Thursday, August 26, 2010

Lean Hospitals Drive Profits and Productivity But Leave Questions Pending Regarding Patient Care

I'm having a hard time embracing the idea of Lean Six Sigma in a healthcare setting. After reading the book Lean Six Sigma For Service I am still convinced that there are no short cuts when it comes to patient care and services. Although many say this book provides clear ideas on how to apply the concept in a healthcare setting, and although there are testimonials on the Internet regarding hospitals that turned around due to implementing Lean and Six Sigma thinking, (yes, they are two separate concepts) I have not been convinced there is anything more to this than good old common sense and perhaps an underline beneath the idea that the hospital should operate as a business.

There is an age old question that many shy away from answering-is the hospital providing a service or is it a business? I still cringe when I overhear the opposing viewpoint that hospitals are businesses and are entitled to turn a profit. I respect that viewpoint, however, in all honesty, it negates the roots of the healthcare industry. Every major hospital began with the idea that the service should be offered to those that could not afford the care, or just plain and simple, needed medical attention. What a clever idea-offering a service to those that are in need of it, as opposed to a business where you try to convince your consumer that they need what you have to offer. When a hospital is identified as a business, healthcare professionals will do whatever it takes to drive profits north, sacrificing the patient in the process. Because, after all, stockholders must remain happy with their shares, eliminating the debt within the business becomes priority, and the consumer is nothing but a pawn used to get these jobs done.

"Lean Six Sigma for services is a business improvement methodology that maximizes the shareholder value...." Does that reasoning, taken directly from page 6 in Lean Six Sigma For Service, have any place in the healthcare industry? This mindset promotes productivity-getting more done quicker-for the sake of the shareholder and that is where the patient has gotten lost in the system. When a hospital is viewed as a provider of healthcare service, being efficient is still part of the equation because doing a job quickly while eliminating errors is in the best interest of the patient and hospital. There needs to be that balance brought to the "methodology" while contemplating healthcare and Lean Six Sigma. It can't be a decision between shareholder or patient-and if it becomes that, I hope the decision leans in favor of the patient.

St. Luke's Hospital is excited that Lean helped them treat heart patients more effectively. "Studies show us time and again if you walk into the emergency room with chest pains there’s a 90-minute window where you get the best outcome … This lean system has helped us hit that target every time now for 10 months." No hospital worth it's name would allow a heart patient to wait in the Emergency Department without immediately providing basic treatment. If ED's are still that negligent and slow, there is a triage issue but not necessarily a Lean issue. This is not a firm argument for Lean Six Sigma in the healthcare setting.

I'm not saying hospitals shouldn't concentrate on greasing their system to insure patients get care as quickly as possible. I'm not saying that thinking in terms of good business practices (like cost reduction, error proofing treatments ect) is a bad thing. I do believe there is an error in judgement when you make the conscious effort to place your shareholders higher than your patient. What if law enforcement, firemen and our military began talking in terms of "profit, shareholder value, and business methodology"? It seems like a contradiction when these are primarily thought of as public servants. If the local ambulance service decided to cut back on service days because of the cost of fuel, many patients would be in trouble. There is a time and place for thinking in terms of business related profits and shareholders, but my belief is that the healthcare industry is not the time or place. Hospitals can make a profit-I'm not opposed to that. But when a profit becomes more important than the patient, that is when the objective needs to change.

A service structure that places the emphasis on the patient seems to be smoke in mirrors. Many healthcare institutions claim the patient is high on their priority list but when I see the emphasis on the happiness of the shareholder through programs such as Lean Six Sigma in the healthcare setting, it saddens me. I believe within the healthcare crisis, among the conversation of offering care to those that need it, there is too much talk of funding the care in terms of turning a profit-not necessarily funding the care in terms of meeting costs. There is more than enough money in our country to fund good care-think St Judes Hospital that operates entirely from private contributions. Our healthcare system is as sick as the patients it endeavors to treat, but trying to fix that system by turning profits is a mistake. A mistake that I believe has sacrificed the patient as well as the American way of healthcare service.

