Uncategorized•
on August 16th, 2010•
(This is part two of a two-part blog)
More tips for sailing the ship into harm’s way:
6. Encourage your managers to network with others who are “like” them. Yes! The only hospitals that are worthy learning partners are those who have the same mission, market, operating strategy, challenges, size, scope, organizational structure, services, volume, physical plant, and mean average temperature.
7. Require your managers to know the ABSOLUTE best practice and how to implement it flawlessly before doing a single thing. That’s right. The ONLY way for you to improve is to slavishly emulate the hospital at the target cost position without regard for your own environment, talent, mission, or goals.
8. Check on your managers’ progress at least once a year. Maybe check in at budget time when they don’t have anything else to do. Reviewing their progress more often or being involved in their plans might make them anxious or think that you actually expect them to do something.
9. Don’t hold your managers accountable for results. You really have to give people time and allow a lot of discretion about when and how they might achieve their goals. Really! Who’s navigating this ship, anyway?
10. Keep progress toward closing the gap under wraps. Oh, wait. This is a given. You didn’t define a “gap” in the first place!
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on August 12th, 2010•
By Shelley Burns
(Part one of a two-part blog)
Given it’s summer, we’ll continue with the nautical theme we started in a prior blog. So, imagine the winds of change are fierce and blowing your hospital ship toward the rocks at a rapid clip. Endlessly measuring the wind with greater precision and understanding each time you take bearings is highly satisfying, and seems a prerequisite to action. However, nothing short of adjusting your sails and changing course will prevent your ship from being dashed against the rocks.
So, if that’s your goal, consider following these tips:
1. Don’t define your “gap.” Really, senior leadership shouldn’t have to set the course for the organization. Surely, you can delegate this detail to someone less senior.
2. Make cost improvement a goal – this year.
3. Keep your managers in the dark about your expectations. Let them guess about the overall dollars you want to squeeze out of the cost structure and the amount you expect each to contribute. Lack of focus and goals are helpful for managers – they like managing to ambiguity.
4. Restrict managers’ access to data and performance improvement tools. All those numbers, graphs, benchmarks, and best practices require such an effort to comprehend. All the managers really need to know is that their costs need to be cut.
5. Join your managers in hashing out the minutiae indefinitely. Absolutely! They must be 100 percent comfortable with even the most irrelevant data before they can make a single cost improvement or suggest any ideas to streamline their processes.
Shelley Burns is HMC’s knowledge manager.
Uncategorized•
on August 9th, 2010•
By Shelley Burns
What kills a hospital benchmarking process faster than anything else? It’s what happens when the administration asks department heads to do something with the benchmark results.
HMC produces a series of benchmarks for our hospital clients on functional cost, clinical cost and utilization, quality, and patient satisfaction. Hospital managers participate in developing the benchmarks by validating the data and our procedures handling it. The benchmark results are presented, and an administrator tells the department heads: “Find out what the lower cost/higher quality hospitals are doing differently than you!”
What do the hospital managers do? They compile long lists of differences, usually focused around their albatrosses, to rationalize the cost difference between themselves and the lower cost/higher quality hospitals. They present this list of differences to administrators as explanation for the cost/quality variances, whether or not said “difference” has a measurable and commensurate impact on cost or quality.
A few examples:
• A hospital with over a million dollars in excess labor costs in environmental services maintains that its high costs are necessary for a clean hospital. Staff cleans all restrooms every two hours. Other hospitals have “lower standards” because they clean restrooms based on need – frequently-used restrooms are cleaned more often; least-used restrooms might only need cleaning once per day.
• A sterile processing manager justifies a cost/ surgical case that is three times higher than all hospitals in their group because they have over 100 physician-preference cards, the Cadillac of sterile processing systems, and a full-time RN trainer to teach techs how to use it.
• A cath lab manager rationalizes her higher costs by noting that other cath labs have shorter operating hours than her 10 hours per day. She averages less than two cath lab procedures per day, but the cath labs, prep, and recovery are staffed three to four hours per day longer than her peers.
