Designing Daily Plans & Hospital Reorganization
How to get started Designing Daily Plans and Hospital reorganizations. This is a quick look at the decisions to be made and how they can be implemented.
Selecting the Routine Procedure to Start With
1. In Article 113. I have listed 15 possible Procedures that appear to fit the category of being routine and relatively safe. I would select an outpatient Procedure first because it is less expensive when the its time to reorganize the hospital facility.
2. The Enterprise Lean Team (aka Continuous Improvement Team) must be in place and a part of the Procedure team selected and meet at least once a week. More meetings will be required as the design of the Daily Plan progresses.
3. Introduce the Lean Team (CI Team) to the concept of the Daily Plan and the reorganization of facilities to support the Daily Plan. Objective to change a low patient volume/high cost Procedure into a high patient volume / low cost Procedure.
4. The selected Procedure is an entirely separate Procedure from all other Procedures in a hospital environment completely staffed with its own facilities. The reason for not having shared facilities is that the Scheduling would destroy the balanced operations of the selected Procedure.
5. The most basic element driving the design is Patient volume. An entire metropolitan area may be available for certain procedures due to the low cost of the Procedure. This will drive the design of the daily plan to handle more volume and will also increase the facilities required. Early on a Patient Volume survey should be conducted for each of the procedures in the metro area identifying overall patient volume and those expected to use the new facility.
For lower patient volume two Completely separate Procedures may be designed using the same facility. The staff would be trained to do two separate Procedures with two separate Daily Plans alternating between them to keep patient volume stable.
What’s needed to build a Daily Plan?
1. Precise times for all the processes done must be known. To these times a increase of 25% is added as a protection from unintended delays. Remember the objective is to work smarter not harder savings come from the continuous operation of the process not from the speed of the process.
2. First take the time of the doctor or surgeons process as a base time identifying how many patient operations can be done in one day. Then identify all processes leading up to the surgery and those following the surgery. For example if a nurse requires twice as much time as the surgery process then two nurses will be required each preparing a different patient in a different room (two Rooms Required). The resulting Daily Plan will balance all the processes allowing no one to wait on another employee.
Patient backlog means that the staff does not wait on patients. If work times can not be balanced then the extra time a staff person has can be designated as “Preparation Time”.
3. With a sufficient backlog of patients the Daily Plan becomes a smooth running operation virtually eliminating Management intervention for budgeting and Scheduling. Supplies are ordered automatically.
Hospital Reorganization
1. If a general hospital is to be reorganized planning for Hospital reorganization should not be under taken until all the Procedures using the hospital facility are known and least most of them have their Daily Plans completed.
2. If several Procedures are using the same hospital facility then the hospital reorganization will encompass all of the Procedures supporting their Daily plans.
3. If the Procedures can be separated into separate clinic facilities then the reorganization process becomes much simpler. Ref: Cataract Surgery Clinic proposed in Article 110 and Article 111. Designing a High Patient Volume Low Cost Hospital.
Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com
Thursday, November 30, 2017
Friday, November 24, 2017
Article 113. Five Year Plan for Missouri Health Care System
Five Year Plan for Missouri Health Care System (MHCS)
Developed by Lawrence Rosier Consulting on November 27, 2017. Ref: LawrenceRosierConsulting Blog Articles 112, 111, 109, 107.
This plan embodies far reaching strategic thinking that overturns false ideas about Health Care and reduces the cost of Health Care in Missouri significantly. Because of the movement from Private for-profit Health care system to not for-profit Missouri government managed hospitals a five year adjustment period is needed. This is an important backup plan that brings Missouri into solvency in health care regardless of what the Federal Government does in a National Health Care plan.
Facts about the current health care system, it is a growth industry that appears to have no limits in cost projections. US Private health care costs double that of European government based health care, neither have the efficient approach embodied in this Plan. Converting from a Private profit based to a not for-profit or government based health care system is expected to reduce Health care costs by 50% due to the reduction in fraud and other efficiency reasons but with increased efficiency I have estimated a conservative 60% reduction in overall health care costs in the new high volume/low cost specialized health care system.
Medicaid
Medicaid costs in Missouri is 9.9 $billion. Only about 10% or $1billion of this cost can be reduced by the efficiency in hospital operations presented in this Plan. Much of Medicaid costs are in long term care where some efficiencies may be implemented by Lean Teams.
Medicare
Medicare however presents a much different view because funding by the Federal Government would go directly to the state of Missouri providing the funding needed to convert private hospitals acquired by the State in its conversion to the Missouri Health Care System (MHCS). An agreement with the Federal government to pay the full amount of Medicare costs to the State until the new efficient system can be developed may be required or the Federal Government might chose funding Missouri’s MHCS. Ref: the example Cataract Surgery Clinic with a 90% decrease in costs at LawrenceRosierConsulting Blog Articles 110,109.
