Lean Integration of Health Care: The Data for Healthy Future

Lean practices have gone out of production in other sectors and functions. Now with the release of the 2010 Lean integration: an approach to the integration of agility in the facility, the terms were first used for data and system integration. Although the book has received strong support from a wide range of industry leaders, discussions with experts in health care issues if a method has its roots in the industry are transferable to the task. While no one disputes the differences between products manufactured and hydrotherapy, this is the tip resistance justified, or is it a case of "not invented here" syndrome?

Lean practices have gone out of production in other sectors and functions.  Now with the release of the 2010 Lean integration: an approach to the integration of agility in the facility, the terms were first used for data and system integration.  Although the book has received strong support from a wide range of industry leaders, discussions with experts in health care issues if a method has its roots in the industry are transferable to the task.  While no one disputes the differences between products manufactured and hydrotherapy, this is the tip resistance justified, or is it a case of “not invented here” syndrome?

This article presents the argument that integration is not only appropriate to address the health care system, but the industry is health care in terms of propensity to take advantage of techniques to achieve breakthrough benefits to a greater extent than most other industries.  In particular, the fragmented silos of health care and sensitivity to the concerns of privacy and data security, and life-threatening nature of errors that require high quality, lean subjects are exactly why the right ideal.  I’ll start with a brief definition of the slope, gives a few examples of the first users of health services, an overview of some key challenges in health care (especially USA), and finally examine how Lean principles can pull everything together.
What is the integration of Lean?

Lean is a management system that focuses on creating value for end customers and eliminate non-value added activities.  Its principles are derived from the Toyota Production System was developed over 50 years, but since mid-1990 this approach has simply been called skinny.  Although based on lean manufacturing, is now regarded as a management approach that can be used effectively to a wide range of industries and services.  Lean is closely related to methodology and borrowed from others, including the value network, Theory of Constraints, Six Sigma and statistical process control.  Lean Integration is a management system that focuses on continuous improvement and elimination of waste at one end to the integration of business and data integration.
Early adopters of Lean in Health

Lean Management is already adopted in several pockets of industry and health care are rooted in some organizations.  This does not mean that most institutions have adopted lean, but the practice began 15 years ago in large organizations is growing.

For example, make the Park Nicollet Health Services, a leading provider of health care in Minnesota, the entire system fully integrated with the commitment to Lean Manufacturing.  Using the techniques of lean manufacturing, Park Nicollet a measurable improvement in care and patient safety, and help control the rising cost of healthcare.  Almost all publications work includes business process improvement or management (Lean, PDCA, Six Sigma, etc.) “under the applicant’s qualifications. Blog in 2009, wrote David Wessner, CEO of Park Nicollet, about how to implement a visual management, kaizen events Andon  and daily activities in the hospital system [1].


PDCA stands for Plan, Do, Check, Act “, in four steps constitute a cycle of process improvement.

In his article titled “Building a better health care system,” Glenn Bodison Texas Quality Foundation lists other health organizations who have chosen the Toyota production system as a model for operation.  For example:

* Center for Quality Health ThedaCare (Appleton, Wis.)
* Children’s Hospital in Seattle (Seattle, WA)
Re McKennan Hospital University Health Center * & (Sioux Falls, SD)
* Royal Bolton Hospital (United Kingdom)
* Virginia Mason Medical Center (Seattle, WA)

A.  April 2010 article in the Winnipeg Free Press, who referred to Dr. John Toussaint, president of ThedaCare, that most of the processes of hospitals have used this year is “defective and unusable.”  By eliminating waste, he said, hospitals are able to “collapse” time and improve quality.  [3]
Challenges of implementing the integration Lean Healthcare

Although examples of highly effective systems and efficient management of health can be found elsewhere in the U.S. health care system in general is pretty average compared to other countries.  This may not be a bad thing, aside from the fact that the per capita cost of healthcare in the U.S. is by far the highest in all countries (7290000000) and more than double the price ($ 2,962) means.  [4]

There are four main reasons why the gap between the high cost and the average results:

* Results of the complexity of the United States in the management of health system costs much higher.
* The American legal system encourages litigation, resulting in high costs for insurance against malpractice defense and medical practice.
* Many users of the system in health care the uninsured receive public funds, but lower statistics, because they receive less preventive care.
* Other factors include a fee structure that rewards reactive rather than preventive medicine, the ability of the entire infrastructure of high technology diagnostic and a high degree of innovation in pharmaceuticals.  All these negative factors, but still, the U.S. pays a premium of 59% for health services in relation to other countries that seem to be equally effective.

