Evidence

I’m pretty sure this post by Kevin MD is a call for design thinking.

What works?

If someone would just tell us what works:

a recent Brown University study found that, although higher co-pays keep older people from going to their physicians’ offices as often as they might, the practice also leads to more hospitalizations.

Or $78,333.34 per second...

jayparkinsonmd:

Healthcare in America.

The U.S. spent $2.472 trillion on health care last year, according to a paper out today in the journal Health Affairs. That’s $282 million an hour. Health spending as a percent of GDP — a key metric that shows how much of all U.S. spending goes to health care — rose from 16.2% in 2008 to 17.3% in 2009, far higher than any other industrialized country. That’s the largest one-year increase since 1960, when the feds started closely tracking national health expenditures.

via WSJ

The absolute first question I’d ask a potential surgeon: “Do you use the checklist?”

“Do cool stuff that lasts.”

Atul Gawande (from a Salon interview on checklists and life):

My teams once asked me what our mission statement is. All I could come up with is to do cool stuff that lasts. That’s all I got.

Hospitals failing

Now that we’ve embraced (rather, been forced to) government bailouts, will we soon be seeing them in healthcare at places like Jackson Health in Miami or St. Vincent’s in Manhattan?

Blaming medical technology

Fast Company has an article about the role of medical technology in sky-high healthcare costs. It even calls (the heretofore untouchable) designers enablers.  An interesting excerpt offers the crux of the issue:

At $2 million apiece, with a monthly maintenance bill running around $20,000, [CT] scanners are bought in bunches by hospitals eager to lure patients and blue-chip doctors. In contravention of basic macroeconomics, the supply is actually driving demand. The more scanners hospitals snatch up, the more scans doctors order—76 million in 2005 versus 40 million in 2000—in part because they’re paid per test (that’s another story), but also to recoup hospitals’ losses on the equipment.

Hand washing compliance

Someone told me once that if a hospital was serious about people washing their hands, they would fire anyone who didn’t.  It’s getting closer to that.  From NPR:

… she washes her hands a lot; she guesses at least 100 times a day. But her hospital’s administrators aren’t guessing — they have installed new devices to keep track.

With information transmitted wirelessly through a special badge Stone wears, the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.

Learning on Mondays

Fred at A VC launches MBA Mondays where he’ll teach you everything you need to know. This week: an intro to present value of future cash flows. Last week is was calculating an ROI.

Healthcare can learn from Toyota's sticky gas pedal

For the past ten years (an aggressive estimate) healthcare has been trying to learn from Toyota’s lauded Toyota Production System. Applying Lean (TPS was the precursor to Lean) principles has made healthcare safer.

But Toyota is now offering another learning opportunity (though this one negative). The company that built its reputation upon the ideals of quality is feeling the pain of a sticky gas pedal that forced Toyota to cease new car sales and issue a recall of millions more. An image Toyota so meticulously crafted, an image it relied upon in unseating General Motors as the world’s largest auto manufacturer almost exactly one year ago, is now in question.

And some are blaming it on their push for growth.  The New York Times:

Toyota executives set an ambitious goal in 2002 to own 15 percent of the global auto industry by 2010, meaning it would surpass General Motors as the world’s largest carmaker. To get there, it would have to grow by 50 percent. It would have to build new plants in the United States, China, and elsewhere in Asia, and introduce dozens of new models.

Toyota managed to win bragging rights as the world’s biggest car company. But that focus on rapid growth appears to have come at a cost to its reputation for quality, creating an opportunity for others to potentially take back market share they lost to Toyota.

Did Toyota ignore quality concerns in its quest to become number one? Evidence points toward yes.  The Los Angeles Times:

The automaker has had difficulties explaining why it didn’t address these problems sooner, considering the fact that it conducted a floor mat recall in 2007, and revealed in a filing to federal regulators that it first detected a problem with sticking pedals nearly three years ago.

Toyota’s mea culpa now demands nothing but transparency. Transparency that is going to cost the company customers, inflict major damage to its reputation, and result in a host of lawsuits.

I’d venture to guess that the vast majority of hospital strategic plans include growth as a major goal. That growth goal usually translates into increased volume. But as the Toyota situation reveals, growth at any cost can have a perilous outcome. It is so vitally important to grow intelligently (read: quality means quality each and every time) lest you be subjected to the wrath Toyota is experiencing.

Ed Cotton:

Toyota’s problem seems to a show a lack of understanding of how to scale their production to achieve optimal quality and not thinking hard enough about the impact of potential failure on the brand.

Quite simply, [Toyota’s brand was] important, but not important enough to be front and center of the CFO and CEOs agenda.