How can you break out of this cycle? Don’t ask your department heads what OTHERS do differently, or ask them to compile lists of differences. Instead, ask your department heads what THEY can do differently to improve their costs and quality. Task them with developing strategies and implementing solutions to cost and quality problems. Put the onus on your managers to take action and make change, not lists and excuses.
A subtle mind shift to be sure, but a critical one.
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on August 6th, 2010•
By Ariana Berberich
In a recent survey, many hospitalist physicians were unable to accurately predict the cost of treating a hypothetical patient. According to the related article in Health Leaders Media, while many of the hospitalist physicians could identify the relative costs of treatments, they were unaware of the exact price tag of the treatment choices they were making.
This lack of price awareness, coupled with a culture of defensive medicine practice, encourage physicians to order excessive testing on patients. These patients, however, aren’t typically in a frame of mind to advocate for only the most economical (read: cost-for-value-added) treatment choices. However, they stand to foot the potentially inflated bill. Admittedly, the complicated hospital pricing structure, dependent on the specific payer, makes it difficult to ever accurately estimate what a final bill will be. Yet, that still isn’t a compelling enough reason to avoid educating physicians about the financial impact of their practice and utilization decisions.
HMC offers hospitals the tools to successfully educate and encourage their physicians to practice financially-responsible and evidence-based medicine. Some of the best practices around this include:
*Establishing a physician champion or medical advisory panel to lead discussions about scientific and best practice models
*Performing internal comparisons to understand the quality and cost impacts of procedure choices within ancillary and nursing costs
*Encouraging professional development conversations with all physicians about specific practice choices, including demand matching
* Reviewing the profitability of physicians, case types, and service lines
*Identifying quality issues requiring improvement
When physicians understand the costs of their practice choices, they can provide the best value of care.
Ariana Berberich is an HMC analyst.
Client News•
on August 3rd, 2010•
Norfolk, Va-based Sentara Healthcare recently announced it will affiliate with RMH Healthcare, based in Harrisonburg, Va. In a statement, Sentara claimed that RMH recognized the value of such an affiliation with another system, and had considered 10 top candidates. “After extensive review, they chose Sentara. We share a not-for-profit mission and a culture of safety, quality and clinical excellence.”
According to a local press article, Sentara officials will oversee finances, although RMH will maintain a local board to retain control of such matters as quality of care. The officials also claimed it will require about six months to finalize the affiliation, which is probably going to occur early next year.
Sentara was founded in 1888
Uncategorized•
on August 2nd, 2010•
By Shelley Burns
(This is the second installment of a three-part blog)
As I said in my earlier blog, all the stakeholders in an unnecessary C-section play an equal parts in the overutilization of the procedure. I am disappointed with everyone in this scenario. Our business culture worships productivity and wants babies delivered on a schedule, so that mom and dad can get back to work pronto. Our reimbursement incentives obviously don’t place a higher value on vaginal delivery, although it’s safer. Our litigious society looks for malpractice in every bad outcome, forcing clinicians to act directly in the process, rather than let nature take its course.
It goes on. Hospitals allow C-sections and inductions that are clearly NOT evidence-based best practice. Nurse educators aren’t preparing mothers appropriately for a normal vaginal delivery. Physicians are not protesting against this, and schedule C-sections and inductions that are not in the best healthcare interest for the mother and child. Finally, the mothers are not fighting for the best possible care and not taking the time to understand the statistics behind their decision.
There are lots of “nots” in there. Everyone involved is simply not doing the best job they could, due to the larger background forces. We’ve overcome these types of hurdles before. Once we all got on the same page about smoking, within a generation’s time, we redefined it from being a normal, almost required activity to an anti-social scourge. The concerted, synchronized voices of the public, the AMA, the legal system, the surgeon general, the AHA and countless others turned the tide on smoking in this country, to the benefit of everyone’s health. Can’t we do the same for mothers and children? Can we decide to do something about overutilization in healthcare?
Shelley Burns is director of knowledge management at HMC.
