Thursday, December 18, 2008

'...Six strategies for waste elimination: ...'

Eliminating Waste in Health Care

The ability to eliminate unnecessary cost is absolutely critical to health care industry. Total spending was $2.3 TRILLION in 2007, or $7600 per person [1]. Total health care spending represented 16 percent of the gross domestic product (GDP). U.S. health care spending is expected to increase at approximately 7% levels for the next decade reaching $4.2 TRILLION in 2016, or 20 percent of GDP [1].

In 2007, employer health insurance premiums increased by 6.1 percent - two times the rate of inflation [2]. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400 [2]. Experts agree that US health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families.

So, how health care system can eliminate waste? The results from my research about medication delivery systems conducted over two years at one community hospital provide some answers to this question.

The results are:
• Fifty two out of sixty three nurses (82.53%) highlighted poor training for medication error reporting and prevention. Six out of six technicians (100%) pointed to the same issues as nurses.
Fifty five out of sixty three nurses (87.3%) reported confusion about their role expectation with respect to medication error reporting and prevention. All technicians stated similar concerns.
Fifty four out of sixty three nurses (85.7%) specified lack of feedback as important factor affecting their psychological safety towards error reporting and prevention efforts. Four out of 6 technicians (66.67%) pointed to the same issue.
• All nurses and all technicians (100%) highlighted productivity pressures as the most stress-generating factor on their daily work averting them from medication error reporting and prevention.
Forty four out of sixty three nurses (69.8%) and three technicians (50%) suggested group behavior influence as another major factor behind poor medication error reporting and prevention.
Forty eight out of sixty three nurses (76.19%) indicated difficulties with utilizing the mechanisms for medication error reporting and prevention. Six out of six technicians (100%) pointed to the same issues as nurses.

Therefore, based on the ‘voice’ from the front line staff, I propose the following six strategies for waste elimination:
1) First, healthcare organizations should recognize the growing need to advance the understanding about healthcare delivery systems, unnecessary waste, as well as Quality Improvement (QI) programs by health care professionals. This can be done via continuum education training on systems and QI.

2) Second, health care organizations should start recognizing their frontline professionals as assets rather than costs. It is everybody’s job to eliminate waste and to do improvements. Therefore, the role expectation with respect to waste elimination and quality improvement should be well communicated to all frontline employees and continuously supported by managers and administrators.

3) Third, organization-wide and constructive feedback to frontline health care professionals about QI needs to be provided on a continuous basis. My research found that health care professionals who felt neglected and under-informed regarding the changes often responded with low motivation and discouragement towards QI efforts.
4) Fourth, the productivity pressures, often mentioned by frontline workers as one of the major contributing factors causing the low QI efforts, should be offset by redesigning systems that minimize the unnecessary waste during daily work. This should allow health care professional to devote more time to continuous improvement efforts.

5) Fifth, to remove the undesired group behavior, managers should physically spend more time and effort to establish and support a culture of excellence with high commitment to patient safety, waste elimination and QI.

6) Finally, all unit managers should provide active leadership at the unit floor for promoting standardized behavior with respect to procedural compliance. The goal is to eliminate the variability in the process by creating a culture that values procedural compliance. In additions, promoting procedural compliance by the manager at the unit floor can increase the rate of error recognition and QI efforts via root-cause problem solving, enhance the manager’s reputation for patient safety, and increase the confidence of health care professionals in her/his leadership abilities/skills.

I hope that the proposed implications and discussions will help health care organizations to achieve satisfactory improvement in waste elimination efforts. In addition, I believe that the proposed insights into this area have potential to enhance professional development of health care managers and professionals.

1. Poisal, J.A., et al, Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact. Health Affairs (21 February 2007): W242-253.
2. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2007 Annual Survey. 11 September 2006.

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