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perspective a quar terly repor t by Volume 02 / 2009 | Volume 02 Overview With the turn of the century, the dynamics of work, health and life have undergone a sea change. Every sphere has seen growth and opportunities in leaps and bounds with newer and better ways of doing things and also doing altogether newer things. The emphasis is shifting towards improving efficiency, precision and reducing time and cost. Although this wave of change has swept across every industry, such dynamism and corporatization has completely changed the face of the healthcare industry. While there are an increasing number of patients, there is also an ever-increasing disease profile and burden. The disease pathway has become much more complex and not just limited to diagnosis and treatment. On the other hand, the implementation of information management systems has made the operation and administration of a hospital more professional and business-like. Over the last decade input costs have gradually increased, however due to increased competition Heathcare Providers are unable to pass this burden onto patients in the same proportion. This presents Hospital Administrators with a complex task of not only streamlining existing operations but also providing flexiblity for future changes in the business model. Hence, now more than ever, with rising demand and unprecedented growth of the sector, there is a growing need to come up with newer models to improve operational efficiency and make processes, infrastructure and our outlook to management more lean and specific. From the softer skills of Customer Relationship Management (CRM) to the core activities of Revenue Cycle Management (RCM), hospitals are undergoing a complete overhaul of how they do business and more importantly focussing on ‘who they do business for’. Exhibit 1 Documentation Paper Records Electronic Medical Records Mode of payment Out of Pocket Third-Party 41 | Building Operational Efficiency in Healthcare Delivery The Ongoing Transformation in Hospitals Public Relations Doctor - Patient relationship Marketing / CRM Quality Sporadic quality checks Accreditation Hospital Financial Operations Accounting Revenue Cycle Management Human Resources Low Employee Participation Active Employee Engagement Customization Mass Approach Personalised Care
Changing Healthcare: ‘The Toyota Way’ perspective a quar terly repor t by Volume 02 / 2009 01 | Volume 02 Changing market dynamics and consumer attitudes are forcing companies to redefine their business models. With growing competitive pressures and rising input costs, they recognize the need to restructure, redefine, redevelop and constantly improvise. While there is no standard formula to do the same, hospitals have improvised and developed their own USP models. However, over the years the challenge that still remains is to reduce the cost of care or keep it constant for the patient while progressively increasing the parameters of quality, accessibility and affordability. Some innovative practices adopted by hospitals to reduce the costs and improve on the throughput: •A popular ‘for-masses’ Indian hospital charges different fees for diagnostic services at different times of the day. They have been able to increase patient volumes by differential pricing. Therefore, while an MRI/ CT scan may cost up to US$ 100 (~INR 5000) for a person choosing to get it done in the day, a poor person can get the same for US$ 10 (~INR 500) at 2 a.m. in the night. More and more hospitals are making an attempt to bridge the socio- economic gap in healthcare delivery through such practices. •To streamline operations, use of ‘Case Process Maps’, wherein the activities of all the staff involved in a procedure are mapped and time plotted allowing the variations to be studied and corrected. This helps to cut out redundancy and errors while improving accuracy and efficiency. Exhibit 3 Surgeon Assistant Machine Support OT Nurse Anaesthesiologist Avoid ‘Muri’: Standardization Start Patient Entry Patient Prep Incision Procedure End Closure Patient Exit Room Cleaning Eliminate ‘Muda’ : Waste Reduction Minimize ‘Mura’: Promote Consistency Muda: Waste Mura: Inconsistency Muri: Randomness Exhibit 2 Changes in Cost of Care Case Process Maps Cost Year 2000 Year 2009 Technology x 2x Manpower x 2.5x Consumables x 2x Land & Building x 2x Cost to Patient Source: Surgical Management Improvement Group Many hospitals are adopting the classic Japanese Process Improvement Triad as shown. Activities such as re-organization, value mapping and best practices are designed to help implement these principles. Building Operational Efficiency in Healthcare Delivery | 42
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