Missouri’s Health Care System (MHCS) Open to all Missourians
As the system grows in the last years of this plan the Missouri Health Care System would be available to all Missourians, open to those with or without insurance. MHCS expected costs to be 20% to 50% less than Private Hospitals. Insurance companies may provide incentives for those insured to use the new system.
Starting the Reorganization
A not for-profit General hospital is selected in a large city. General Hospitals do nearly all procedures therefore they are low volume/high cost facilities. Nearly all routine procedures are removed and reorganized into high patient volume/low cost specialized Clinics. The General Hospital now serves vital care and emergency trauma care patients. How the specialized clinics use the old General hospital space will require a good deal of planning. But the in-patient special clinic patients will require hospital bed space and will most likely remain in the General Hospital facilities while out-patient procedures will be in new individualized Clinics.
List of implementation events for the Missouri State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid patient area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
Lean Teams may require help in designing Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid and $6 billion in Medicare & Regular health care costs for the State.
8. States may also agree to share Daily Plans & facility designs.
Overview of the Missouri Health Care System (MHCS) Plan
Stage 1. The Startup Stage Beginning January 2018
The State Government may acquire General Hospitals under financial stress at little to no cost or enter into an agreement with a private not for-profit hospitals. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired in St Louis, Kansas City and Springfield in stage 1. As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Stage 2. Medicaid and Medicare Patients continued move to new system
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
Stage 3. Accommodation of Patients without Health Care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the new facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the MHCS.
Stage 4. The MHCS will be Available to all Missourians
The expanded MHCS will be available to all Missourians. Health Insurance Companies will gradually require that patients move to the less expensive MHCS. Private Hospitals will still be available for those who want them.
The MHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 to 50 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Criteria for the Selection of Routine Procedures:
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
1. Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
2. Colonoscopy
3. Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
4. Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
1. Appendectomy
2. Natal care (Baby Deliveries)
3. Cesarean section (also called a c-section)
4. Cholecystectomy (surgery to remove the gallbladder)
5. Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
6. Hemorrhoidectomy (surgical removal of hemorrhoids)
7. Hysterectomy (surgical removal of a woman's uterus)
8. Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
9. Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
10. Prostatectomy (surgical removal of all or part of the prostate gland)
11. Tonsillectomy (surgical removal of one or both tonsils)
Savings for Routine Procedures
With Cataract surgery at 90% reduction of costs it appears that there are other procedures where savings were estimated at 60% are now estimated at 70% to 80% reduction in costs. These savings appear to be impossible but this approach has never been considered before.
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesion's. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Developed by Lawrence Rosier Consulting on November 27, 2017. Ref: LawrenceRosierConsulting Blog Articles 112, 111, 109, 107.
This plan embodies far reaching strategic thinking that overturns false ideas about Health Care and reduces the cost of Health Care in Missouri significantly. Because of the movement from Private for-profit Health care system to not for-profit Missouri government managed hospitals a five year adjustment period is needed. This is an important backup plan that brings Missouri into solvency in health care regardless of what the Federal Government does in a National Health Care plan.
Facts about the current health care system, it is a growth industry that appears to have no limits in cost projections. US Private health care costs double that of European government based health care, neither have the efficient approach embodied in this Plan. Converting from a Private profit based to a not for-profit or government based health care system is expected to reduce Health care costs by 50% due to the reduction in fraud and other efficiency reasons but with increased efficiency I have estimated a conservative 60% reduction in overall health care costs in the new high volume/low cost specialized health care system.
Medicaid
Medicaid costs in Missouri is 9.9 $billion. Only about 10% or $1billion of this cost can be reduced by the efficiency in hospital operations presented in this Plan. Much of Medicaid costs are in long term care where some efficiencies may be implemented by Lean Teams.
Medicare
Medicare however presents a much different view because funding by the Federal Government would go directly to the state of Missouri providing the funding needed to convert private hospitals acquired by the State in its conversion to the Missouri Health Care System (MHCS). An agreement with the Federal government to pay the full amount of Medicare costs to the State until the new efficient system can be developed may be required or the Federal Government might chose funding Missouri’s MHCS. Ref: the example Cataract Surgery Clinic with a 90% decrease in costs at LawrenceRosierConsulting Blog Articles 110,109.
Missouri’s Health Care System (MHCS) Open to all Missourians
As the system grows in the last years of this plan the Missouri Health Care System would be available to all Missourians, open to those with or without insurance. MHCS expected costs to be 20% to 50% less than Private Hospitals. Insurance companies may provide incentives for those insured to use the new system.
Starting the Reorganization
A not for-profit General hospital is selected in a large city. General Hospitals do nearly all procedures therefore they are low volume/high cost facilities. Nearly all routine procedures are removed and reorganized into high patient volume/low cost specialized Clinics. The General Hospital now serves vital care and emergency trauma care patients. How the specialized clinics use the old General hospital space will require a good deal of planning. But the in-patient special clinic patients will require hospital bed space and will most likely remain in the General Hospital facilities while out-patient procedures will be in new individualized Clinics.
