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Quote of the Month
"Good ideas are not adopted automatically. They must be driven into practice with courageous patience."
Admiral Rickover
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New York City's Public Hospital System to Cut Jobs and Programs
New York City's public hospital system announced Thursday that it was cutting 400 jobs and closing some children's mental-health programs, pharmacies and community clinics that serve more than 11,000 patients.
Alan D. Aviles, president of the city's Health and Hospitals Corporation, blamed reductions in state Medicaid reimbursement, a sharp increase in uninsured patients and the rising cost of labor, drugs and medical supplies for the cuts.
He warned that he would probably announce further job and service cuts in a month or two. The hospitals face a looming $316 million budget shortfall for the coming fiscal year, which begins in July, and the current plan would save $105 million.
"This is only the first round; we're only dealing with one-third of the problem," he said. "We do anticipate that there will be additional cost-containment measures."
Speaking at a subdued news conference in the hospital system's Manhattan headquarters near City Hall, Mr. Aviles said that the cuts would come at the expense of some of the city's most vulnerable patients, the poor and uninsured, who he predicted would have a harder time finding the medical care they need. He said the system had been stressed by more uninsured patients, who numbered 450,000 at the end of last year, an 8 percent rise from the previous year.
The rise in the number of people without insurance is accelerating in the city and nationally as unemployment rises, he said, adding that the corporation's cost of treating the uninsured was $850 million last year.
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More
Quotes
It's quite fun to do the impossible
Walt Disney
Don't find fault, find a remedy; anybody can complain.
Henry Ford
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| Greetings!
Now what should we do?
OK, the economy and the stock market is totally out of control - up one hour, down the next; bailouts to everyone who ever mismanaged anything in a major way; cutbacks in schools and nursing homes; more people than ever without health insurance, so emergency rooms and ICUs find themselves with even more nonpaying patients than ever. What can healthcare managers and leaders do? In some cases leaders seem to have chosen the panic route, no plan, no results, just panic.
I suggest that the best approach doesn't require a rocket scientist to develop (although I believe all the rocket scientists who subscribe to this newsletter will agree with me) it will require guts and, worst of all, common sense. In a common sense response we would actually use another cliché, that is, a back to basics plan that reduces waste, improves quality and productivity and holds or even reduces costs. I believe that many healthcare organizations may finally be desperate enough to use the ultimate weapon: the insight of their own employees!
I have been fortunate. In my consulting practice I work with employees and managers that really believe in and trust their own staff. If you think that organizations trusting their own employees are a common thing, talk with possibly soon to be ex General Motors, various newspaper, banking and hospital employees. They will tell you stories like the second example taken from the book Toyota Culture below. They will tell you that front line staff worked around poorly designed systems for years and they will tell you that management showed no signs that they were aware or cared about poor performance until it reached a crisis point.
An average size hospital employs more than 1,000 brains - put them to use to improve customer service and safety and to reduce waste. It's time to move, time to act.
Ken
KenBast@MgtConsultinginHealthcare.com |
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Two Cases from the book: Toyota Culture The Heart and Soul of the Toyota Way
Jeffrey K. Liker and Michael Hoseus
#1 On line at Tsutsumi, The Camry Plant in Toyota City, Japan
As a new group leader, I was sent to Tsutsumi to spend a month getting an appreciation of working on the line and mastering one process. The team leaders told us no one would be able to complete the whole job by the end of the month, but I was determined to prove them wrong. I was installing liners underneath the wheel well when my air gun slipped, and the driver bit scratched the paint on the inner lip of the wheel well. I gasped and looked around - no one saw me do it - but they had told me to pull the andon (rope) cord if I made or caught any defect. It was my moment of truth. My first reaction was to let it go. No one would probably see the scratch anyway, and no one would know that I made it. But my conscience got the best of me, and I wanted to see if they really meant what they said about admitting mistakes. So I pulled the andon and the team leader came to fix the problem and showed me how to hold the bit with a free finger in order to stabilize it better. But he did not seem angry at me for making the scratch.
Then at break we gathered for our afternoon group meeting where the group leader gave out information on safety and quality issues and heard back concerns from the members.
They spoke Japanese so I could not understand what they were saying until I heard the words, "Mike-san" Well that got my attention so I listened carefully... more Japanese and then "scratchee scratchee" ... and then more Japanese. So here it was: finally I was going to get called out for messing up and they were going to do it in front of everyone. Then, all of a sudden, the whole group clapped and smiled and patted my back and shook my hand as they headed back to the line, they were applauding me because I made a mistake and I admitted it. I felt like a million bucks, and guess what I did the next time I made a mistake?
#2 This is Lean in the USA?
They had told us that solving problems was important in lean, and that we should all work together as a team in order to do it. A machine operator called me and told me he had an issue with a safety guard on a piece of equipment. They also told me that it was important that I "go and see." So I left my desk and went down to the work area to meet with the person and look at the equipment and consider the safety issue. I spent some time talking with the operator and understanding the issue when I was paged to see the plant manager. When I got to his windowed office, he and the HR manager were both there and wanted to know what I was doing down there. After explaining the situation, I was hoping for some recognition and support, but instead I got reprimanded. I was told "you can't just talk with every operator about safety issues. Once they tell you that makes us liable with OSHA, and we can get in a lot of trouble. Just do your job!" I left the room thinking "I thought lean was supposed to be different."
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www.MgtConsultinginHealthcare.com
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Newsletter Archive Page.
(Past Issues)
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World Conference on Quality and Improvement
May 18 - 20, 2009
Minneapolis Convention Center,
Minneapolis, MN
Session Number:
HCW11
Session Title:
Through the Looking Glass - Reviewing & Renewing Your Organization's Commitment to Quality
Session Start/End Time:
Wednesday, May 20, 2009, 8:00 AM -12:00 PM
Session Description:
Ken Bast & Katherine Reller follow a 150-bed community hospital on its journey to improve quality. Discuss the pros and cons of each step the hospital took along the way. What would you have done? Is your hospital at a crossroad? Watch and discuss as a dynamic organization faced difficulties and came out on top by using simple tools.
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