Digging a little further in these cases to see how they add to overall costs of health care.
The costs of high system complexity and management overhead of 14%

According to a New England Journal of Medicine study, used 31% of health spending in the United States the administrative activities instead of providing health care, while administration accounts for only 16.7% in Canada (a difference of 14%).  separation [5] An attempt to stream flows of money or services from the health care system in the United States gives up in frustration or end up with a migraine.  That these two streams are not adjusted part of the problem.  The U.S. system has evolved over the past 80 years in mind-numbing complexity of the institutions in the silo and millions of independent professionals.

The end result is a physician-patient-safe “dance” for many transactions.  In contrast, do patients in Canada, Britain and other countries that deal directly with the doctor, and do not need to be involved in the payment at all.  United States, is a common practice for patients to first get prior approval for medical expenses before the insurance company to contract with the provider of health care.  So, when treatment is completed, the patient must fight in a complex appeal and complain when the insurance payment is not in line with the supplier’s invoice.  An important factor in the low level of customer satisfaction comes from the complexity of financial and administrative struggles, rather than actual clinical services.
Environmental Litigation: overheads by 10%

According to a 2006 study by PricewaterhouseCoopers, 2% of health spending in the United States for the costs and 8% for the defense of medical practice.  [6]

The American legal system, it is very easy, and free for patients to continue or hospital.  Lawyers of the structure of their fees as a percentage of damages, if, in essence, there is no cost to the patient in the application proceedings.  If the patient loses the case, there is no obligation to cover the cost of health from a court or legal costs.  This legal protection is deeply rooted in American culture, and more generally a positive, but unintended consequences:

* Doctors in the U.S. in general, further tests (many of them useless) just to reduce the risk of being sued for negligence.
* The high cost of legal fees and insurance against malpractice is included in the price of medical services.

In contrast to countries with social health systems ensure legal protection for health professionals.  For example, in Finland, the damage to a patient in the law of patients entitled to compensation from the government, the unpredictable damage that occurred as a result of treatment or diagnosis.  Health professionals should not be shown to be legally responsible for the accident.  To receive compensation, damages are sufficiently unpredictable that is defined by law has occurred.  Guidelines deal with medical care established by medical experts, but these are only guidelines, and doctors are free to decide how to treat patients.  The government does not regulate how doctors can treat their patients.
uninsured population: 8% off

According to a 2004 report from the Institute of Medicine of the National Academies, the U.S. is the only one of 30 rich countries in the OECD does not guarantee that all residents have basic coverage.  [7] It is not entirely true, because if someone is very sick and goes into an emergency room, the patient will receive medical assistance.  These costs are charitable services will ultimately be paid by Medicaid (funded in turn by tax revenues and the federal government) or higher service fees for the rest of the population.  Working an average of less uninsured and preventive medicine, so when they get tired of their stay in hospital is often longer and more intense.  The estimated number of uninsured residents ranged from 15.4% [8] and 29%.  [9]
Other factors: 27% off

United States has the highest score in 190 countries regarding access to health care.  This function is performed by a high degree of specialization and complete facilities.  For example, the United States with 34 CT scanners per million inhabitants, while Canada has 13 and the United Kingdom eight.  Similarly, the U.S. has 26 MRI machines per million, compared with Canada, with 7 and the United Kingdom eight.  This high capacity which increases costs and encourage unnecessary tests, and if you have an MRI on his hands, why not a test, if the results can show anything useful?  In addition, the maturity structure of suppliers based on a fee for the service that provides a financial incentive to perform diagnostic tests.  From an economic standpoint, the best patient to the doctor a new one with different medical conditions, which form the basis for a large number of diagnostic tests.