List of implementation events for the Missouri State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid patient area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
Lean Teams may require help in designing Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid and $6 billion in Medicare & Regular health care costs for the State.
8. States may also agree to share Daily Plans & facility designs.
Overview of the Missouri Health Care System (MHCS) Plan
Stage 1. The Startup Stage Beginning January 2018
The State Government may acquire General Hospitals under financial stress at little to no cost or enter into an agreement with a private not for-profit hospitals. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired in St Louis, Kansas City and Springfield in stage 1. As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Stage 2. Medicaid and Medicare Patients continued move to new system
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
Stage 3. Accommodation of Patients without Health Care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the new facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the MHCS.
Stage 4. The MHCS will be Available to all Missourians
The expanded MHCS will be available to all Missourians. Health Insurance Companies will gradually require that patients move to the less expensive MHCS. Private Hospitals will still be available for those who want them.
The MHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 to 50 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Criteria for the Selection of Routine Procedures:
- Repeatable processes with the time being the same for
- all patients (relatively routine)
- Sufficient Patient Backlog for Continuous operation
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
1. Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
2. Colonoscopy
3. Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
4. Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
1. Appendectomy
2. Natal care (Baby Deliveries)
3. Cesarean section (also called a c-section)
4. Cholecystectomy (surgery to remove the gallbladder)
5. Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
6. Hemorrhoidectomy (surgical removal of hemorrhoids)
7. Hysterectomy (surgical removal of a woman's uterus)
8. Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
9. Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
10. Prostatectomy (surgical removal of all or part of the prostate gland)
11. Tonsillectomy (surgical removal of one or both tonsils)
Savings for Routine Procedures
With Cataract surgery at 90% reduction of costs it appears that there are other procedures where savings were estimated at 60% are now estimated at 70% to 80% reduction in costs. These savings appear to be impossible but this approach has never been considered before.
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesion's. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Thursday, November 9, 2017
Article:112. Federal Government and State Health Care Suggestions
Federal Government and State Health Care Suggestions
The Health Care recommendations in this Blog are freely given to be used by the Federal government and the States with only the acknowledgement of its origins.
The Federal Government shall Repeal and Replace the Affordable Health Care Act with the following new National Health Care System (NHCS). The Federal Government shall immediately cease payments to Health Insurance companies. Block Grants may be given to States instead.
Key Characteristics of the National Health Care System (NHCS)
The Role of the Federal Government, the VA and the States
The Federal Government will implement the NHCS by supporting each state’s acquisition and conversion of hospitals to the NHCS requirements. Ref: Articles 109,110.
The Veterans Affaires Hospitals will be reformed to make them more efficient. Veterans will also be able to use the new NHCS state hospitals.
Each State will acquire, reform and manage hospital acquisitions for the NHCS. This will begin in its larger cities where the largest number of Medicaid recipients live. Ref: Articles 107,109,110.
Proposed Implementation Plan for the National Health Care System
The plan is to implement NHCS (by changing from a private based system to a government based system) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the Nation. We will allow the VA Health Care system to use the NHCS consisting largely of Medicaid and Medicare in the first stage.
Savings
The savings resulting from switching from a Private to a Government System is estimated at 60% of current costs. Medicaid savings is expected to average $1billion for each state. Due to the increased efficiency of the NHCS staffing and
hospital facilities can be reduced by 20% or more in larger cities. General Hospitals in rural areas will be less affected because of low patient volume.
If you have an efficient effective Government Run Health Care system then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the private system they will drive up the cost of healthcare to get profits. I call our current Health Care system a “fraud based system” because it is largely funded by fraud. Our Fraud Based Healthcare system costs double that of European Government health care systems and even they are not efficient. The present fraud based system cannot be fixed and it is best scrapped as the most costly mistake ever made in health care.
Stage 1. The Startup Stage Beginning January 2018
Each State Government will begin immediately to acquire General Hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired by the state in each major city in stage 1.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the following criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Criteria for the selection of Procedures:
Repeatable processes with the same time for all patients (relatively routine)
Sufficient Patient Backlog for Continuous operation
Daily Plan efficiently designed by each Lean Team
Balanced Operations (no one waits on others to do their jobs).
Veterans will share NHCS hospitals with Medicaid and Medicare patients
Lawrence Rosier Principal Consultant is making the following proposal to States:
In the interest of quickly bringing my recommended reforms to as many States as possible allowing them to benefit in massive savings in regular State Government activities, and in Medicaid and Medicare health care. Saving To each State 60% of current Medicaid hospital costs or an average of $1billion per State.
