People Process Technology Blog

Lean in Healthcare or ‘We’re working the wrong problem.’

Posted by: Ken Pilone, Sr. OD/Lean Consultant, TBD Consulting

With all the fuss about the ‘Obamacare’ legislation, it seems we have lost sight of the REAL problem here.  All of the attention seems to be focused on how to pay for our nation’s healthcare needs.  Rarely if ever do you hear anybody asking, "Why are health costs so high in the first place?" 

The question needs first to be asked, why providers charge so much.  While there are no easy answers, this much is clear:  The entire end-to-end process of providing health services is riddled with waste! 

There are at least two ways to look at the formula for making a profit.  The first and most common is, cost + profit = price.  You have only to look at the Post Office to see how this plays out.  Their motto might be, “Inefficient, no problem.  Just raise the price of a stamp.”  This formula doesn’t allow for any scrutiny into what drives cost in the first place.  The second formula, and the one most overlooked is, price – cost = profit.  This works well in highly competitive markets where price is more or less dictated by the customer and thus is essentially fixed. 

Think about it.  For any consumer product to have a chance at being successful in the marketplace, it shouldn’t cause sticker-shock for the customer.  For example, if I want to buy a toaster, I can expect to pay between $15 and $50 depending on features, brand, retailer, etc.  But, if I see a toaster on the shelf with a price of $200, I might react like, Jeez, I just want toast for Pete’s sake!  Does it also do my laundry? We’re not likely to be too sympathetic if the maker responds with, “Well, that’s just what it costs to make it plus a little profit.”  That’s not our problem!  If they can’t compete, well, then they have the right to go out of business!

Herein lies the rub.  When healthcare providers THINK and subsequently ACT as if they have no real competition, where is the incentive to look for and eliminate waste?  There is also a mindset working in this industry that cost doesn’t really matter to their customers (patients) because those big, greedy, money-grubbing insurance companies are going to foot the bill anyways.  Right?  We think it’s all their fault we’re in this mess.  And the finger-pointing ensues.

If we zoom out far enough, we can find some hope from this dilemma.  Ironically, there is a potential model right under our noses in the Emergency Rooms across the country.  The routines in place when an ambulance pulls up are very tight, efficient and well-rehearsed.  This is a completely customer-centered process.  All non-essential tasks and activities are suspended until the crisis is over.

Unfortunately, we haven’t examined all other healthcare related ‘value streams’ with the same eye towards fast, efficient, waste free work. It’s as if by some invisible elastic band around us, we revert instantly back to the ‘norm’.  But, what if we used the same critical lens to look at all the other processes in place in the system?  Start with identifying who are REALLY the customers and track backwards to see how value is created for them.  Along the way we will find waste of unimaginable proportions. 

Doing this will help us solve the healthcare crisis its root cause, waste and inefficiency.  This is the center point around which healthcare providers’ lean/PI staff SHOULD be revolving.

IT, Change Management and Training: They MUST Work Together for Successful EMR Implementation

Posted by:  Jonena Relth, President and Leadership Evangelist of TBD Consulting.

 

Ok, so we know that electronic medical records systems (EMRs) are designed to transform traditional, paper-based medical records into cutting-edge, electronic records that provide entire clinical teams with a more complete picture of their patients' needs and more tools to continue delivering superior healthcare.

 

What many leaders don't understand is why our best efforts to implement EMR systems fall on deaf ears and our medical professionals are struggling to make the change from paper to paper-lite. After all, we've done our best to build new and improved workflows and customized the system to meet the needs of our users. Well, my experience has been with EMR implementation is that leaders don't understand that the most important component of an EMR implementation is related to change management – the people side of integrating new processes and technology.

 

IT professionals aren't change management experts, nor are they training professionals. Without the three disciplines working together during the entire life of the project, all the "I's" won't get dotted and the "T's" won't get crossed.  In other words, you'll have a software system installed but the people you want to use it won't be communicated with in a way that allows them to accept and adopt the changes, nor will they be trained in a way that meets their learning style.

