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April 2006
A Rapid Response Team (RRT), also known as a Medical Emergency Team (MET) or Medical Response Team (MRT) is a team of clinicians who bring critical care expertise to the patient bedside. They are small but powerful teams designed to intervene with patients before they develop serious medical problems. Today, more than 2200 US Hospitals use Rapid Response Teams.
Early Intervention to Avoid Adverse Events
Life-threatening events such as cardiac arrest often have as much as six hours of warning time. An RRT brings experienced clinicians to the patient bedside to pro-actively address these warning signs rather than waiting for an event to occur and reacting to it.
The Team may be summoned at any time by any employee of the hospital to assist in the care of a patient who appears acutely ill, before the patient has a cardiac arrest or other adverse event.
Encouraging Results and Proposed JCAHO Patient Safety Goal
Rapid Response Teams are a fairly new concept in the US. These teams have been shown to reduce potential adverse events and save lives. Baptist-Memphis hospital in Tennessee was an early adopter of Rapid Response Teams in the US, beginning in 2003. They have seen a 28% drop in codes since implementing RRT’s at their facility, and a reduction of transfers to ICU from 82% to 46%. Due to these types of results, the use of RRTs are a proposed JCAHO Patient Safety Goal. (continued...)
May 2006
Supply chain management is often an overlooked subject in healthcare even though it holds great potential for direct cost savings. Many organizations focus almost exclusively on clinical areas when addressing performance improvement opportunities, thereby short-sighting their goal to improve overall operations.
With median operating margins running at a 1.8% deficit, hospitals must aggressively look for new ways to reduce operating costs. Hospitals able to develop supply chain plans that are both comprehensive and favored in the allocation of resources and technology will yield significant savings within each management area of the supply chain, including:
- Product Selection
- Product Sourcing
- Product Distribution
Review and analysis of current systems and processes surrounding these elements will reveal the impact of supply chain savings opportunities for a particular organization. (continued...)
June 2006
Quality and productivity are companions, not trade-offs. Quality outcomes can be enhanced only if managers manage to both quality and productivity. But hospitals seem to be missing out on both dramatic increases in productivity currently experienced by other industry sectors, and positive changes in patient outcomes. Without increases in productivity hospitals will continue to increase charges, further perpetuating rapid increases in healthcare costs. Without increases in quality outcomes, hospitals are placing a portion of their revenue at risk.
Hospital systems in the United States face two significant problems – decreasing productivity and neutral changes in quality outcomes. Starting in 1997, the Budget Reconciliation Act began reducing scheduled Medicare reimbursements to hospitals. Suddenly, responsibility for healthcare expenses began shifting to acute care hospitals, where management still finds itself grappling with the need to develop strategies to reduce hospital costs and improve the quality of patient care.
In 2006, the ability to maintain a competitive cost position will be further compounded as hospitals will have a portion of their reimbursements at risk, that is, based on hospital performance as measured by quality outcomes. Mixing decreased reimbursement with quality outcomes makes the pressure to increase quality an important initiative. However, it also places a concomitant squeeze on the financial resources of a hospital since it seems that the few solutions to delivering a higher quality of care require a significant investment in information systems and additional labor. Implementing any of the potential solutions to providing a higher quality of care, such as Computerized Physician Order Entry (CPOE), without considering how these components are integrated, or how other currently available resources will be impacted, will result in further decreases in productivity and ultimately a higher cost position for hospitals. (continued...)
July 2006
Harvesting ideas yields empowerment, innovation, service, and quality. The ability to collect ideas is critical as work demands become greater, change happens faster, margins become thinner, and resources become scarcer. How does an organization continually harvest ideas to stay ahead of the curve?
A large part of the answer is right under our nose. The answer is in the staff we hire to run the business. They are trained at carrying out policies and procedures, but shouldn't they be trained to look for waste, in its many hidden forms, as well as improve the work they engage in each day? Are they tuned to a customer’s desires? Do they know the value of even one missed opportunity and how it impacts the bottom line? Do they know how to offer up legitimate idea proposals and does management know how to treasure this input?