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams. This will allow up to 50 Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant. After review of each State’s developed Daily Plans for a Procedure by Lawrence Rosier Consultants it is made available for implementation to the subscribing States allowing for immediate savings to become available. This is a continuous process until all hospital Procedures meeting the criteria have been completed. Note that the new hospital operations do not require management scheduling and budgeting personnel. Ref: Article 109.
Stage 2. Medicaid and Medicare Patients continued move to NHCS
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the NHCS Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the NHCS.
Stage 4. The NHCS will be Available to all Americans
The expanded NHCS will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS Health care system.
Private Hospitals will still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide rural traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service traveling Dialysis Vans for patients in remote rural areas.
Concurrent Reform of the VA Health Care System
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems including its management problems. This is the same approach that works for a complete US government run healthcare system. Start by implementing this new efficient approach using Enterprise Lean through out the VA Health Care System. See Article 104 and 96.
The Health Care recommendations in this Blog are freely given to be used by the Federal government and the States with only the acknowledgement of its origins.
The Federal Government shall Repeal and Replace the Affordable Health Care Act with the following new National Health Care System (NHCS). The Federal Government shall immediately cease payments to Health Insurance companies. Block Grants may be given to States instead.
Key Characteristics of the National Health Care System (NHCS)
- The NHCS covers all Medicaid Patients and eventually all Americans
- No one will be required to purchase Health Care Insurance but those who can afford it will be required to pay for their own health care or acquire insurance.
- Catastrophic Health Care will be funded by savings from elimination of waste in the current Healthcare system and in the Federal governments operations.
- Catastrophic Health Care will not be funded by individuals purchasing Insurance.
- Insurance Companies will return to their practices before the Affordable Care Act.
The Role of the Federal Government, the VA and the States
The Federal Government will implement the NHCS by supporting each state’s acquisition and conversion of hospitals to the NHCS requirements. Ref: Articles 109,110.
The Veterans Affaires Hospitals will be reformed to make them more efficient. Veterans will also be able to use the new NHCS state hospitals.
Each State will acquire, reform and manage hospital acquisitions for the NHCS. This will begin in its larger cities where the largest number of Medicaid recipients live. Ref: Articles 107,109,110.
Proposed Implementation Plan for the National Health Care System
The plan is to implement NHCS (by changing from a private based system to a government based system) in stages as it gradually becomes the nations primary health care system. The plan also separates rural health care from urban health care to accommodate the needs of the Nation. We will allow the VA Health Care system to use the NHCS consisting largely of Medicaid and Medicare in the first stage.
Savings
The savings resulting from switching from a Private to a Government System is estimated at 60% of current costs. Medicaid savings is expected to average $1billion for each state. Due to the increased efficiency of the NHCS staffing and
hospital facilities can be reduced by 20% or more in larger cities. General Hospitals in rural areas will be less affected because of low patient volume.
If you have an efficient effective Government Run Health Care system then no private health care company can compete with it because private companies must make healthcare run more efficient than government healthcare. If they can’t do this then there are no profits. If there are no profits in the private system they will drive up the cost of healthcare to get profits. I call our current Health Care system a “fraud based system” because it is largely funded by fraud. Our Fraud Based Healthcare system costs double that of European Government health care systems and even they are not efficient. The present fraud based system cannot be fixed and it is best scrapped as the most costly mistake ever made in health care.
Stage 1. The Startup Stage Beginning January 2018
Each State Government will begin immediately to acquire General Hospitals under financial stress at little to no cost. I emphasize that the government is not in the business of buying hospital facilities. The reason is that the operation of government hospitals will be significantly less than that of private hospitals who will not be able to compete with the efficient government hospitals. At least one General Hospital will be acquired by the state in each major city in stage 1.
The Hospitals will be reorganized in the following manor:
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. Procedures which do not meet the following criteria will remain in the General hospital system with Urgent Care. Ref: Article 110.
Criteria for the selection of Procedures:
Repeatable processes with the same time for all patients (relatively routine)
Sufficient Patient Backlog for Continuous operation
Daily Plan efficiently designed by each Lean Team
Balanced Operations (no one waits on others to do their jobs).
Veterans will share NHCS hospitals with Medicaid and Medicare patients
Lawrence Rosier Principal Consultant is making the following proposal to States:
In the interest of quickly bringing my recommended reforms to as many States as possible allowing them to benefit in massive savings in regular State Government activities, and in Medicaid and Medicare health care. Saving To each State 60% of current Medicaid hospital costs or an average of $1billion per State.
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams. This will allow up to 50 Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant. After review of each State’s developed Daily Plans for a Procedure by Lawrence Rosier Consultants it is made available for implementation to the subscribing States allowing for immediate savings to become available. This is a continuous process until all hospital Procedures meeting the criteria have been completed. Note that the new hospital operations do not require management scheduling and budgeting personnel. Ref: Article 109.