 

Effective EMR training requires a comprehensive change management initiative that informs and involves the intended users. Changes shouldn't be just "told" to people.  Everyone needs the opportunity to assimilate information about the changes coming and be able to ask questions, etc.  Just putting a positive spin won't work.  Allow people the opportunity to accept, embrace and adopt the changes - which will result in their integrating the system in their daily tasks once the system goes live. This takes time and serious effort by the change management experts who will determine various methods to ensure change options such as live meetings, newsletters, interactive webinars, website, posters and other media, etc.  Oh yeah, and don't forget the food. Tip to remember: "If we feed them, they will come."  (Sounds like a move, huh?)

 

That leads me to my next pet peeve: One-size-fits-all training.  Just because the IT folks learn best with hands-off WBT or that the training folks prefer face-to-face instruction, doesn't mean that all the audience will fit into one of those categories.  People have different learning styles and learning requirements.  For instance, it's going to be a VERY hard sell to get physician to stop seeing patients in order to sit through a day of un-paid training.  Let's face it; physicians make their living by seeing patients.  For this reason, we need to provide just-in-time training with super users or short e-Learning modules that the physicians can take during their breaks.  And depending on their roles and learning styles, clinical staff could be trained with a combo of e-Learning and Day-in-the-Life, Face- to-Face training.

 

In any event, the training should be carefully designed using a systematic approach that builds on the organizations stable foundation of processes.  Only by doing this will the training meet the needs of both the users and the different departments.  And don't forget that the training plan should include assessment so you will know if the users are able to apply the new skills, knowledge and information they learned.  Last, but not least, be sure to implement some sort of easily accessed, online reference and/or learning management system where current users can go for refresher information and new users can take training and read up on what they missed during go-live training.

 

Sounds like a lot, I know; but without all three - - IT, Change Management and Training, EMR implementations will not succeed to the level our organizations need.  With these professionals working together, we can achieve:

• Increased adoption of the many changes from paper to paper-lite
• Increased project ROI
• Improved patient safety and patient satisfaction due to greater accuracy by users
• Improved employee satisfaction because they can provide quality patient care
• Comprehensive, user-friendly, training that is designed and delivered before go-live to everyone who will use the EMR
• Validated transfer of knowledge via learning assessments in the training
• Refresher and ongoing training available for future employees and contractors
• Shortened user time to efficiency
• User-friendly online reference tools and/or learning management system

As always, I love to get comments from my readers.  Please let me know if your experience with EMR implementations and training are in alignment with mine.

 

Jonena

 

TBD Consulting has a 19-year, proven track record for ensuring employee performance improvement which translates to EMR usage and patient care success.  Organizations interested in ensuring true ROI for an EMR implementation, please contact our Corporate office at 602-263-1961.

 

TBD Consulting, Inc. Solutions…Not Just Strategies!

Wishing you a Healthy and Prosperous 2010!

Posted by:  Jonena Relth, President and Leadership Evangelist

 

As we approach the New Year, we are prompted to pause for a moment, count our many blessings and to thank you, our customers, suppliers and associates who have helped to make our success possible.  Yes, it’s been a challenging year as we have all worked to weather the financial difficulties plaguing our great country, but we still have so many reasons to be grateful.

Fitting with our tradition, we have once again experienced a year of change.  I formally changed my title to President and Leadership Evangelist.  Yes, I'm on a quest to spread the word on Transparent Leadership and why our country and business' must get on board with the the concept of leading with transparancy, honesty and trust.

 

We’ve tightened our belts and concentrated on meeting the needs of our active clients while getting our COREformance Curriculum ready to sell as off-the-shelf products.  We re-launched our island in Second Life, Learning Innovation Campus, as a learning incubator for learning professionals to collaborate and grow with the many demands of the changing learning landscape.  Drop by and even consider joining us as a resident.  http://slurl.com/secondlife/Learning%20Innovation/128/148/24

 

We started the EMR / EHR Clinical Transoformation Group in LinkedIn, which is growing and has many active members. Additionally, we’ve launched two new blogs:  Second Life Learning Innovation Campus and Healthcare Talent Transformation.  All of our blogs can be accessed from our webpage:  www.tbdconsulting.com.

 

One thing will always remain the same: Our commitment to our customers as we strive to help you improve your performance management, employee engagement and process effectiveness.

Wishing you a Healthy and Prosperous 2010!

