Tag: health care

OM Podcast #41: Healthcare Supply Chains

In our latest podcast Barry Render is joined by Misty Blessley, professor of supply chain at Temple University, to co-host a conversation with Jennifer Taylor, Director of Contracts at Universal Health Services (UHS).

Jennifer shares her journey to leading procurement and sourcing at one of the nation’s largest healthcare providers. The discussion covers the challenges of transitioning industries, managing purchasing across hundreds of facilities, and navigating the complexities of tariffs and product allocations in healthcare supply chains.

Jennifer Taylor

You’ll also hear about UHS’s innovative internship

Misty Blessley

program designed to build a pipeline of young talent in supply chain management—and how it’s already producing full-time hires.

 

Barry Render

 

TRANSCRIPT
A Word document of this podcast will download by clicking the word Transcript above.

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Guest Post: Health Care and Location

Prof. Howard Weiss, who developed the Excel OM and POM software that comes free with our text, shares his insights monthly.

Figure 8.1 in the Location Chapter in your Heizer/Render/Munson textbook explains that two of the factors that affect site location decisions are proximity of services and customer density. Consider doctor visits.

House Calls
At the turn of the 20th century, family doctors would come to a patient’s house to give medical attention. For the patient, visits could not be more proximate than at home. House calls peaked in the 1930s but the life cycle of house calls is essentially at the end today. One reason is that there are fewer family doctors now. Another reason has to do with insurance company reimbursement requirements. There are, however, more visiting nurses, physical therapists and other medical care personnel making house calls.

Urgent Care
In the 1970s, doctors began to open urgent care centers to serve patients who do not have emergency needs. There are over 10,000 urgent care centers in the U.S. The advantages of urgent care centers are
 Centers typically do not require an appointment
 Centers are open for more hours than doctors’ offices.
 In most cases, patients are within a 10-minute drive of a center.
 Centers generally post fees and these fees are typically less than the fee at a doctor’s office or emergency room.

Mobile Health Clinics
Also, in the 1970s, health care organizations began using mobile health clinics to serve rural and underrepresented areas that have less patient density. There are over 2,000 mobile clinics in the U.S. each providing an average of 3,500 visits annually.

Medical clinics in retail outlets
Around the turn of the 21 st century, pharmacies, supermarkets and other retail outlets began to place medical clinics in their facilities. These clinics are more plentiful than mobile clinics and create a win-win situation for the patient and the retail outlet. Advantages to the patient are the same as those for urgent care centers. The advantage to the retail outlet is that the clinic increases foot traffic to the store and yields a new revenue stream.

Telehealth visits
The most recent location change has been telehealth. This brings us back full-circle to care in the home as the patient is home and communicates with a doctor via internet or telephone. Telehealth also includes using devices, such as heart monitors, that send information to the doctor’s office. There are. however, still some legal issues surrounding telehealth.

Classroom Discussion Questions:
1. Where was your last visit to a physician?
2. What might some of the legal issues of telehealth be?

OM in the News: The Dangers in Measuring Hospital Quality

nurseOne of our definitions of quality in Chapter 6 is user based: “quality lies in the eyes of the beholder.” The Atlantic’s article (April 17, 2015), titled “The Problem With Satisfied Patients,” states though, that a misguided attempt to improve healthcare has led some hospitals to focus on making people happy, rather than making them well. When healthcare is at its best, hospitals are 4-star hotels, and nurses, personal butlers at the ready—at least, that’s how many hospitals seem to interpret the government mandate by the Department of Health and Human Services. DHHS announced that 30% of hospitals’ Medicare reimbursement would be based on patient satisfaction survey scores. The goal: transparency and accountability, which would improve healthcare.

But a recent study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Worse, the most satisfied patients were significantly more likely to die in the next 4 years. As one MD said: “Patients can be very satisfied and dead an hour later.”

The concept of “patient experience” has characterized patients as customers and nurses as automatons. Some hospital job postings advertise that they are looking for nurses with “good customer-service skills” as their first qualification. By treating patients like customers, hospitals accept the cultural notion that the customer is always right. But hospitals, too, can offer poor care and still get high patient-satisfaction ratings. A study of poor performing hospitals found that 2/3 of them scored higher than the national average on the key patient question; “YES, they would definitely recommend the hospital.”

Research has shown that hiring more nurses is the true key to patient satisfaction. Higher staffing of nurses has been linked to fewer patient deaths and improved quality of health. Failure-to-rescue rates drop. Patients are less likely to die or to get readmitted to the hospital. Their hospital stay is shorter and their likelihood of being the victim of a fatigue-related error is lower.

Classroom discussion questions:
1. What are the definitions of quality (see Chapter 6) and how do they relate to hospitals?

