Better health care delivery: doing more with existing resources

The healthcare sector faces challenges which are constantly escalating. Populations are growing worldwide and so is the share of the elderly in society. There is a constant proliferation of new medications, diagnostic methods, medical procedures and equipment, and know-how. This huge progress greatly improves the quality of medical treatment but at the same time increases its costs. Governments and authorities are allocating ever growing budgets to healthcare systems but the increased budgets do not cover the increased costs of providing quality healthcare to the public. It is becoming clear that there is an urgent need for practical knowledge and effective tools for people in managerial as well as staff positions.

In response to this need, there are several methods and simple tools that can ease the challenges experienced by every health care organization in the modern day, which don’t have to cost more money. In fact, one can do much more with the same resources in terms of throughput, response time, and quality by using simple practical tools and techniques, all based on common sense. This is achieved through a system view that touches upon issues of performance measures, operations management, quality, cost-accounting, pricing, and above all, value creation and enhancement. Every manager, at every level, within a health care organization will be able to implement immediate actions resulting in relatively rapid improvement in most performance aspects of the organization. The focus is on reducing waste and avoiding non-value-adding activities.

This is the essence of the “Lean concept.” Lean is a philosophy: based upon tools that are simple, easy to comprehend and use, and have already achieved amazing results in many healthcare organizations. It is the use of the Theory of Constraints (TOC), a management paradigm, along with other focusing tools such as the Focusing Table, the Focusing Matrix, the Complete Kit concept, and Pareto analysis that provide the highly added-value for healthcare managers. This is especially critical in face of the problems with the Affordable Care Act and other emerging healthcare reforms.

One of the most powerful tools to improve a hospital, laboratory, or clinic, is the small batch concept. People have been trained to use “economies of scale” to avoid possible costly turnovers, resulting in working with large batches. Reducing batch size can do wonders for processes and organizations. Using small batches, one can dramatically reduce response times (especially in laboratories and imaging services).

All the above mentioned tools help break the myth of the “input-output” model where you need more inputs. One can increase throughput, reduce response times, and increase quality, all with using existing resources.

It is difficult to dismiss the amazing achievements that many hospitals have made while using only existing resources. They have shown that an increase throughput in operating rooms by 10-20% and reduction of response times in places like emergency departments and clinics by 20-40% is a sustainable goal—realistic rather than aspirational. For example, in the operating room of the ophthalmology department in a public hospital, within only four months, the number of operations increased by 43%, waiting time for surgery decreased by 41%, all this with a significant improvement in quality. Further success stories will follow.

A clear example of the successful application of the Theory of Constraints can be seen in the below case study of a General Hospital in the United Kingdom.

The objectives were:

1. Discharge patients from the emergency arena in less than four hours

2. Reducing delayed admissions that exceeded 12 hours

The results within one year, following the application of TOC, were:

· 35% improvement in less than four hours throughput in the emergency arena from 68.0% to 92.2%

· No delayed admissions that exceeded 12 hours

· 91% reduction in delayed admissions that exceeded four hours

A large Private Hospital in Tel Aviv, Israel, saw impressive results that were achieved within just nine months using TOC:

· Number of operations increased by 20%

· Profits nearly doubled (fixed costs accounted for 80% of costs so additional operations were very profitable)

· Waiting times for operations decreased by 20%

· Queues for operations and imaging tests decreased by more than 20%

· Improved clinical quality and service quality

According to the CEO of the hospital, the three tools with the most impact were eliminating dummy constraints, using specific contribution, and working with complete kits. These tools are used in the OR as well as in the ED, internal medicine wards, laboratories, and imaging services, in large healthcare organizations as well as in small and medium size ones.

Managers of hospitals and clinics can do much more using only existing resources. The way to succeed in implementing changes and getting successful results lies in integrating several tools and philosophies, such as combining TOC and Lean together. TOC can achieve fast results by focusing on the few important points. On the other hand, Lean enables teams to analyze and improve processes. By combining both managerial philosophies, TOC can point out the areas to improve, as Lean can provide tools to get the work done.

Featured Image Credit: “A row of chairs in the hospital hallway” by hxdbzxy. Via Shutterstock.