My mother passed away recently. As her children reminisced about her life, we recognized that one of the biggest gifts she had given us was her practical wisdom. This wisdom came in the form of countless proverbs with which she would admonish or help us, some more well-known than others, such as, “don’t saddle the horses before the cart is ready,” “the night is a bad advisor,” “better late than never,” and, “bad news travels fast.” Adding to these was the oft repeated reminder about the wisdom of the story, A Message to Garcia, when explaining why she set high expectations without giving clear instructions.
So it’s not surprising that I often find myself thinking of proverbs I learned from her in my daily life. A proverb that summarizes for me what happens when healthcare leaders don’t spend time in the gemba (Japanese for “at the site”) is, “out of sight, out of mind.” Continue reading →
This year I attended the 5th Annual Lean Healthcare Transformation Summit, and I was excited to hear James Hereford, COO at Stanford University Medical Center give his keynote presentation. He had a lot to share, and I had a lot to learn.
First, Hereford explained that lean is nothing new. Henry Ford was following lean principles when he designed flow into the early assembly lines in Highland Park. But what is new is that lean thinking has the power to fundamentally transform the way healthcare is delivered. He bases this thought on the years of experience he gained while experimenting with lean at Group Health Cooperative, the Palo Alto Medical Foundation, and now in his role at Stanford.
However, unlike applying lean thinking in manufacturing, healthcare has a much more complicated operating environment. No other industry has the amount of specialized buildings, the high priced capital equipment, such a large number of labor intensive specialties, and such a highly engaged customer base as healthcare. Continue reading →
Recently, I was skimming through travel websites in search of the most scenic route to take from my home town in northeast Wisconsin to a location in southern Indiana where our bi-annual family reunion will be held next month. We have made this trip a number of times and are ready to look out the window at something new during the nine-hour trip. As I scanned the pages, reading traveler comments, (‘Beautiful’, ‘Excellent!’, ’Don’t do it – speed-trap!’) I encountered a phase I have never heard before – at least in regard to road-tripping – ‘elephant racing’. Next thing I knew, I was six sites deep into the theory of elephant racing as a significant contributor to traffic congestion and road rage. Certainly, a little deeper than was necessary to plan our trip to the family reunion but, interestingly enough, I found some valuable relevance in the concept of elephant racing that we can use to understand and improve information flows in healthcare. Really? Yes, seriously. Let me share… Continue reading →
“It is no longer the question of why we need change in healthcare, it is how to change,” stated Helen Zak, president and COO of the ThedaCare Center for Healthcare Value in her opening remarks at the Fifth Annual Lean Healthcare Transformation Summit held June 4-5, 2014 in Los Angeles. Hosted by the ThedaCare Center for Healthcare Value and the Lean Enterprise Institute, the focus of this year’s annual event showcased how real leaders and real organizations are making substantial and sustainable change in the healthcare industry. Over 600 healthcare industry leaders representing 43 US states and five countries descended on sunny downtown Los Angeles for two exciting days of learning, sharing, and connecting. Continue reading →
The Robert Wood Johnson Foundation published an article earlier this month about the efforts in Wisconsin to move from the traditional fee-for-service model of paying for healthcare, to more innovative, cost-effective methods. Two Wisconsin healthcare organizations, ThedaCare and Bellin Health, joined forces in 2011to form a Pioneer ACO (Accountable Care Organization) under the CMS Shared Savings program. The results in 2012 were 4.6% lower cost for Medicare beneficiaries in northeast Wisconsin – the best performing Pioneer ACO nationwide based on per capita cost.
While more than 80% of the reimbursement for Medicare patients is still fee-for-service, the ACO’s efforts show that there is a better way. Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, has been a strong influence in the state as well as nationally, and has proven that better care can come at a lower cost.
This is the first in a series of blog posts where we will discuss our current thinking on each of the principles that work together as a system to guide the thinking and actions behind better healthcare. The focus of this post is to explain what we mean by “guiding principles for excellence in healthcare.” We will describe our current thinking behind these principles, and we invite you to share your thoughts as well. We published a white paper in 2011, which provides some background about our journey to understand these principles. A fuller description of guiding principles, some of the sources behind our thinking, as well as current examples of application can be found in this case study. Much of what we have learned can be attributed to our work with partner organizations like the Lean Enterprise Institute, the Shingo Institute, the Institute for Enterprise Excellence, and others. We believe we are just scratching the surface of what these principles mean for us. We try to continue to learn and share what we are learning with others.
Why focus on principles? The reason is because they are foundational to a lean transformation, and they need to be understood by senior management in any healthcare organization. Most people gravitate to the lean tools and try to copy them, but they don’t know what to copy. Some people are imitating the behaviors they see (like having huddle meetings, or using white boards, or gemba walks). These activities are not wrong, but need to be understood in light of the principles behind the behaviors. Continue reading →
Earlier this month I had the opportunity to observe and capture video of the Seattle Children’s Hospital’s surgical department’s patient flow. Beginning at the hospital’s entrance, the Surgery Center’s system is designed to lead the patient through the process step-by-step, from start to finish. A surgical nurse commented, “Because everything flows in one direction, it is very obvious if something is going the opposite direction; you know it is out of the ordinary and everyone can see that something is not following the standard work.” The patient flow system was designed so each Operating Room is served by two induction suites where the patients are cued up and ready for their procedure as soon as the room preparations are complete. Continue reading →
By Marta Karlov, Education Director, ThedaCare Center for HealthCare Value
From the flurry of activity in the lean healthcare world, one would conclude that the adaptation of lean methods is commonplace in healthcare. New consulting organizations are born every day, major universities are offering degree programs, experienced healthcare systems are opening their doors to visitors, and many new books have been published on the topic. Moreover, organizations that are practicing lean are accomplishing great results that are benefiting entire communities. And it seems like every other individual I meet in the healthcare business, including clinicians and operational leaders, is experimenting with some form of lean.
All the hype around the release of Medicare billing data clearly points out what little understanding there is when it comes to real problem regarding healthcare data. How many patients a doctor sees, and how many Medicare bills she racks up is not helpful when it comes to improving care. It may identify certain issues related to fraud and abuse for the very few doctors who are crooks; it does nothing to identify best practice and overall resource utilization.
Fortunately, a few legislators understand the real problem. That is why I am very excited about the bill being introduced by lead sponsors, Rep. Paul Ryan (R-WI) and Rep. Ron Kind (D-WI), both of whom are Ways & Means members. HR 4418, the Expanding the Availability of Medicare Data Act allows Qualified Entities to obtain a copy of the entire Medicare data file. It also allows for release of the file to providers of care for the purposes of understanding variation. Once doctors have this data, they will be looking for best practice. This will change the game from not knowing who is the best performer, to every doctor moving to best performance. By doing so we will finally start to see quality and cost improvement for Medicare patients.
Hats off to our legislators in Wisconsin who understand the real problem.
To access an article and more information on this topic Click Here.
Congress kicked the can down the road for another year this week in a disappointing end to a bipartisan bicameral bill that would have permanently fixed the flawed doctor payment legislation. More importantly the permanent fix bill had important provisions that could have saved billions of dollars, and improved care for Americans. Link to full article
For now, we will be fighting in D.C. to add the medicare data provisions back into next year’s SGR bill. It is a shame when the right thing to do for America does not get done by our elected officials.