to keep track of your PHI, and make sure it is kept as protected and confidential as possible.

© Lane R. Hatcher, 2006

In addition to more than 15 years experience in healthcare systems and management, Lane R. Hatcher has been the HIPAA Compliance Officer for the largest military hospital in the U.S. for more than three years. Feel

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