Article 120. Approach to a Two Part Health Care Reform

Approach to a Two Part Health Care Reform

Lawrence Rosier Consulting
12143 Cedar Grove Rd. Rolla, Missouri 65401
573 426 2997

My two Part Health Care Reform of hospitals can bring significant improvement in operations as well as an average of 60% savings in Routine Procedures.  The First Part of the reform implements Lean Teams (developed by Toyota) to make continuous improvements to Procedures and can be implemented almost entirely by existing Hospital personnel. The Second Part develops a highly efficient Daily Plan for each routine Procedure (requires a consultant).  Once the Daily Plan is developed it can be used in other hospitals. I have included a List of suggested Routine Procedures that can be used in Outpatient Clinics attached to a Hospital.

Part 1. Implementation of Lean Teams:

Consultant starts by working with clients Training Personnel to do the following:
1. Develop enterprise wide introduction plan
    Presentations to selected groups
2.  Determine the number of Facilitators needed
    Each Facilitator meets with about 10 Lean Teams
    Helping them get started: election of Team Leader (by secret
    Ballot) and how to work together to implement improvements. 

Part 2. Development of the Daily Plan

Consultant works with Lean Teams whose processes repeat on a daily basis in Health Care.

Daily Plan for Healthcare:
1. Make a list of all possible Routine Procedures.
2. Determine the number of Patients treated at this hospital location for each routine Procedure.
3. Estimate the number of Patients treated in the metro area for each routine Procedure. This determines the number of patients available or backlog.
4. Select first Procedure based on Highest number of Patients and the shortest time for a Surgeon to do the Procedure. Example: With Procedures requiring an hour of surgery time only 7 patients a day can be done.  While for Procedures requiring only a few minutes as many as 20  can be done per Day.  See Example Cataract Surgery with 90% Savings. Lawrence Rosier Consulting Blog Article 110.

The Consultant begins the design of the Daily Plan working with the selected Procedure Lean Team To do the following:
1. Make a cell phone video of the current operation of the selected procedure. 
2. The Number of Patients per day is determined by the length of time for the Surgeon to do the Procedure.
3. Balance the Patient Prep and Recovery time by nurses to the surgeon’s time allowing the Surgeon to do one surgery after another for the day. Review Cell phone video make sure that work load is distributed evenly among nurses so that no one is waiting on others to complete their jobs.
4. Document the Daily Plan.  After completion the Daily Plan can be implemented by other Lean Teams in other hospital locations.

Application to Metropolitan Hospitals

A state’s metro areas offers the biggest savings in Medicaid and in Medicare with a higher number of Patients the routine procedure Clinics can operate on a continuous daily basis.  If the number of patients in the backlog of a clinic is more than the clinic can manage a second duplicated clinic can be added to reduce the Patient backlog.

Application to Hospitals in Smaller Towns

Where Patient Backlog is not enough to support each Routine Clinic:
A Lean Team may have to develop as many as three routine Procedure Daily Plans and switch between them to maintain Patient backlog.  The Lean Team can do a particular routine Procedure for two weeks then switch to another Procedure for a week and then to the third Procedure.

State wide Health Care in Rural Areas

Suggested Small Town Health Care System
Small Clinics could be built in towns of about 10 thousand and about 25 miles apart.  The Clinics can be of the following design: They should 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.

Possible List of Routine Patient Testing and Procedures

Appendectomy
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 adhessions. (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)