Stage 2. Medicaid and Medicare Patients continued move to NHCS
In addition to the continuing acquisition of private Hospitals new Eye clinics will be acquired or built in urban cites of over one hundred thousand population to perform mass Cataract Surgery. This a significant cost saving of 90% the current approach. Ref: Article 110.
As this stage progresses Medicaid patients will be served first followed by Medicare Patients to make sure of a continuous backlog of patients.
Stage 3. Accommodation of Patients without Health care Insurance
Regular Health Care Patients without Health Insurance will be allowed to use the NHCS Facilities as they become available. These Patients will be required to pay for their own health care but at a cost of about 20% less than in the private sector. This is a key element of the NHCS.
Stage 4. The NHCS will be Available to all Americans
The expanded NHCS will be available to all Americans. Health Insurance Companies will gradually require that patients move to the less expensive NHCS Health care system.
Private Hospitals will still be available for those who want them.
The NHCS Rural Health Care System
Small Clinics should be built in towns of about 10 thousand and about 25 miles apart. The Clinics will be of the following design: They will be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port. Some designs may have more beds. Besides doctors and nurses this system depends on volunteers from within the community.
Besides an Emergency function the clinics can serve as place for state wide rural traveling Cataract Surgery teams to do Cataract Surgery. The clinics can also service traveling Dialysis Vans for patients in remote rural areas.
Concurrent Reform of the VA Health Care System
As a government run system the current VA health care system may be worse than that of European health care but they both have the same problems: massive bureaucracy, low efficiency, high patient backlogs and uncontrolled costs. My approach fixes nearly all of the VA’s health care problems including its management problems. This is the same approach that works for a complete US government run healthcare system. Start by implementing this new efficient approach using Enterprise Lean through out the VA Health Care System. See Article 104 and 96.
Wednesday, November 8, 2017
Article 111. Designing a High Patient Volume Low Cost Hospital
Designing a High Patient Volume Low Cost Hospital
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. The design is first to be used for Medicaid patients and will save an average of $1billion for each state. Several Hospitals will be required located in the State’s largest cities. Please review the following: Articles 107, 109, 110.
The Procedures chosen will be similar to the Cataract Eye Clinic design in Article 110. The Procedures are completely independent within the hospital and have their own staff and facilities. Should the patient Volume be higher than that of the design the procedure can be redesigned or it can be duplicated with added staff and facilities.
The first order of business is to Identify all the routine hospital and clinic procedures which apply a probable list is included later in this article. Each Procedure will require the same time to perform for all patients deviations from this requirement should be rare. The hospital will have on call its own Urgent Care staff. It will not have an emergency Room serving the public.
The approach is first to find a General Hospital near the areas in the city that has the most Medicaid patients that is willing to completely revise its mod of operation to the new design or to turn over operations to the State so that the State can make the required reforms. This will be most likely a non-profit hospital heavily in debt. It is better to select an existing staffed hospital rather than one that has been shut down because the staff can be formed into Lean Teams who will be important in the design of a Daily Plan for each of the procedures which meets the required criteria.
Role of Lawrence Rosier Consulting:
The current role of Lawrence Rosier Consulting is to enter into an agreement with a State to assist in the choice and the design of the selected Hospital to meet the above criteria. Lawrence Rosier Consulting will train Facilitators to assist in the implementation of Enterprise Lean in the hospitals. The Facilitators will also assist in the design of the Daily Plan for each Procedure and assist in its implementation.
List of implementation events for the State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid for each State.
8. States may also agree to share Daily plans & facilities designs.
Criteria for the selection of Routine Procedures:
Prenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Natal care (Baby Deliveries)
Cesarean section (also called a c-section)
Cholecystectomy (surgery to remove the gallbladder)
Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
Hemorrhoidectomy (surgical removal of hemorrhoids)
Hysterectomy (surgical removal of a woman's uterus)
Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
Prostatectomy (surgical removal of all or part of the prostate gland)
Tonsillectomy (surgical removal of one or both tonsils)
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesions. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
General hospitals do nearly all Procedures with low patient volume and at high cost. The New hospital design I am proposing is exactly the opposite: wholly independent routine procedures with high patient volume at the lowest cost. The design is first to be used for Medicaid patients and will save an average of $1billion for each state. Several Hospitals will be required located in the State’s largest cities. Please review the following: Articles 107, 109, 110.
The Procedures chosen will be similar to the Cataract Eye Clinic design in Article 110. The Procedures are completely independent within the hospital and have their own staff and facilities. Should the patient Volume be higher than that of the design the procedure can be redesigned or it can be duplicated with added staff and facilities.
The first order of business is to Identify all the routine hospital and clinic procedures which apply a probable list is included later in this article. Each Procedure will require the same time to perform for all patients deviations from this requirement should be rare. The hospital will have on call its own Urgent Care staff. It will not have an emergency Room serving the public.