Thursday, August 19, 2010

Surgery on Sunday

Surgery On Sunday, Inc. works closely with community partners to provide essential outpatient surgical procedures to income-eligible individuals. Patients are referred to Surgery on Sunday, Inc. by numerous partner agencies.

Featured in People Magazine Heroes Among Us

How Our Program Works
In today’s world, many people in America simply do not have adequate medical coverage. This means that basic outpatient medical procedures are out of reach for millions of Americans.

Surgery on Sunday, Inc. is a non-profit organization that provides essential outpatient surgical services for free for those in need who cannot afford insurance and who are not eligible for federal or state programs. Patients are referred from existing organizations in the community and receive much needed surgical procedures.

Our services are provided by doctors, nurses, and other medical professionals who volunteer their time and expertise to reach out to those in need. If you need medical assistance and wonder if you qualify for our program, please check out the Referral Agencies link to find agencies in your area. If you are a member of the medical community and would like to become involved with our program and donate your time please check out the Volunteer section for information.

Surgery On Sunday is a proud partner of United Way of the Bluegrass. Dependent on the generosity of private foundations and donors to help clients receive the surgeries they require, Surgery On Sunday is also honored to receive funding from The Samaritan Foundation, Rotary Club of Lexington, Fayette County Medical Society, and The Keeneland Foundation.

Wednesday, August 11, 2010

Hospitals and Facebook Under Fire in HIPAA Related Dispute

William Wells arrived at the emergency room at St. Mary Medical Center in Long Beach on April 9 mortally wounded. The 60-year-old had been stabbed more than a dozen times by a fellow nursing home resident, his throat slashed so savagely he was almost decapitated.

Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook.

Four staff members were fired and three disciplined, according to a St. Mary spokeswoman. At least two nurses were involved, but none was fired, a union spokesman said.

read full story here

This story has recently sparked outrage directed at facebook and medical institutions. To solve the problem, some feel facebook should not be accessed within a hospital setting. They further argue hospitals don't do enough to zip the lips of employees. After all, 14 year old Stephanie also had her picture plastered across facebook back in 2008. What about the EMT that took crime scene photos of 26 year old Caroline Wimmer-taken less than an hour after her death-and posted those to facebook?

I have to argue in defense of facebook and medical institutions-aka hospitals. First things first. Yes, I believe facebook should monitor closely the content that is posted on their site. However, they immediately took the photos down and even offered a tribute to the victims. They maintained an element of class and did the right thing when presented with the issue. Facebook is a social network-to eliminate its access in a hospital setting, I believe, would cut off great interaction between those in the medical field. There is a camaraderie between health care employees-they get each other. The day to day stress of saving lives and losing lives can only be shared adequately with those that experience the same thing. To share that element of pressure with those outside of the medical field would be, well, like holding a dead fish. No response. There is also a lot of consulting that goes on between the facebook walls of medical professions. I do not encourage the elimination of social networking within the hospital nor do I think it would make the problem go away.

Here is where the breech is occurring-within the employee. If it was within rules, all your hospital human resource department would have to do was state "Do not post photos of patients on facebook. Do not take photos of patients." See how ridiculous that sounds? Some things you should not have to tell a person. Some things lie within the integrity of an individual. If you have to point blank make the ruling "Don't take photos of patients", you have an integrity problem, not a problem within your regulations or within facebook.

You can not legislate compassion. Either your employees have it or they don't. You can't hold their hand and tell them how to act. The responsibility falls in hiring those that you believe will act in a graceful, compassionate, trustworthy manner, and then you fire them when they prove otherwise. You will make a pretty big "no tolerance" statement and those extra rules will be unnecessary.

Employees will talk. I know. I've been there when it happened over the body of a comatose patient, in a public elevator, even in the cafeteria. These are all places where confidentiality is breached. Here the patient is given a piece of paper upon admittance that states your hospital follows HIPAA guidelines, yet by taking locker room talk into the public arena, aren't the employees violating HIPAA? It all goes back to the integrity of the employee. Are they willing to hold to a higher standard of service or are they willing to breech the privacy of patients in the name of gossip? That is the question that needs to be addressed.

If hospitals have contributed, it is not within the context of allowing access to facebook. It lies within the focus and integrity of it's employees. Perhaps that is where this problem should be approached.