2. What are the flaws, if any,  in surveying patients to measure hospital quality?

OM in the News: Measuring Health Care Quality

hospital“The goal of tying more Medicare payments to the quality—not the quantity—of health care by 2018 has intensified the debate over how ‘quality’ is defined and measured,” writes The Wall Street Journal (Jan. 31-Feb.1, 2015). Many doctors, hospitals, insurers and cost experts want to move away from the myriad quality metrics that largely measure process–toward broader measures that assess patient outcomes. This week, the National Quality Forum submitted recommendations on 199 performance measures to the U.S. Dept. of Health and Human Services. The goal is to better align measures among various programs and replace narrow process-oriented metrics with “measures that matter.”

Some doctors question whether the measures that exist can adequately measure quality. And there is little agreement on what measures matter most or are more likely to produce good value. “Measurement fatigue is a real problem in hospitals,” said a Dartmouth medical prof. “But, to me, the only metric that matters is, did you get better?”

As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures. State, local and private health plans use hundreds more. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use. The Centers for Medicare and Medicaid Services wants to move toward more quality measures “that matter most to patients and clinicians,” and note that some already had an impact on outcomes. Central-line bloodstream infections have dropped by 50% since hospitals were required to report them, and 150,000 fewer Medicare patients were readmitted to hospitals within 30 days of discharge in 2012-2013 under a federal program holding them accountable. More than 2,600 hospitals will see their Medicare payments cut 1- 3% this year—a total of $428 million— for not reducing 30-day readmissions sufficiently.

Classroom discussion questions:

1. What are the advantages and disadvantages of setting quality metrics?

2. Why do doctors oppose some of the quality measures?

Good OM Reading: Health Care Kaizen

Paula’s husband had just come out of open-heart surgery. Laying in the recovery room with a breathing tube in his throat, he was clearly agitated. He motioned at his arms to try sign language, but the limbs would not move. Paula (a nurse at the hospital) began to panic along with him. When the anesthesia wore off, he said his hands and arms were numb–they remained so for weeks. It turns out that when surgeons performed the procedure, they had leaned over the  man and put pressure on his arms. With a single, small improvement, a nurse found that arm sled “positioners” could be used to tuck a patient’s limbs in place while removing the pressure.

This story is just one of 100’s in a new book called Health Care Kaizen, by Graban and Swartz, that describes small improvements made by those who do the work.  Kaizens are low-cost, low-risk process changes that can be easily implemented. The idea, say the authors, is to challenge and empower everyone in the organization to use their creative ideas to improve their daily work. And what better a place to see improvements than in our health care systems!

It is often said that “people hate change.” But in this readable book, we see that people actually love change when:  (1) they are fully engaged in the process, (2) they get to make improvements that help patients, and (3)  they don’t fear losing their jobs as a result of the changes. At one hospital, the CEO offered to shave his head if employees generated ideas that saved $3.5 million that year. The staff responded with $7 million in savings (such as $22,000 by switching from paper gowns to cloth ones) and the boss shaved in public.

At another, the neonatal ICU had automated paper towel dispensers. A nurse noticed babies flinching from the ongoing noise and decided to study the impact of what turned out to be a 50 decibel sound. The kaizen result was manual dispensers which allowed babies to get more rest, thereby gaining weight and getting home sooner–saving $2,000/day ICU fees.

Whether you teach health care OM or are looking for great examples of kaizen for class, this is a book worth reading.

OM in the News: Iowa Hospitals Saving Millions With Lean Techniques

Though lean has been around for the past 3 decades in manufacturing,  its use in driving health-care performance improvement has been much more recent.  In fact, many of the lean specialists working at hospitals  have been hired from manufacturing companies in the past 6 years. They’re now applying skills once devoted to making factory floors more efficient to health-care challenges such as decreasing patients’ waiting time in ERs.

The Business Record (Feb. 24, 2012)  just  reported that in my home  State of Iowa (I was born in Dubuque), more than 70% of the 118 hospitals say they are now using lean techniques. This is up from 50% just 3 years ago. The Iowa Medical Society provides 73 separate detailed, and on-line, monthly quality measures based on reports from all of the state’s hospitals.

Iowa’s 2 major quality goals are to reduce hospital-acquired infections by 40% and reduce preventable readmissions by 20%. If these two goals were achieved nationwide, health care costs in the US would be reduced by $35 billion. Since the Congressional Budget Office (CBO) expects health-care spending to increase at a rate of 8%  per year between now and 2022, Medicare/Medicaid programs will double in the next decade to $1.8 trillion, or 7.3% of our nation’s total economic output.

Under the Patient Protection Act, hospitals’  medical reimbursement payments will be linked to their performance on such procedures as cardiac, surgical, and pneumonia care. “Health care is turning to lean to continue to stay in business,” says the CEO of  the Iowa Healthcare Collaborative. Currently, one of its biggest projects is an initiative to ensure operating room supplies are delivered to the right place at the right time, to minimize unnecessary movements of supplies.

You might want to show the Arnold Palmer Hospital video on JIT (see Ch.16) if you discuss this article with your class. It illustrates the many ways OM and lean are  critical to the future of hospitals.

Discussion questions:

1. Why is lean so important in the health-care system?

2. Name several areas in which lean can be applied in a hospital.