The approach is first to find a General Hospital near the areas in the city that has the most Medicaid patients that is willing to completely revise its mod of operation to the new design or to turn over operations to the State so that the State can make the required reforms. This will be most likely a non-profit hospital heavily in debt. It is better to select an existing staffed hospital rather than one that has been shut down because the staff can be formed into Lean Teams who will be important in the design of a Daily Plan for each of the procedures which meets the required criteria.
Role of Lawrence Rosier Consulting:
The current role of Lawrence Rosier Consulting is to enter into an agreement with a State to assist in the choice and the design of the selected Hospital to meet the above criteria. Lawrence Rosier Consulting will train Facilitators to assist in the implementation of Enterprise Lean in the hospitals. The Facilitators will also assist in the design of the Daily Plan for each Procedure and assist in its implementation.
List of implementation events for the State board of Health:
1. State Board of Health Selects State Hospital and Clinic Management Team
2. First hospital is selected and acquired in a high Medicaid area.
3. Enterprise Lean Teams are organized for the entire Hospital.
4. Lean Teams in Procedures meeting criteria design Daily Plans.
5. Hospital facilities are designed & built to meet the needs of each of the selected Procedures.
6. New high patient volume low cost plan is implemented.
7. Once Daily Plans and Facilities have been designed and the process tested mass implementation can be done throughout the State saving an average of $1billion in Medicaid for each State.
8. States may also agree to share Daily plans & facilities designs.
Criteria for the selection of Routine Procedures:
- Repeatable processes with the time being the same for all patients (relatively routine)
- Sufficient Patient Backlog for Continuous operation (Medicare patients can be added if needed to maintain patient backlog)
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations
Routine Outpatient and Inpatient Procedures
Outpatient Testing and Procedures
Radiology/Diagnostic Imaging Including MRI, CT scans, ultrasound, nuclear medicine, mammography and x-ray.
ColonoscopyPrenatal care, also known as antenatal care is a type of preventive healthcare, with the goal of providing regular check-ups
Cataract surgery Ref: Articles 109,110 Example of a Daily Plan.
Inpatient Testing and Procedures
AppendectomyNatal care (Baby Deliveries)
Cesarean section (also called a c-section)
Cholecystectomy (surgery to remove the gallbladder)
Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
Hemorrhoidectomy (surgical removal of hemorrhoids)
Hysterectomy (surgical removal of a woman's uterus)
Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
Prostatectomy (surgical removal of all or part of the prostate gland)
Tonsillectomy (surgical removal of one or both tonsils)
Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.
Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhesions. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)
Friday, November 3, 2017
Article 110. Daily Plan For Cataract Surgery Clinics
Daily Plan For Cataract Surgery Clinics
This is an example created by Lawrence Rosier based on his experiences of having cataract surgery. Ref: Articles: 109, 107
This is a design for a Cataract Surgery Clinic to be built in each major city of a State and operated by the State. This is done to reduce health care costs in the State and the Federal Government. The Clinic will reduce the costs expended by as much as 90%. The design of the Daily Plans necessary for the Cataract Clinic also provides examples of how Daily Plans are constructed. Ref: Article 107
The Cataract Surgery Clinic is designed to efficiently process 40 patients per day and meets the required criteria for the implementation of Enterprise Lean and Balanced processes.
Eye Examination Facility Daily Plan
Patients:
40 Patients with appointments each day for eye examinations or for post surgery glasses and
40 Patients with appointments the same day for post surgery exam by Surgeon from the day before.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Exam Room A Optometrist #1 20 min Exam Eyes for Cataracts or Glasses
Exam Room B Optometrist #2 20 min Exam Eyes for Cataracts or Glasses
Post Surgery C Surgeon #1 10 min Exam Eyes of surgery Patients
Surgeon #1 Trades off Surgery every other day with Surgeon #2.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Prep Patient Room A Nurse #1 20 min Preps Patients for surgery, eye drops
Prep Patient Room B Nurse #2 20 min Preps Patients for surgery, eye drops
Anesthetist 10 min Anesthetizes Patients
Surgery two Rooms Surgeon #2 10 min Performs Cataract Surgery
Surgery two Rooms Surgery Nurse10 min Supports Surgeon during operations
Recovery Room A Nurse #3 10 min Move Patients,Surgery to Recovery
Recovery Room B Nurse #4 10 min Move Patients,Surgery to Recovery
Ophthalmologist Surgeon does Cataract Surgery in Operating Room #1 while patients are moved from Operating Room #2 and another patient is brought in. With the completion of surgery in operating Room #1 the surgeon returns to Operating Room #2 to perform surgery on the next patient.
