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perspective a quar terly repor t by Volume 02 / 2009 | Volume 02 Another example is the innovative restructuring and transformation brought about on these very principles by the Virginia Mason Medical Center (VM) in Seattle. Virginia Mason, a 336 bed hospital present in 9 locations and employing over 400 physicians and 5000 employees in 2000, was undergoing a period of organizational lethargy. In a bid to bring greater efficiency and vitality to their institution’s operations, the senior administration designed a hospital-wide program called the Virginia Mason Production System and successfully ‘leaned’ various arms of the hospital. At the heart of the system were Rapid Process Improvement Workshops (RPIWs) with VM having inculcated over 500 of them. These workshops essentially redesigned the job descriptions of physicians and front-line staff as described below: The system aims to go to the root cause of a problem involving all the levels of hierarchy concerned. Each task is graphically represented through boxes showing the process flow and time allocated. A copy of this is displayed on the wall and observed from time to time to identify the missing links and areas requiring improvement through Rapid Process Improvement Workshops (RPIWs). These workshops are conducted over five working days and change is implemented the following Monday. Also there are monthly, bi-monthly and 90-day audits to further improve and regulate work-flow. This approach helps in identifying and correcting problems in real-time. Exhibit 4 An example of a RPIW Chart tracing movement or footsteps of staff while on duty. The colored lines represent different nursing and paramedical staff movements. The system also promotes the concept of ‘kaizen’ which is continuous incremental improvement. By going the Toyota Way, Virginia Mason Hospital showed how work-flow optimization techniques were appropriate for universal application. Some of the improvements they observed in just two years are illustrated in the Exhibit 5. Most of these radical overhaul methods do not require huge investments or manpower. These learnings can be replicated in Indian hospitals to result in significant savings and quality healthcare for all. 43 | Building Operational Efficiency in Healthcare Delivery Before RPW After RPW Exhibit 5 Results: Source:Team Medicine- Virginia Mason Results Achieved In two years (‘02-‘04) Savings in budgeted capital US$ 12 Mn to US$ 15 Mn Reduction in staff walking distance 38% Reduction in travel distance of supplies 77% Saving in inventory 50% Reduction in lead time 53% Gain in productivity 44%
Customer Relationship Management perspective a quar terly repor t by Volume 02 / 2009 02 Customer Relationship Management (CRM) is a method for an organization to track, maintain and organize a database of its current and prospective customers. In the healthcare sector, there is a wide difference between the customer and the consumer. While an ill patient is the consumer, a doctor prescribing medicines is an essential customer. Hence, there is a series of relationships that need to be nurtured and managed to enhance patient retention. Exhibit 6 Application of CRM CRM has now evolved into a science which has been used very effectively and productively to enhance the efficiency of various sectors such as the banking industry. Multi-channel Integration Customer Marketing Customer Analysis Customer Care Credit Cards, Insurance Schemes Customer profitability, Propensity to buy, Attrition behaviors CRM is increasingly being applied in the healthcare industry in the following ways: Collection & Integration of Customer data Customer Delight & Retention Analysis & Application of this data to provide quality service to customers •The consumer or patient in healthcare is not one, essentially by choice. Apart from the illness, the consumer finds himself dealing with financial burdens, anguish of medical procedures along with the ongoing mental agony. Here the intervention of an active CRM goes a long way in building patient confidence and goodwill. It eventually becomes a deciding factor for the patient while choosing a hospital again. Customer satisfaction is one of the major drivers of repeat business. •Another important consideration is that in a hospital, the patient comes in contact with the entire series of touch points, right from the receptionists, doctors, nurses, paramedics, to the administrative personnel. So in an active CRM programme it is necessary to train every member of the hospital in providing quality care and service to the patient. It also plays an important role in retaining a patient. •The adage that the cost of efforts undertaken to retain a customer is ten times lesser than that of acquiring a new one, still holds true. The mathematical parameter of Customer Lifetime Value (CLV), where financial | Volume 02 Building Operational Efficiency in Healthcare Delivery | 44
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