 

Jonena L. Relth and Staff

Hey, maybe it isn’t so bad after all! New Poll: American Confidence in Access to Care Is Growing

Posted by: Peggy Salvatore

 

"Americans are showing more confidence in their ability to get and afford the health care they need, according to a poll released Tuesday,” The Associated Press reports on Cleveland.com.  Jul 22, 2009

 

This Associated Press story comes with many caveats, and it is based on Robert Wood Johnson monthly polls that are not considered statistically valid, but rather a sample of opinions collected unscientifically. But certainly, the top line is instructive as health reform efforts wend their way through Congress past a wary citizenry. To sum it up, Americans are looking at the current administration, the economy and the fate of companies like GM and Chrysler, and saying to themselves, “Hey, maybe our healthcare system isn’t so bad after all!”

 

• Can we afford all the care we need and want? For most folks, the answer is sometimes but not always.

• Do we always get the best care the first time? For most folks, the answer is not always.

• Do we think some services may be overpriced? Sure.

• Do we think we can do better, give more care to more people and lower costs in the bargain? Sure we do. It is in our collective character to wonder how we can do it better, cheaper and help more people. We are innovators and humanitarians. Those traits are hard-wired into our national psyche.

 

So, it’s not that Americans don’t want to tackle health reform. We are just looking a bit askance at the current players who want to improve the system and find ourselves asking if this is the gang and these are the conditions under which we want to conduct that good old American exercise of continuing to make a good thing better.

The Hot Health Reform Debacle

Posted by: Peggy Salvatore

More heat than light in the dog days of summer. So, turn on the ceiling fan, fill an ice tea glass, and sit back in the lounge chair to take a long, cool look at the health reform debacle.

Back in June, I spoke on the health system at a Toastmaster’s meeting locally here in Pennsylvania. My subject dealt briefly with the structure of the health system, and was inherently and intentionally benign. Afterwards, I was approached by members of the group who said, “You didn’t mention the uninsured,” and the ever-popular, “Why didn’t you talk about a nationalized health system, like they have in Canada?”

Quite on purpose, my passion and mission is education about the system.  Informed debate is the best vehicle for defining a problem and crafting a solution to that problem. Under the hot August sun, our collective national passions have been ignited in town hall debates around the country.  The health care debates are informed by our personal – read: emotional – experiences with the health system and propelled by our political proclivities.

Let’s slowly swirl the ice cubes around in our tall glass and consider that there are those stubborn things called facts that will ultimately, whether we include or ignore them, drive outcomes. In the quest for higher quality, lower costs and the pursuit of a truly compassionate patient experience, let’s consider that the more we know about the health system, using the best data collected under optimum conditions, will give us the right answers. You can hear the solutions just under the din of the fan blades overhead.

 

CER and EHR: The Acronyms for Rationing? Or are they?

Posted by: Peggy Salvatore

Fear mongering is usually the fodder of the political campaign season. Not this year. The US is so politically divided that the campaigning (read: fear-mongering) doesn’t stop as both political camps stake out their territory on all the issues – carbon cap-and-trade, bank bailouts, car company bailouts and, of course, the ever-popular nationalization of healthcare.

The bogeyman of opponents of nationalized healthcare is the specter of rationing. Just like all very complex and expensive issues, healthcare rationing is not easy to explain or execute.  Making rationing work requires a well-funded item in the Congressional budget called Comparative Effectiveness Research, known as CER.  Valid CER is not possible without another acronym, EHR. We need fully implemented and interoperable electronic health records to get good CER. I’ll tell you why.

Comparative Effectiveness Research really just means that we know which treatments, therapies and procedures work best for whom and at what cost. Then we decide how much to pay for them based on that knowledge. To get the answer to the question what works best for whom and at what cost, we need to have the results of everyone’s experience.

1. I mean everyone, not just a select population -  fully documented over time.
2. I mean a lot of time and what it costs – I mean really costs taking into consideration all that time.

Then people can make supportable decisions about choosing the very best treatment, therapy or procedure the first time for the correct patients.

To get truly valid data about what works, we have to collect everyone’s experience with every encounter with every provider, organization, product, and service over about a generation.

