healthcare

The World’s Cheapest Hospital Has to Get Even Cheaper.

Cancer surgery for $700, a heart bypass for $2,000.

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This is particularly interesting to me as it is managed differently from lean healthcare and still profitable. I’m curious how adding an element of cross training to increase staff flexibility would affect it. For those who think lean is the answer, stay open minded, there may be much to learn here.

Points for my notes:

“A pulmonary thromboendarterectomy. in the U.S., the procedure can cost more than $200,000. Shetty did it for about $10,000 and turned a profit.”

“outcomes for patients meet or exceed international benchmarks. Surgery for head and neck cancers starts at $700.

Endoscopy is $14;

a lung transplant, $7,000.

Even a heart transplant will set a patient back only about $11,000.”

“investment bank Jefferies estimating that it can profitably offer some major surgeries for as little as half what domestic rivals charge.”

“In 10 years, India will become the first country in the world to dissociate health from affluence.
India will prove that the wealth of the nation has nothing to do with the quality of health care its citizens can enjoy.”

“he learned that the cause of their complications was simple:
The patients couldn’t afford the protein their bodies needed to mend.
So he began handing out hard-boiled eggs;”

“upskilling or task-shifting.”

“the average Narayana surgeon performs as many as 6 times more procedures annually than an American counterpart.”

“surgical gowns are procured from a local company for about a third of the cost of international suppliers.
The tubes that carry blood to heart-and-lung machines are sterilized and reused after each surgery; in the West, they’re thrown away.
The machines themselves, along with devices such as CT and MRI scanners, are used well past their warranties, kept running by a team of in-house mechanics.”

“Whereas preparing a U.S. surgical theater for the next patient can take 30 minutes or more, Narayana has gotten the process down to less than 15

“in part by keeping turnaround teams with fresh instruments, drapes, and other supplies on immediate standby, ready to roll the moment a room is available.
Even patients’ families are part of the upskilling model. Narayana trains them to bathe patients and change bandages in the hospital, as they’ll do when they get home.”

"the retail cost of a heart bypass, its most common operation, down to $2,000, about 98% less than the U.S. average."

“mortality rates are comparable to or lower than those in the developed world, at least for some procedures.”

“also outperforms Western systems in results for valve replacements and heart-attack treatment”

“it may become a model not only for competitors in India but also for Western health-care operators, which are trying desperately to contain costs. Nowhere is this more true than the world’s most expensive health-care market, the U.S.”

Full article link: https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper

Adopting Toyota Philosophy Saves Healthcare Business

My summary notes, link to article below

2001 startup Nurse Next Door (NND)

  • patient care demands zero tolerance for cracks "If you're a manufacturer and you mess up, you could lose money or even go out of business; but we take care of people's lives. We could seriously hurt someone if we mess up, so something has to change."

  • Most organizations tend to create practices and processes that increase over time in complexity, but have less and less importance to the customers.

  • NND identified these processes through a customer survey that asked two questions:

  1. On a scale of one to 10, how would you rate our services?

  2. What is your biggest reason for giving us this score?

  • feedback helped NND recognize

  • many of its practices were a waste of effort "We used to think customers wanted our caregivers to show up in uniform" The company provided home-care staff with a uniform allowance, paid for cleaning the uniforms, and was about to draft policies governing the wearing of uniforms, as well as an enforcement protocol. "Then we found out our customers didn't care"

  • A bigger concern proved to be that the company's invoices were too confusing - a 45-minute fix that improved its customer satisfaction score by 20%.

http://www.vancouversun.com/life/adopting+toyota+philosophy+saves+healthcare+business/5633334/story.html

20200604 Vancouver Sun Adopting Toyota philosophy saves healthcare business.JPG

What Zero Looks Like: Eliminating Hospital-Acquired Infections

What Zero Looks Like: Eliminating Hospital-Acquired Infections

IHI (Institute for Healthcare Improvement)

follow link to article below, some points from it:

  • 1.7 million hospital patients ― 4.5 of every 100 admissions ― become infected each year, causing or contributing to the deaths of nearly 100,000 people.

  • Beginning in 2005 with its initial 100,000 Lives Campaign and now 5 Million Lives Campaign, and with the help of several scientific partners, the Institute for Healthcare Improvement has targeted for prevention and reduction 3 HAIs:

    1) ventilator-associated pneumonia (VAP),

    2) central line-related bloodstream infection (CLRBI), and

    3) surgical site infection (SSI)

    ― which, according to the CDC, account for an estimated 50% of all HAI-related deaths.

  • Joe McCannon, manager of the 5 Million Lives Campaign, and an IHI vice president

  • Hospitals participating in the Campaign significantly reduced their monthly HAI rates, in some months all the way down to zero, and “a surprising number were getting down to zero and staying there.”

  • FOR CHANGE TO STICK, AN ORGANIZATION HAS TO REVAMP ITS CULTURE as well as its procedures.

  • not just zero infections but zero tolerance for non-compliance with proven prevention measures

  • When you’re talking about something that can cost people their lives and zero is possible, no other benchmark makes sense.

  • “We dug into the details and found that, officially, good processes were in place but they had broken down or, in some places, were being ignored.” Staff re-education and greater accountability were part of the remedy but the hospital also decided to post large charts in the corridor of the operating rooms, tracking monthly SSIs with big black dots. “That helped keep all staff and physicians aware of our need to improve,”

  • “We don’t blame anyone, we look for poorly designed processes and try to fix them”

  • After much work on “culture and transparency, we now have nurses admitting to short-cuts and violating policies ― and they tell us why.” 

  • the rate of deep chest surgical site infections following CABGs got down to zero and with some exceptions, has remained at zero for multiple months at a time ― the longest was a 15-month stretch

  • hospital has been able to reduce its rate of ventilator-associated pneumonia ― an infection that enters the body via a mechanical breathing tube ― to zero, sustaining that level for as long as two years.

  • overall infection rate was reduced from 3.6 cases per 1,000 patient days before the intervention to 0.85 cases

  •  it’s reasonable to expect that zero infections will become a widely-accepted goal for hospital performance.

  • "People want to do the right thing.

    http://www.ihi.org/resources/Pages/ImprovementStories/WhatZeroLooksLikeEliminatingHospitalAcquiredInfections.aspx