Most staff are trained how to do their jobs but not how to improve upon it. Thus, bad habits die hard. As a manager or management engineer: here’s your chance to open the floodgates of employee engagement, and to have all eyes looking for ways to make a cumulative difference. The largest hindrance to this type of employee engagement is that most organizations don’t have an idea-friendly environment; for example, environments where ideas are welcome, developed, justified, resourced, implemented, recognized and shared. If there are no deliberate processes, communication plans, and job aids to facilitate each of these steps, it’s no wonder legitimate ideas aren't coming. As Dutch Holland of Holland & Davis Inc.[1] put it: 'If we don't run the business, we won't eat tomorrow; if we don't change the business, we won't be here next year'. In the early 90's the typical Japanese worker was implementing 32 ideas per employee per year. Their American counterpart... 1 idea every 8 years. So what will it take to turn the corner? What's missing? (continued...)
August 2006
Physician retention is a topic worth considering as an increasing number of dissatisfied physicians and specialists opt for early retirement and non-clinical work. Doctors see their autonomy constrained by large managed care businesses, their incomes limited in certain specialties, their paper work and medical insurance increased, and their relation to their communities diminished. This deep personal dissatisfaction is causing physician turnover, especially among primary care physicians. Research shows that physician turnover results in high replacement costs for health care institutions, dis-enrollment and noncompliance rates among patients, and low quality and substandard care. The growing turnover rates and decreasing number of primary care physicians in general is especially alarming due to the impending rush of baby boomers needing medical care in the next ten years and the low number of medical school applicants in recent years. (continued...)
September 2006
Effective leadership alignment within healthcare organizations is swiftly becoming critical as healthcare expenses become a greater percentage of the United States gross domestic product (GDP). Healthcare premiums are increasing at an alarming rate, and, at the same time, change in hospital productivity is decreasing. Moreover, the ability to maintain a competitive cost position will be further compounded as hospitals now have a portion of their reimbursement at risk based on quality outcomes. Trustees can play a leadership role in putting the organization on course to achieve improvements in productivity and quality outcomes. To accomplish this successfully, trustees first need to understand the varying perspectives of multiple stakeholder groups and, secondly, recognize that a paradigm shift may be necessary in order to implement the processes and programs that will help the organization achieve its goals.
During a recent conference sponsored by the California Healthcare Foundation, attendees were asked to prioritize twenty-four practices that most significantly contribute to California hospitals’ pursuit of high quality patient care. The results of the poll were grouped according to the respondent’s position or role in the organization. When analyzing the results, it is interesting to note the alignments between various stakeholder groups (board members, physicians, nurses and senior management) and how their perspectives differ.
- Board members and nurses were aligned in placing the highest importance on having evidence-based protocols and care guidelines.
- Physicians believed investments in information systems supporting medical error reductions would have the most significant impact on providing high quality patient care.
- Senior managers ranked having interdepartmental cooperation as the most influential aspect of providing quality care.
Not only does this comparison indicate there is little agreement on how hospitals should approach delivering quality care, more importantly, it points out the need for understanding the dynamics between evidence-based protocols, technology and interdepartmental cooperation. The foundation for driving and achieving improvements in productivity and quality outcomes is at the intersection of these three factors. (continued...)
October 2006
November 2006
So why does the term "supply chain management" create such anxiety in an organization? Why are organizations so paralyzed by the concept? Why are so many hospitals ineffective at managing supplies? Why are so many consulting firms making money off of the latest craze? Is it possible that an organization can figure it out on its own?
Consultants will typically come in to an organization, use an organizations own people and systems to analyze its data, regurgitate it into impressive spreadsheets and graphics, often agitate the players, and potentially leave behind more rubble than there was before they arrived. There can be significant cost improvements, but results can be short lived without appropriate training, monitors, and will to continue the process. In HMC’s experience, organizations must ultimately manage the inputs and outputs of the processes, and in most cases, organizations have the data systems, internal talent and resources to figure it out on their own. Would a hospital be better off trying it itself? It does take some organization, resources, time and most importantly commitment at all levels, but those who do it themselves usually have better and more lasting results. Only an organization can assess its capacity and ability to take on supply chain management. (continued...)