What we do with that information might be called rationing to fear mongers. It might be called verifiable best practices to others, resulting in cost-effective and efficient, quality care.

Rationing has to do with letting the payer decide whether to pay for the best practices we learn from the information we get from EHR. The payer, not the patient, decides what to do with the  information we learn from CER. In that light, perhaps the idea of a one-payer system, especially if that system is the government, needs a closer look.

[Blogger’s note: Most researchers and statisticians will tell you that my conditions for valid CER – everybody, all experiences, over lots of time – are rubbish. To understand my position, I refer you to one of my favorite expressions that I sent my three children off to college with: There are lies, damned lies, and statistics. Question everything, then cut the cards, or something like that. Give me lots of good data, over lots of time, involving lots of people, and I’ll give you lots of good information.]

Peggy Salvatore has been developing managed care and healthcare reimbursement web-based training programs for the healthcare industry for 10 years. She also writes eLearning programs on general business topics such as time management, project management and leadership. Prior to that, her background includes extensive research, analysis and writing for professional journal articles, white papers and executive background briefings on a broad range of health policy issues. She was a political reporter and columnist and covered the 1988 Republican National Convention before leaving daily journalism for the business world. She holds an MBA with a concentration in strategy and economics.

A Whitman’s Sampler of EHR Issues

Posted by: Peggy Salvatore

Remember the Whitman’s Sampler? It was that big yellow box of high-cal, low-cost chocolates in the drug store near the checkout on Mother’s Day wrapped in an ersatz pink bow imprinted on the box. When you opened the box, every candy was different. So, Mom bit in with great anticipation – was it cherry crème or peanut cluster?

Today’s health news headlines are like a Whitman’s Sampler of issues, each one containing some luscious nugget that suggests how the implementation of electronic health records might impact the healthcare system.

Let’s pick a few morsels from the news, courtesy of HealthLeaders Media on July 30, 2009. http://www.healthleadersmedia.com/enewsletter/web-version/HealthLeadersMediaDaily_30_July2009.html

“Millions of Dollars are Lost Because of Miscoded Durable Medical Equipment Supply Claims. Durable medical equipment suppliers miscoded claims in 2006 resulting in the federal government, private insurance, and individuals overpaying them $42 million for items like wheelchairs and oxygen, an investigation by the Office of Inspector General said yesterday.”

How might we make sure we are paying the right price for DME on time and with less administrative cost? Proper coding saves time, efficient electronic billing and payments tied to the codes expedite correct payment. As one wag said, a million here and a million there, and pretty soon you are talking about real money. DME coding is just one financial leak in the system that can be repaired.

Or how about this little nugget:

“Red Flags Deadline Pushed Back Again. The Federal Trade Commission announced today that—for a third time—it has pushed back enforcement of the Red Flags anti-fraud regulations until Nov. 1, a full year after it was first scheduled to take effect.”

Red Flag compliance is about making sure financial institutions and creditors have written identity theft programs.  For our purpose here, the interesting fact we take away is that government agencies make a lot of rules and regulations, but they often don’t take effect when or how they are supposed to. A lot happens between the law and its implementation, so consider that fact as you look at the laws regarding electronic health records, how timelines affect you, and the kinds of implementation procedures you may need.

A look into the sampler box of news items every day reveals yet another flavor of issues. And, of course, each problem contains its own solution. There is no problem or issue facing the health system that we can’t resolve by tapping into the deep reserve of brilliant, caring people who populate our hospitals, medical offices, research facilities, insurance industry and manufacturing sectors.  Interconnect these people, their financial and medical information, and put it to the service of patients in the interest of quality care at a reasonable cost using the information technology at our disposal today, and you’ve got a boxful of answers.

Smart Change: Healthcare Intelligence

Posted by: Peggy Salvatore

“Now or never.” These are the words of the President of the United States on health reform. Today, we in America are faced with making critical decisions regarding the future of our healthcare system. We all have opinions about how to improve our system to serve more people, make it more affordable, and improve the quality of care. Our opinions are almost always based in personal experiences, such as when you took your child to the ED or your mom to the oncologist.

With a nod to the fact that this is an incredibly complex issue and there is no simple solution, some changes to our current system will simply be smarter than others and net better long-term results.

