3 Reasons the General Public Doesn’t Think Healthcare Can Improve

Mark Graban

Lean thinkers see the waste in healthcare when they are at the hospital “gemba“. I think this is true whether you are a Lean person who is new to healthcare or if you’re a long-time hospital person who has learned Lean. Experts (doctors) ranging from John Toussaint to Patricia Gabow to Don Berwick all estimate that between 30 to 50% of healthcare spending is waste.

It seems that, often, when you take this sort of discussion to the general public, people react emotionally as if “reducing waste” equates to not providing people the care they deserve – they think Lean healthcare is about taking away, instead of reducing cost and improving quality. I think this happens even outside of charged political circles. Why is that? I have a theory.

Some of the common waste is described in this article about a new Master’s Degree program at Dartmouth:

Disney knows precisely how to gauge the wait for rides at its theme parks.

Major airlines know how to maintain near-perfect safety records on their aircraft.

But hospitals? Most don’t know how to avoid making patients wait — some just build bigger waiting rooms.

Medical centers spend increasing amounts of money on patients, but don’t necessarily deliver better care.

And estimates suggest that each year in the United States there are 15 million incidents of medical harm, some of which result in injury or death.

Now, a new master’s degree program at Dartmouth College is intended to bring more of the business of safety, cost-effectiveness, and efficiency into medicine

My theory is that the general public puts a lot of faith in our healthcare system – blame TV or the movies, I guess. Would they think that a program like Dartmouth’s is even needed?

I think people find it hard to believe the 30 to 50% waste estimates because they assume healthcare is fundamentally pretty perfect, or that it should be.

It breaks down into three categories… because we have the following, we should already have perfect waste-free healthcare delivery:

  1. We have highly trained, motivated people who care a great deal about patients
  2. We have relatively new, modern hospital buildings
  3. We have amazing healthcare technology (equipment, software, and medical knowledge)

So what could go wrong, given those three things? Yet, Lean thinkers know the overall system just doesn’t work. I think it’s hard for the general public to see that 1+2+3 = a lot of waste when they would likely assume 1+2+3 = awesome.

So when errors occur, the general public wants to blame and punish individuals – assuming they must be bad people working in an awesome system. When cost is high, people want to blame the greedy or the incompetent. People don’t tend to look at the overall system, they wouldn’t expect the problem is bad processes, not bad people. The general public assumes quality is good, when the data show otherwise.

It’s safe to say there are indeed a lot of great things about modern healthcare (see 1, 2, and 3, above). But we don’t get the high quality and patient safety we deserve and we, in America, certainly spend way more than we have to — and this high spending is partly due to waste, not due to 1, 2, and 3.

Do you think the public shares that perspective that I described above? Does that common (and arguably incorrect) view get in the way of the public calling for real systemic improvement that reduces cost and improves quality/safety? If so, how can we change that perception that 1+2+3 automatically equals awesome?

Jim Womack: “Tipping Point” for Lean Healthcare?

By Mark Graban,  Senior Fellow at the Lean Enterprise Institute. Source: LeanBlog.

Mark Graban

I’m still catching up on things I wanted to blog about related to our Lean Healthcare Transformation Summit that we held June 9 and 10. It was an amazing event and something we’re looking forward to duplicating – improving and expanding – in 2011 (click for the Healthcare Value Leaders main page that has a link for registering for more information).

In conjunction with the Summit, Jim Womack published his most recent e-letter titled “The Tipping Point?”

Since LEI doesn’t really have an easy way for readers to comment publicly about the e-letters, I’ll take initiative to open that discussion here, since I’m curious to hear what people’s reactions were.

Jim ended his letter with this:

Despite the hurdles ahead I’m now hopeful that the availability of proved lean methods will push providers past the tipping point on the journey to lean healthcare, now that all the easy fixes have failed and there is no other option.

What do you say?

The Golden Hour

By Gerard Cachon and Christian Terwiesch, The Wharton School at the University of Pennsylvania. Source: Matching Supply with Demand.

Christian Terwiesch

Gérard Cachon

Sirens and speeding ambulances are the symbols of emergency care. The basic idea is that the sooner we get seriously injured trauma patients to the hospital, the bigger the chance of their survival. The first 60 minutes after an accident are known as the “golden hour”. Getting the patient to the hospital in this golden hour is claimed to be critical. This is intuitive. But, unfortunately, this claim is not really supported by a whole lot of empirical data. In fact, the authors (who are ER physicians) of a recent Slate story discuss the statistical evidence supporting the myth of the golden hour. They discuss a recent study published in the Annals of Emergency Medicine that finds no support for the importance of extra speed.

But why then, are the ambulances driving so fast? From an operations management perspective, two explanations come to mind. First, the fact that an extra couple of minutes do not matter much in predicting patient survival rate does, of course, not imply that the driver can stop at the next Starbucks… Second, there might be an alternative explanation for the speeding ambulance. Let’s call it the NY cab driver syndrome: The faster you drive, the sooner you will be available for the next trip. After all, it is all about productivity.