Lo, Harold M.

MBA – 2

Fixing Healthcare from the Inside, Today

By: Steven J. Spear

Synopsis:
In the United States, the health care system often fails to deliver on the promise of the
science it employs. Care is denied to many people, and what’s provided can be worse
than the disease. It can be compared that you are about as safe in a U.S. hospital as
you would be parachuting off a bridge or a building. But it doesn't have to be that way.
It’s not that caregivers don’t care. Quite the contrary: Health care professionals are
typically intelligent, well-trained people who have chosen careers expressly to cure and
comfort. The problems with American health care are rooted in regulatory and market
failures. They argue that institutions and processes mandated by law and custom are
preventing demand for health care from matching efficiently to those most capable of
providing it
The problem stems partly from the system’s complexity, which creates many
opportunities for ambiguity in terms of how an individual’s work should be performed
and how the work of many individuals should be successfully coordinated into an
integrated whole. Unless everyone is completely clear about the tasks that must be
done, exactly who should be doing them, and just how they should be performed, the
potential for error will always be high. As a result, people confront “the same problem,
every day, for years” regularly manifested as inefficiencies and irritations—and,
occasionally, as catastrophes.
Right now, some hospitals are making enormous short-term improvements, with no
legislation or market reconfiguration and little or no capital investment. Instead of
waiting for sweeping changes in market mechanisms, these institutions are taking an
operations approach to patient care.
In case after detailed case, the article describes how doctors, nurses, technicians, and
managers are radically increasing the effectiveness of patient care and dramatically
lowering its cost by applying the same capabilities in operations design and
improvement that drive the famous Toyota Production System. In which operations are
expressly designed to reveal problems as they occur. When they arise, no matter how
trivial they are, they are addressed quickly. If the solution to a particular problem
generates new insights, these are deployed systemically and managers constantly
develop and encourage their subordinates’ ability to design, improve, and deploy such
improvements.

By applying lessons from these highest-performing industrial organizations when it

comes to designing, operating, and improving health care processes. The following
steps are necessary:
1. Specify “normal.” When problems in quality, safety, efficiency, responsiveness,
and the like occur, quickly determine exactly what is abnormal and determine
what might be causing them.
2. Develop a “treatment plan”—process changes that will eliminate or counteract
the causal factors.
3. Run the process with a modified, watching for gaps between actual and expected
outcomes. When gaps occur, do a new work-up, diagnosis, treatment plan, and
test. Lessons in designing, operating, and improving processes can be taught
just as medical expertise is developed.
4. Teach basic frameworks didactically; then, provide hands-on experience in
applying those principles to real problems. Start with simple well-bounded
situations that can be practiced frequently, with rapid feedback and close
mentoring before advancing to more complex, less well bounded situations that
occur less frequently and provide less immediate feedback between action and
outcome.
5. Incorporate development of process improvement skills into residency training so
that deepening expertise within specialties is complemented by greater skill at
integrating functional knowledge into well-integrated care processes.

They are removing ambiguity in the output, responsibilities, connections, and methods
of their work processes. These changes-which can be done in the course of an ordinary
workday, sometimes in a matter of hours-are designed to make the following crystal
clear: Which patient gets which procedure (output); Who does which aspect of the job
(responsibility); Exactly which signals are used to indicate that the work should begin
(connection); and Precisely how each step is carried out (method). Equally important,
managers are being transformed from rescuers who arrive with ready-made solutions
into problem solvers who help colleagues learn the experimental method. Thus, these
hospitals are breaking free of the work-around culture that routinely obscures the root
causes of so many problems, creates so much waste, and leads to so many
unnecessary deaths.
Problem Identification:
Main Problem
How can health care professionals ensure that the quality of their service matches their
knowledge and aspirations? As a number of hospitals and clinics have discovered,
learning how to improve the work you do while you actually do it can deliver
extraordinary savings in lives and dollars.

Conclusions:
Pilot projects have shown that if you apply process management principles and skills to
health care delivery, the outcomes are much better and the effort needed to produce
those outcomes is actually less. In the cases mentioned, it was as if the facility had
gained extra staff. While the transition from pilot project to policy would encounter
institutional obstacles, the potential benefits are so great that one can argue that it
would be unfair to doctors and irresponsible to patients not to do so. No doctor should
be in a position where he or she will be responsible for a process that involves the lives
of the patient and was then untrained for such responsibility who found himself
responsible for processes on which people’s lives depended but untrained for such a
responsibility. Also with nurses being in a position having his or her best efforts turned
into disaster because one vial of colorless fluid looks like another. Lastly, No patient
should be in the position where they fall into a process of flawed health care system.

Recommendations:
The importance of improving health care was mainly emphasized in the study. It was
clearly explained how the process was adapted and applied from a different industry
and to the health care industry. The study can be improved by applying the same
concept from even the same healthcare industry but on a different setting and to see
whether it will gain the same benefit or not. Also, conducting an explorative study and
supporting facts presented such as regarding the history of healthcare and statistics
could also strengthen the claims of this study.