Cost Analysis:
Medicare Reimbursement
1. Exam of both Eyes for Cataracts $ 320
2. Cataract Surgery for eye #1 2,400
3. Cataract Surgery for eye #2 2,400
4. Exam of both Eyes for Glasses 320
Annual Medicare Reimbursement $5,440 x 20/day x 200/days per year
= $21,760,000
Annual Estimated Clinic Salary Expenses $1,130,000
Annual Estimated Clinic Operation Costs 1,500,000
Total Estimated Clinic Costs $2,630,000
Annual Estimated Savings = $21,760,000 -$2,630,000 = $19 million
90% reduction in costs
Note: 1. Manager of the Clinic is an Ophthalmologist and fills in when needed for absenteeism or vacations
2. Office personnel are also nurses and fill in when needed
3. Secretaries fill in for Waiting Room Receptionist
4. There is no other supervision required
5. Supplies are ordered automatically
Once the process has been setup it will run automatically as long as it has sufficient backlog of Medicaid and Medicare Patients. The only difference a patient should see between this cataract surgery and that normally done is that there are more people in the waiting room.
Since the Federal Government is unlikely to do anything about the high cost of Cataract Surgery in the near term I recommend that States establish an Eye Clinic in each of their major cities using the Medicare payments to fund the Clinics.
Examples of Major Savings in Cataract Surgery
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons). Drs Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure (both eyes) caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors. The two Surgeons were doing about 200 eye surgeries per day. I give you this example of how little a cataract surgery actually costs in Burma $25 (only for the Lenses) in the US $4800 both eyes.
Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients. In a week he can perform 40 eye surgeries paid for by Medicare at $2400 each eye. The surgeon is grossing nearly $4 million annually from Medicare. These examples prove that certain health care operations can be reduced significantly in cost.
This is an example created by Lawrence Rosier based on his experiences of having cataract surgery. Ref: Articles: 109, 107
This is a design for a Cataract Surgery Clinic to be built in each major city of a State and operated by the State. This is done to reduce health care costs in the State and the Federal Government. The Clinic will reduce the costs expended by as much as 90%. The design of the Daily Plans necessary for the Cataract Clinic also provides examples of how Daily Plans are constructed. Ref: Article 107
The Cataract Surgery Clinic is designed to efficiently process 40 patients per day and meets the required criteria for the implementation of Enterprise Lean and Balanced processes.
Eye Examination Facility Daily Plan
Patients:
40 Patients with appointments each day for eye examinations or for post surgery glasses and
40 Patients with appointments the same day for post surgery exam by Surgeon from the day before.
Facilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Exam Room A Optometrist #1 20 min Exam Eyes for Cataracts or Glasses
Exam Room B Optometrist #2 20 min Exam Eyes for Cataracts or Glasses
Post Surgery C Surgeon #1 10 min Exam Eyes of surgery Patients
Surgeon #1 Trades off Surgery every other day with Surgeon #2.
Cataract Surgery Facility Daily Plan
Patients: 40 Patients with appointments for Cataract SurgeryFacilities Staffing Time/Patient Duties
Waiting Room Receptionist All day Signs Patients in
Prep Patient Room A Nurse #1 20 min Preps Patients for surgery, eye drops
Prep Patient Room B Nurse #2 20 min Preps Patients for surgery, eye drops
Anesthetist 10 min Anesthetizes Patients
Surgery two Rooms Surgeon #2 10 min Performs Cataract Surgery
Surgery two Rooms Surgery Nurse10 min Supports Surgeon during operations
Recovery Room A Nurse #3 10 min Move Patients,Surgery to Recovery
Recovery Room B Nurse #4 10 min Move Patients,Surgery to Recovery
Ophthalmologist Surgeon does Cataract Surgery in Operating Room #1 while patients are moved from Operating Room #2 and another patient is brought in. With the completion of surgery in operating Room #1 the surgeon returns to Operating Room #2 to perform surgery on the next patient.
Cost Analysis:
Medicare Reimbursement
1. Exam of both Eyes for Cataracts $ 320
2. Cataract Surgery for eye #1 2,400
3. Cataract Surgery for eye #2 2,400
4. Exam of both Eyes for Glasses 320
Annual Medicare Reimbursement $5,440 x 20/day x 200/days per year
= $21,760,000
Annual Estimated Clinic Salary Expenses $1,130,000
Annual Estimated Clinic Operation Costs 1,500,000
Total Estimated Clinic Costs $2,630,000
Annual Estimated Savings = $21,760,000 -$2,630,000 = $19 million
90% reduction in costs
Note: 1. Manager of the Clinic is an Ophthalmologist and fills in when needed for absenteeism or vacations
2. Office personnel are also nurses and fill in when needed
3. Secretaries fill in for Waiting Room Receptionist
4. There is no other supervision required
5. Supplies are ordered automatically
Once the process has been setup it will run automatically as long as it has sufficient backlog of Medicaid and Medicare Patients. The only difference a patient should see between this cataract surgery and that normally done is that there are more people in the waiting room.
