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:

• 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.

Colonoscopy
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.

Inpatient Testing and Procedures

Appendectomy 
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)