Tag: hospital

OM in the News: Building a Hospital in Wuhan, China in 10 Days

Among the serious issues facing China as the coronavirus continues to spread, are the impact of the border, factory, and store closings, and shutdowns which are beginning to affect global supply chains from auto parts to iPhones (see our blog on Feb. 2, 2020). Facing criticism that the official response to the outbreak was delayed, the Chinese government has stepped up containment. One of its initiatives was to build two new hospitals in Wuhan –in 10 days! Since our Chapter 3 video case study, “Project Management at Arnold Palmer Hospital,” details that 60 month construction task (which included 13 months of planning), this OM project is worth discussing with your class.

Here is how The New York Times (Feb. 4, 2020) describes the task, which began on Jan. 24th:

Construction teams of 7,000 workers with armies of trucks and excavators dug and scraped around the clock. The city government completed a feat recalling the SARS epidemic of 2003, when Beijing built a hospital in a week. For China, the new Wuhan facility would also serve as a potent symbol of the government’s drive to do what needs to be done. Leaders pledged to build the 1,000-bed complex in 10 days and vowed that another new 1,600-bed hospital would be ready by Feb. 5.

Wuhan, a city of 11 million, has been eerily quiet since the authorities locked it down, preventing residents from leaving and severely limiting public transportation and private cars. But the roads around the hospital building site were packed with cement mixers, trucks and other construction vehicles. Migrant workers and suppliers of materials were roped in to build the complex. Workplace safety precautions included temperature checks to try to detect signs of coronavirus infections. By Feb. 3rd, ambulances begun transporting patients to the new hospital.

Classroom discussion qestions:

  1. How did this project differ from the construction of the Arnold Palmer Hospital in Orlando?
  2.  Could this project be replicated in the US? Why or why not?

 

OM in the News: Time & Motion Studies and Knee Surgery

“Competitive forces are out of whack in health care,” writes The Wall Street Journal (Aug. 22, 2018). Hospitals are often ignorant about their actual costs. Instead, they often increase prices to meet profit targets. For nearly a decade, Gundersen Health System’s hospital in Wisconsin boosted the price of knee-replacement surgery 3% a year till the list price was more than $50,000, including the doctors. Yet administrators admitted they had no idea what it cost to perform the surgery—the most common for hospitals outside of childbirth.

So during an 18-month review, a Time & Motion expert trailed doctors and nurses to record every minute of activity and note instruments, resources and medicines used. The hospital tallied the time nurses spent wheeling around VCR carts, a mismatch of available postsurgery beds, unnecessarily costly bone cement, and delays dispatching physical therapists to get patients moving. The actual cost? $10,550–everything included. On average, a nurse assistant needed 10 minutes to collect personal items from patients before surgery. A technician took another 20 minutes to insert an IV into patients. Time spent in Gundersen’s operating room—the most expensive minutes of a patient’s hospital visit—averaged 95 to 105 minutes.

On busy days, the hospital had no available beds for knee-replacement patients after surgery. Patients with nowhere to go remained in temporary postsurgical units for as long as 24 hours, prolonging their recovery. Also, the hospital had been exclusively using brand-name cement, premixed with antibiotics. It slashed its cement costs by 57% by switching to a generic, which can be used with the same results. Changes to this series of processes means the knee surgery now costs the hospital an average of $8,700 to perform, an 18% savings. The more Gundersen wrings from its costs, the more profit it earns.

It turns out that on knee-replacement surgery, higher-cost U.S. hospitals spent almost twice the amount lower-cost hospitals spent, despite similar quality and comparable patients.

Classroom discussion questions:

  1. What tools in Chapter 10 were likely used in this study?
  2. What might be the hospital’s next step to improve operational efficiency?

OM in the News: Amazon Targets the Hospital Supply Chain

Amazon is seeking to supply hospitals.

Amazon, always expanding, is pushing to turn its nascent medical-products business into a major supplier to U.S. hospitals and outpatient clinics that could compete with distributors of items ranging from gauze to hip implants. “The firm is expanding its business-to-business marketplace, Amazon Business, into one where hospitals could shop to stock outpatient locations, operating suites and ERs,” writes The Wall Street Journal (Feb.14, 2018).

The market for medical supplies is one of a growing number of businesses the online retail giant has set in its sights, from groceries to clothing, often with market-moving results. Amazon said it seeking to sell hospitals on a “marketplace concept” that differs from typical hospital purchasing, which is conducted through contracts with distributors and manufacturers.

“Our goal is to be something new,” said Amazon’s head of global health care. “We’ve been actively building out new capabilities and features to simplify purchasing.” Amazon’s comparison-shopping ethos could shake up the hospital- and clinic-supply business, where middlemen fees add costs and proprietary contracts obscure price differences. But Amazon faces challenges. Some hospitals have been reluctant to buy supplies from Amazon Business, for reasons including lack of options and lack of control over purchases and shipping.

When doctors and nurses reach for a familiar product, they know its specifications. Jumping online to look for the best deal could disrupt that continuity. Hospitals today typically sign contracts to buy supplies directly from manufacturers or from distributors, which include Owens & Minor, Medline Industries, McKesson, and Cardinal Health. Also in the chain are companies known as group-purchasing organizations that negotiate on behalf of multiple hospital buyers, seeking to leverage collective demand. Hospitals formed and own a stake in many such groups, as we note in our Video Case Study “Arnold Palmer Hospital’s Supply Chain” in Chapter 11.