Since the Federal Government is unlikely to do anything about the high cost of Cataract Surgery in the near term I recommend that States establish an Eye Clinic in each of their major cities using the Medicare payments to fund the Clinics.
Examples of Major Savings in Cataract Surgery
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons). Drs Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure (both eyes) caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors. The two Surgeons were doing about 200 eye surgeries per day. I give you this example of how little a cataract surgery actually costs in Burma $25 (only for the Lenses) in the US $4800 both eyes.
Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients. In a week he can perform 40 eye surgeries paid for by Medicare at $2400 each eye. The surgeon is grossing nearly $4 million annually from Medicare. These examples prove that certain health care operations can be reduced significantly in cost.
Article 109. Implementation of State Collaborative Reforms
Implementation of State Collaborative Health Reforms (updated)
Lawrence Rosier Consulting12143 Cedar Grove Rd. Rolla, Missouri 65401 Phone 573 426 2997 cell 573 578-4716
About Lawrence Rosier: See Article 102. Lawrence Rosier Consulting Blog.
States who are interested in learning more about this collaborative effort or have questions or want to become a subscriber may respond by Email to: LawrenceRosier4@gmail.com
State governments are currently facing large Medicaid health expenditures which most states will find difficult to meet. This is exacerbated by health care cuts by the Federal Government. This collaborative solution would provide an average saving of up to $1billion for each subscribing State annually when fully installed throughout the State (This is obviously a long term saving).
Lawrence Rosier Principal Consultant is making the following proposal to State Governments and other interested parties:
In the interest of quickly bringing my recommended health care reforms to as many States as possible allowing them to benefit in savings in Medicaid and Medicare health care (saving the State 60% of current routine Medicaid hospital costs).
Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams organized for each routine Procedure. This will allow up to 15 or more Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant.
After review of each State’s submitted Daily Plans by Lawrence Rosier Consultants they are made available for implementation to all of the subscribing States. This is a continuous process until all selected routine hospital Procedures have been developed and made available to all subscribers.
Daily Plans will vary to meet expected patient backlogs which arise by the size of the metro area. Some Daily Plans may simply be doubled to accommodate larger metro patient backlogs. Note that nearly all routine Procedures performed in a metro area may be done by a single hospital due to its low cost for routine Procedures.
After the Daily Plan has been developed it will be used to reorganize the selected General Hospital facility. As many as 15 routine Procedures will need to be organized at the general hospital facility grounds all with access to the ER.
Each Subscribing State will Agree to the following Requirements:
1. Pay an annual modest subscription fee to Lawrence Rosier Consulting in return for access to Daily Plans and Consulting assistance by remote conferencing including training sessions.
2. Enter into agreement with or acquire in each of the state’s major cities at least one Primary Care Hospital that performs routine operations and agrees to implement Enterprise Lean and reorganize to install a Daily Plan for each of their routine Procedures.
3. The reforms include: Enterprise Lean Teams which develop efficiently designed Daily Plans. Daily Plans are not easily developed and should not be developed without input from the Lean Team familiar with the details of the Procedure. This is what makes them so valuable they can be simply implemented by states doing the same Procedures and start receiving the savings. The receiving State may also make continuous improvement to the Daily Plans and coordinate these with the consultant. Ref: Article 110. Example Cataract Surgery 90% reduction in costs.
4. Video Conference training is planed to be available for each participating State’s Facilitators who will facilitate the organization of the Lean Teams for each function and the development of their Daily Plans. Ref: Articles: 110, 107,106, 105, 104, 101.
I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in State Government Functions. It has also been successfully implemented in the Cleveland Clinic well known for its health care. The process consists of working teams that meet regularly (once a week) to review and discuss how the work they are doing can be improved. For those Lean Teams involved with routine Procedures, their first task is the design and implementation of their Daily Plan. I recommend that Enterprise Lean be implemented throughout each medical facility. Employees become excited about their jobs with their involvement providing continuous innovative solutions to work problems.
Routine Procedure Criteria:
- Repeatable processes (relatively routine)
- Sufficient Backlog of patients for Continuous operation
- Patients must be able to wait in a backlog
- Daily Plan efficiently designed by each Lean Team
- Balanced Operations (no one waits for others to do their jobs)
The savings from the metro hospital is based on high patient backlogs for routine Procedures based on the Daily Plan. High patient backlogs are not available in rural areas. An alternative for rural General hospitals to meet lower patient backlogs is: to train Lean Teams to use several Daily Plans for routine Procedures and be able alternate between them.
Update March 9, 2018:
36 State Governors were contacted by social Media (Twitter) all showed some interest in the project. 15 Governors showed above average interest and 12 Governors were very interested.
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