On the Mend

On the Mend, Revolutionizing Healthcare to Save Lives and Transform the Industry, by John Toussaint MD and Roger A. Gerard, PhD with Emily Adams, 2012  

Every day we hear another frightening statistic from this industry.  One of the biggest was a 10,000 percent mark-up cited for simple painkillers.  Any other day a web search will reveal fragmented communications that derail or damage a living product, humans, lurching down a peculiar run of assembly line operations that end…. Who knows where?  And along the way this human product may be touched, massaged, or cured by the medical experts who seem to be gateway operations to the cure. 

Is there another way?  Might the US adopt a non-bankrupting, healthy approach to an industry that represents approximately 15% of its GDP?   Estimates of US spending per person on healthcare at $7K fall below the average per capita public education spending per pupil – in the teens - in our most affluent communities, yet one wonders if the results are equally disappointing. 

Could there be proven methods that are cheaper and more efficient in an industry changing very fast?  Or is the whole healthcare industry too big to tackle?

As one would expect, the answer to this question comes from a meeting of doctors with lean advocates.  In this case, On the Mend is a collaboration of a doctor with a lean expert, supported by the vision – or dissatisfaction with the system – of Jim Womack, founder of the Lean Enterprise Institute.  In terms of visionary, systemic change, we could hardly hope for higher, more credible drivers.

But the problems are big and growing.  The best way to understand and visualize a big systemic change, like MRP, or JIT, or lean healthcare, is to see an actual pilot turned reality.  And that is what the authors offer us in On the Mend.  You will recognize all the usual lean tools in the background of this implementation, although some of the vocabulary changes.  Working with help from pioneers such as George Koenigsaecker, the ThedaCare teams in Wisconsin tackled quality, patient satisfaction, length of stay, average cost per case over a three year period, and the results are impressive:

                                                            2006                            2007                   2008                2009

·          Defect-free admission   1.05 defects per chart   .01          0                     0

·         Patient satisfaction         68%                             87%       90%          4.5 out of 5

·         Length of stay                3.71 days                     2.96        3.16         3.01

·         Average cost/case        $5669                        $4467       $5849        $5567

Interesting to see patient satisfaction rise so dramatically, while cost reductions plateau.

When I first heard Jim Womack talk about attacking the US healthcare system’s problems over 15 years ago, I felt he was unrealistic and would be overwhelmed by the system – too big, too “different,” too complex.  But two things have worked in our favor – 1.  The aging Boomers who always got, one way or the other, what they wanted, and 2.  Government, as the biggest consumer, attention. 

Fortunately for us, we now have great resources in place to analyze and diagnose these very expensive healthcare problems.  On the Mend is a great illustration of what can be done.  In the purchasing area, many medical institutions are also making inroads in spend reduction.  The combination of these two very powerful problem-solving approaches should, we hope, stop the waste, and deliver better care for more consumers.  We’ll have to wait and see if our hopes are converted to reality.

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