Classroom discussion questions:

  1. Describe the role of the group purchasing organization (GPO) in the hospital supply business.
  2. Refer to the Arnold Palmer Hospital case study in Ch. 11. How does that organization’s supply chain work?

OM in the News: Kaizen at San Francisco General Hospital

Kaizen team leader at SF General Hospital
Kaizen team leader at SF General Hospital

At San Francisco General Hospital, clinicians, executives and staff are peppering their conversations with Japanese words like kaizen and muda.  This “Toyota Way”, writes the San Francisco Chronicle (Oct. 14, 2013),  is an effort to infuse the Japanese automaker’s management philosophy and practices into the way the hospital delivers medicine to its patients.

To make the system work, a team of employees is assigned to analyze a particular area targeted for improvement. The group immerses itself in a weeklong, hands-on session, and emerges with a plan to make specific changes designed to have a big impact on costs or the patient’s experience. One recent kaizen focused on the number of minutes it takes from the moment a patient is wheeled into the operating room to when the first incision is made. A team spent a week trying to come up with ways to whittle 10 minutes off the hospital’s average “wheels in” to incision time of 40 minutes. Another targeted the Urgent Care Center and dropped the average wait from 5 hours down to 2.5 by adding an on-site X-ray machine–instead of forcing patients to endure a 15 min. walk to the main radiology department.

Toyota’s production system has been increasingly adopted by hospitals trying to improve medical quality and increase patient satisfaction. Here are some of its Japanese terms, many of which do not have a direct English translation: Gemba: the place where work is performed. Hansei: a period of critical self reflection. Heijunka: a level production schedule that provides balance and smooths day-to-day variation. Jidoka: using both human intelligence and technology to stop a process at the first sign of a potential problem. Kaizen: continuous improvement. Kanban: a visual card or signal used to trigger the fulfillment of need, such as restocking supplies. Muda: anything that consumes resources but provides no value. Poke-yoke: a mistake-proofing device that prevents errors.

(Ironically, the day before this flattering article about quality appeared, NBC News reported that SF General  lost a 57-year old female patient for 2 weeks–she was just found dead in a hospital stairway.)

Classroom discussion questions:

1. Why are hospitals adopting the “Toyota Way”?

2. Which of the many Japanese terms above could have prevented the lost patient?

OM in the News: RFID Tags Ensure Hospital Hygiene Practices

Wristband contains RFID reader and motion sensors to measure hygiene
Wristband contains RFID reader and motion sensors to measure hygiene

My wife was so disturbed with yesterday’s post about hospital quality problems, that I decided to provide a positive hospital story today. RFID Journal (April 1, 2013) reports  that IntelligentM has developed a hospital solution that employs RFID readers built into wristbands to identify tags on soap dispensers, intravenous (IV) solution packaging, surgical drains and ID badges–thereby alerting users if they fail to wash their hands, or need to do so more thoroughly.

Users’ wristbands incorporate very small readers that interrogate RFID tags installed on sinks, disinfectant dispensers and other objects. IntelligentM also sends weekly hand-hygiene “report cards” to employees. In developing the system, the firm wanted to be able to provide alerts that would lead to corrective action being taken before a patient was exposed to potentially infectious materials. The wristband is small enough so as not to be cumbersome to users who may also be wearing and removing rubber gloves.

When the nurse places her hand under a sanitizer or soap dispenser, the wristband reader interrogates the tag mounted there. The reader vibrates once, reminding the wristband bearer to indeed wash her hands, and indicating that it has read the dispenser’s tag. If the band detects that she has stopped washing before the proper amount of predetermined scrubbing time has elapsed, it vibrates three pulses, thereby prompting her to wash her hands a second time using the proper procedure.

When the nurse meets with a patient and begins a procedure, such as opening an IV package, a tag on that package is read and the system again identifies the action based on the tag’s ID number. The wristband’s software checks its database to determine the last time this worker had washed her hands. If it was not recent enough, the tag vibrates three times to indicate she must wash her hands before continuing the procedure.

Discussion questions:

1. What other uses for RFID can you envision in hospitals?

2. What prevents this system from being universally applied?

Video Tip: Lean Six-Sigma at Franciscan St. Elizabeth Hospital

I just came across a wonderful 5-minute video about lean six-sigma that Mark Graban mentioned in his blog–one of my favorites– about Lean Hospitals (see our Links We Like on the right side). The video is narrated by Brian Hudson, a  researcher at Franciscan St. Elizabeth Hospital.  Hudson was trying to improve the time it takes to get a patient with chest pain from “door” (arrival at the hospital) to “balloon” (insertion of a tube to unblock a clogged artery) down  from 114 minutes to the national standard of 90 minutes. A faster “door to balloon ” time often is the difference between life and death for a heart attack patient.

A year after Hudson started his research in 2007, using lean 6-sigma, he had been able to get his hospital’s average to 74 minutes. In 2009, Hudson suffered a heart attack, watching the clock in the emergency room the whole time with the same mental checklist he had developed for doctors. If you don’t show this video in class, watch it yourself–it may save your life!