In addition, according to several studies, the U.S. is the world leader in biomedical research and development and introduction of new biomedical products.  Research and development of medical devices and pharmaceuticals, with support from public and private sources.  In 2003, expenditure on research and development around 95 billion U.S. dollars with 40 million dollars from public sources and $ 55,000,000 from private sources.  These investments in medical research has been the U.S. leader in medical innovation, measured by revenue or number of new drugs and equipment in place.
How the principles of Lean can provide all

Especially because of the health sector is so fragmented, it is inevitable to adopt lean practices.  Lean Integration is a natural way to solve many problems throughout the organization through the application of the principles of waste management, mapping of the supply chain, strengthen teams, and optimization of all parts.  See how the seven principles of lean integration may have an impact on your business.
Eliminate waste

“Waste” is in the eye of the beholder, and welding in the waste from the perspective of the customer.  The only thing that everyone in the industry have agreed to taxpayers, regulators, doctors, nurses, hospitals, laboratories, pharmacies, medical product manufacturers, researchers, and so on, that the goal is to improve health and quality of life in humans.  This target means that patients in the client.  Lean techniques such as supply chain stream mapping helps to shape the end to end services that result in patient care, clearly identifying the value-added activities (customer perspective) and it is not necessary.

When the image is clear, all working together to promote changes that eliminate waste.  This is still a difficult question, given the different incentives for all actors in the value chain, but we have many more opportunities to make significant improvements if we focus on the customer and a common goal.
Automating processes

Most health professionals in the United States still use paper as the primary means of medical records.  This makes it very difficult (impossible actually) to share information about a referral, or with a team of therapists in the same patient.  The technology is clearly going beyond the prescriptions written by hand or by fax and mail as the primary means for exchanging medical records.  Lean shows how this integration can be achieved gradually and sustainably.
Empowering the team

A basic principle for the integration of lean bottom-up rather than top-down changes, led by frontline employees.  Although public support and commitment from top management is required, the leaders have been disconnected from the realities of daily work, and therefore can not make the best decisions.  People who work should be able to drive change, give them the information they need to see the whole picture, and support their ideas with the tools and the right resources.
Continuously improve

The solution is health is a “boil the ocean” the problem boils the sea is a cube at a time.  Continuous improvement means just that: the changes never end.  Lean integration shows how changes can be done “gradually, from bottom to top, and without significant results.
For example, construction

Lean practical techniques for integration gives a calculation error on the test.  It’s like the light bulb factory that has figured out how to end the testing of each bulb, through the design and construction, so that 100% of them work.  It is a great belief that mistakes are inevitable, particularly in the complex world of software, so we put a lot of tests.  We must break this pattern instead of starting to ask: “How can we change the process of building quality, to the point where the test is redundant?
Plan for Change

One of the five laws of integration described in Lean integration: “It is a final statement.”  For example, it is a mistake to build computer models based on electronic patient records monolithic and rigid.  However, be designed to fit the natural learning curve associated with new opportunities.  For example, the ideal data model is updated with metadata efficiently, the database stores “means” of data and its relationship to other data items over time.
Optimizing all

Sometimes, in order to optimize the whole, it is necessary to sub-optimization of the parties.  For example, from an economic perspective, a doctor will not be optimal to take preventative measures to prevent a patient from getting sick, but in light of the patient and health care in general, this experiment would clearly beneficial.  Over time, policies and structure of wages to all who play a role in the system must change, adapt to a new set of indicators designed around comprehensive care to patients.  At the same time we must recognize and emphasize that leaders of good behavior.
Getting Started

All these exercises are easy to implement lean, no significant changes in policy and broad support, but that does not mean we have to wait until all the stars to align before.  Lean is intended to be implemented gradually, and may have a significant effect, even if we start with the principles of one or two.  It did not take many years before we can look back and say, “Wow, what a difference!”

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  1. Thanks for sharing.

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