Ponder a personal experience and consider what could have improved the interaction with your physician, hospital or pharmacy. All politics is local, and all healthcare is – ultimately- personal. Think about it.

What is the best experience you’ve had? The worst? The one you wouldn’t wish on your worst enemy? And what could have made it better?

Here is where I’ll start to beat my personal drum: electronic health records, when fully integrated and secure, will solve many quality-of-care issues, lower system costs and, by extension, make care accessible to more people.

How would your complete medical record, accessible to all your caregivers, have affected your experience in the health care system?

Smart change requires intelligence. We have the electronic capability to gather good intelligence and use it. Estimates say it will take a full generation to put enough medical data online to reap the benefits of our investment. “Time’s a’wastin”. The government’s offering the money to make it happen now. So, how ‘bout it?

Peggy Salvatore has been developing managed care and healthcare reimbursement web-based training programs for the healthcare industry for 10 years. She also writes eLearning programs on general business topics such as time management, project management and leadership. Prior to that, her background includes extensive research, analysis and writing for professional journal articles, white papers and executive background briefings on a broad range of health policy issues. She was a political reporter and columnist and covered the 1988 Republican National Convention before leaving daily journalism for the business world. She holds an MBA with a concentration in strategy and economics.

Stop The Train, Senator Kennedy! I Need To Go To The Potty!

As President of TBD Consulting, I am pleased to introduce you to our newest guest blogger, Peggy Salvatore, whose concentration will be on healthcare.  Coming Soon: A new healthcare blog that you can sign up for feeds to learn about the latest news and Healthcare Intelligence information.

 

 

 

Peggy Salvatore has been developing managed care and healthcare reimbursement web-based training programs for the healthcare industry for 10 years. She also writes eLearning programs on general business topics such as time management, project management and leadership. Prior to that, her background includes extensive research, analysis and writing for professional journal articles, white papers and executive background briefings on a broad range of health policy issues. She was a political reporter and columnist and covered the 1988 Republican National Convention before leaving daily journalism for the business world. She holds an MBA with a concentration in strategy and economics.

 

From Modern Physician Alert: HELP Committee approves Kennedy healthcare reform bill

 July 15, 2009 10:42 a.m. EDT

Breaking News

 The Senate Health, Education, Labor and Pensions Committee voted 13-10 along party lines to approve Sen. Edward Kennedy's comprehensive healthcare reform bill, the Affordable Health Choices Act.

Stop The Train, Senator Kennedy! I Need To Go To The Potty!

I am convinced that we are never more impressionable than when we are 2, 3 and 4 years old. Some of those very early memories, conscious or not, imprint forever. We have reactions at 50 years old that stem from, well, our brain stem, a place forever altered by significant emotional events when we were too young to filter them or categorize them logically into something we could process rationally. 

One of those events for me was a very comical moment when I was 4 years old. *How long ago was that? Way back before Medicare and Medicaid were enacted, so don’t ask!* In any event, our family mud room contained an open steel-tubed coat rack with a shelf on the bottom for shoes where my 2-year-old sister and I would sit to play a game called “train.” As the older sister, I got to be the engineer and drive the train. She obediently sat behind me and rode along as we rocked the coat rack back and forth in a swaying, train-like motion. One day, soon after her potty training had taken effect, she felt the urge to use her new bathroom skills while we were chugging along. But being a good passenger, my sister didn’t disembark while we were in motion. She wailed from behind me, “Stop the train! I need to go potty!”

Forever etched in my memory is urgent cry of “stop the train!” to avert an impending disaster. Today, as the headlines blared that Sen. Edward Kennedy (D. Mass) pushed a health reform bill through the Senate Health, Education, Labor and Pensions (HELP) Committee, I could hear the plaintive cry from the back of the coat rack to “stop the train!” It is that sense of impending disaster that lurks in my brain stem leftover from my years as a coat rack engineer.

The health reform bill is over 1,000 pages. Who has read them? Who understands all of the implications among the tons of verbiage planted by hundreds of wonks in the leafy, lurking monster that is the Kennedy health reform bill? Who can extrapolate the myriad unintended consequences of those implications? Is it just a coincidence that the acronym for the Senate committee is HELP?

Just asking…