Hospital Efficiency Should Top Healthcare Reform

In the wake of Ted Kennedy’s death, it seems appropriate to discuss health care reform. But rather than debating the merits of universal coverage or single-payer options, I want to point to a more fundamental problem: Inefficient hospitals.

There’s an excellent article in today’s Boston Globe called No Waiting that examines research and consulting work by Eugene Litvak, a professor at Boston University. Here’s an excerpt from the article:

If hospital executives concentrated on moving patients smoothly through the hospital the way that the local Applebee’s restaurant moves diners, he [Litvak] believes, they could make hospitals better places to work, safer environments for patients, and cheaper to operate.

Litvak applied some of his operational principles to Cincinnati Children’s Hospital which estimates that these and other streamlining measures…

will allow the hospital to generate an additional $137 million in revenue this year from treating more children with the same levels of staffing in surgery and other departments. 

My take: I completely agree with Litvak. The lack of focus on the operational flow through hospitals causes delays, requires rework, and introduces quality risks. This is very similar to the quality problems that the US auto industry faced in the 1980s. The auto industry learned that a focus on operational efficiency (and effectiveness) can improve quality AND cut costs. Take a look at a few of my previous posts:

No matter what payment options the country adopts, healthcare will always be far more expensive than it needs to be unless hospital systems go through an operational makeover. While politicians continue to fight over health care coverage, let’s honor Ted Kennedy’s memory by collectively demanding better, more affordable treatment from hospitals. Who can argue with that?!

The bottom line: Hospitals can (and must) deliver better, lower-cost care

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I'm an experience (XM) management catalyst; helping organizations improve results by engaging the hearts and minds of their employees, customers, and partners. I enjoy researching and speaking about leading-edge XM topics. I lead the Qualtrics XM Institute, which is the world's best job. We're igniting a global community of XM Professionals who are inspired and empowered to radically improve the human experience. To achieve this goal, my team focuses on thought leadership, training, and community building. My work is driven by a set of fundamental beliefs: 1) Everything starts and ends with human beings, so you need to understand how people think, feel, and behave; 2) XM is a discipline that needs to be woven throughout an organization's entire operating fabric; and 3) Building the XM discipline requires a combination of culture, competency, and technology.

5 thoughts on “Hospital Efficiency Should Top Healthcare Reform”

  1. I completely agree. Having experienced hospitals inner workings as both an employee and a patient, it is amazing anyone gets the proper care. It isn’t that the nurses, doctors, lab techs, and everyone else associated with health care don’t care about the patient; they care very much. But the system is hamstrung by old fashioned work-flow processes and some foot dragging on the part of some of the medical establishment that prefer to pick apart proposals for better work-flow instead if coming up with solutions.

    As a laboratory technologist I saw my share of patients having blood drawn more often than needed simply because several doctors were giving the orders and invariably we could not use the sample we already had and so had to collect again, even though the patient had just been stuck 5 to 30 minutes prior. Many tests were ordered to be performed stat (right away, forget whatever else you are doing right now), not because the patient’s life was at risk but because the test was not ordered on time, or someone thought it would be more convenient for them to have the answer quickly, regardless on patient outcome from the test result.

    As a patient, I have always wondered why it took such extreme amounts of time to check people into the hospital for in-patient or out-patient care or testing. The clerks are forced to go through an endless parade of forms that could have been filled out by the patient before ever arriving, creating a logjam at the very beginning of treatment. Then there are the wait times for someone to escort the patient to the right area, the wait for lab tests, the wait for radiology, and so on.

    Certainly patients don’t always follow a predictable time table in emergencies or need for immediate hospitalization (childbirth, something found during a routine exam), but an analysis of the processes and work-flow surrounding these activities would likely reveal a large number of inefficiencies.

    This includes doctors and nurses charting manually, in handwritten notes, some filled with indecipherable handwriting, acronyms, and shorthand that cannot be understood by the person responsible for putting orders through to the various departments or who must read that chart later when following up. This results in duplicate orders for tests, treatment or medication.

    Patients can wait an entire day for a doctor to give the order for them to be allowed to check out, even though they could have left first thing in the morning if the order had been given.

    Many hospitals have been trying to improve these issues piecemeal, but the entire medical establishment must agree to improve in every area. In some cases this has meant handing out restaurant style buzzers and light gadgets to patients waiting so they are not stuck in the waiting room. Certain medical specialties have been created like a doctor called a “hospitalist” or an “intensivist” through whom all patient care is coordinated by someone familiar with the hospital or treatment area (ie ICU) to get things done correctly and efficiently with little rework or delay.

    Computerization has and will continue to help resolve many of these issues but not unless everyone is willing to embrace electronic records with a standardized format or application so data can be shared easily. Yes, it needs to be secure, but we already trust our money and other sensitive parts of our lives without worrying overly much about security. I would prefer someone to find out about my health rather than have many people scrambling to get things together from an outmoded system.

  2. Very good article. I try to learn from customer environments like these to improve my business.

    Are hospitals inefficient because they have no economic need to become efficient?

    There is over 100 years of chronological experience out there that hospitals could tap into to become more efficienct, if they wanted to. (Computerization of records might make things easier, but not required. )

  3. Many hospitals have been trying to improve these issues piecemeal, but the entire medical establishment must agree to improve in every area. In some cases this has meant handing out restaurant style buzzers and light gadgets to patients waiting so they are not stuck in the waiting room.

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