Even  with  “ObamaCare”  Upheld,  Much  Hard  Work  Remains  to  Protect  Patients   and  Make  Care  Affordable

.     By  Mark  Graban,  www.MarkGraban.com       Even  with  this  week’s  Supreme  Court  ruling  that  upheld  most  provisions  of  the  2010   law,  hospitals  and  health  systems  around  the  country  will  have  to  continue,  if  not   accelerate,  their  improvement  efforts  that  started  well  before  the  passage  of  the   Patient  Protection  and  Affordable  Care  Act.    These  practical  changes,  driven  by   proven  systems  engineering  and  management  principles,  often  referred  to  as  “Lean   thinking,”  will  continue  making  care  safer  and  less  expensive,  regardless  of  what   happens  in  our  nation’s  capital.     For  example,  Denver  Health,  the  city’s  public  safety  net  hospital,  has  used  the  Lean   methodology,  based  on  the  famed  Toyota  Production  System,  to  reduce  costs  by   more  than  $135  million  since  2006.  By  getting  staff  members  involved  in  process   improvement  projects,  quality  has  improved,  as  Denver  Health  ranks  first  in  patient   survival  rates  among  academic  medical  centers.     Outside  of  hospitals,  Group  Health  Cooperative,  a  Washington-­‐based  health  insurer   and  care  provider,  will  continue  its  “patient  centered  medical  home”  (PCMH)  efforts   that  are  reducing  costs  while  improving  the  quality  of  care.  Better  coordination  and   communication,  along  with  increased  preventive  care,  has  led  to  a  29%  reduction  in   emergency  room  visits  and  6%  fewer  hospitalizations  for  these  patients.       Group  Health  reports  that  the  quality  of  care  is  higher,  patients  have  better   experiences,  and  fewer  clinicians  are  burned  out.  With  Group  Health’s  efficiency   improvements,  the  average  patient  visit  is  actually  longer  with  PCMH,  going  from  20   to  30  minutes.  Using  Lean  methods  to  reduce  waste  in  the  clinicians’  day  means  they   can  dedicate  more  time  to  patient  care  instead  of  searching  for  missing  information,   equipment,  and  supplies.     ThedaCare,  a  five-­‐hospital  health  system  in  Wisconsin,  has  radically  redesigned   many  of  its  emergency  care  and  inpatient  processes,  for  the  benefit  of  patients  and   payers.  For  patients  with  chest  pain,  the  “door  to  balloon”  time  (from  arrival  at  the   emergency  room  to  the  clearing  of  a  heart  blockage)  fell  from  90  minutes  to  just  37   minutes,  meaning  less  heart  damage  and  faster,  less-­‐expensive  recoveries.         For  patients  who  are  admitted,  satisfaction  increased  from  68%  to  90%  with   ThedaCare’s  new  “collaborative  care”  hospital  methodology,  where  physicians,   nurses,  and  pharmacists  work  as  a  team  with  a  single  integrated  plan  for  a  patient’s   care.  The  health  system  has  achieved  impressive  improvements  for  cardiac  bypass   surgery  patients  –  reducing  post-­‐operative  mortality  and  length  of  stay,  which  leads   to  about  30%  lower  costs.      

ThedaCare  has  also  reduced  the  average  neonatal  intensive  care  unit  stay  from  30   day  to  just  16,  through  better  pre-­‐natal  care  and  the  more  careful  scheduling  of   cesarean  births.  These  improvements  clearly  benefit  mothers  and  babies  and  costs   for  the  healthcare  system,  broadly  defined,  are  reduced  greatly.    However,  due  to  the   current  structure  of  our  healthcare  payment  system,  the  savings  generated  by  the   hard  work  of  ThedaCare’s  employees  and  leaders  are  captured  by  the  payers  -­‐  both   private  and  public.     Organizations  like  Group  Health  are  somewhat  unique  in  that  they  benefit   financially  by  keeping  patients  healthy  and  out  of  the  hospital.  They  are  both  the   payer  and  provider  of  care,  so  savings  in  one  part  of  the  organization  benefits  the   other.  Leading  healthcare  providers,  like  ThedaCare,  often  find  their  revenue  is   lower  as  the  result  of  shorter  hospital  stays  and  improved  patient  care.  Even  non-­‐ profits,  like  all  three  organizations  cited  here,  need  to  have  a  positive  financial   return  to  be  able  to  invest  in  their  futures.       Hospitals  and  health  systems  are  highly  motivated  by  their  mission  and  their   patients’  needs.  Future  reform  efforts  need  to  go  beyond  ensuring  coverage.  They   must  focus  on  ensuring  health  systems  can  be  rewarded  financially,  or  at  least  not   be  harmed,  for  doing  the  right  thing  –  including  keeping  patients  healthy  and   reducing  errors  and  infections.    
ABOUT MARK GRABAN Mark Graban is the author of the Shingo Award-winning book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement and the new book Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. He is also the founder of LeanBlog.org and Chief Improvement Officer of KaiNexus, a software startup. With a background in engineering and manufacturing, Graban has worked exclusively in healthcare since 2005 where he applies "lean" and Toyota Production System principles to improve quality of care and patient safety, to improve the customer/patient experience, to help the development of medical professionals and employees, and to help build strong organizations for the long term. For more information, please visit www.MarkGraban.com.

 

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