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The Paradox: Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the worlds best individual health systems are located in the U.S.each a unique result of visionary leadership and
In this groundbreaking collaboration, award-winning authors Bauer and Hagland draw upon numerous case studies to show how pioneering health care organizations are using such performance improvement tools as lean management, Six-Sigma, and the Toyota Production System to produce excellent services as inexpensively as possible.
The Paradox: Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the world’s best individual health systems are located in the U.S.—each a unique result of visionary leadership and private initiative, not government-driven health reform. The Imperatives: Due to powerful new forces explained in this book, medical spending has stopped growing. Purchasers, payers, and patients are no longer willing or able to keep paying more. To stay in business and improve population health, providers and their business partners must eliminate the shameful waste generated by inefficient and ineffective production processes. The Solution: Simply repairing or repealing the Affordable Care Act will not get us where we want to go. The fundamental roadblock is a wasteful system, not uninsured Americans. Reform needs to be immediately redirected to creating the best health care system that 17 percent of GDP can buy. Money saved by taking the new path to reform can then be used to improve population health through access for all. Paradox and Imperatives in Health Care is the roadmap for getting there. Supplies updated perspectives on health care’s problems and solutions Details the reasons why government-driven reform does not solve problems Provides a justification for regulatory relief tied to performance improvement Suggests specific new policies for a better approach to desired outcomes Presents content written expressly for busy executives and policy makers
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.
Medicine is not a precise science. There are always several options to manage and cure a disease. The best help for the treating doctor comes from the patient. The better informed the patient is, the more helpful this is to the physician.
With the same clarity that made the previous edition a bestseller, Healthcare Delivery in the U.S.A.: An Introduction, Second Edition provides readers with the understanding required to navigate the healthcare provider field. Brilliantly simple, yet comprehensive, this updated edition explains how recent health care reform will impact hospitals and health systems. It includes updated case studies and describes the new organizational structures being driven by current market conditions. Focusing on healthcare management, the book addresses the range of topics critical to understanding the U.S. healthcare system, including the quality of care movement, recent finance reform, and the recent increase in merger and acquisition activity. Dr. Schulte walks readers through the history of the development of U.S. healthcare delivery. She describes the various venues of care delivery as well as the different elements of the financing system. Offering a glimpse into the global market and medical tourism, the text includes coverage of legal and regulatory issues, workforce, and the drivers and barriers that are shaping healthcare delivery around the world. Painting a clear and up-to-date picture, this quick-and-easy read provides you with the understanding of the terminology, structures, roles, relationships, and nuances needed to interact effectively and efficiently with anyone in the healthcare provider field.
This 25th Anniversary edition completely updates the powerful insights and policy recommendations of Not What the Doctor Ordered, first published in 1993 by renowned healthcare futurist and medical economist the author. It presents specific solutions to serious problems of cost, quality, access, and outcomes by allowing all Americans to purchase services directly from caregivers who provide an expanding array of medical services at least as well as physicians—at lower cost. Focusing on new realities of the 21st century, the authorshows not only why giving consumers the right to choose advanced practitioners is the top priority for improving our overpriced, underperforming medical care delivery system, but also how to make the necessary changes. As he clearly and concisely explains from medical and economic perspectives, the key is eliminating physicians’ monopoly powers over advanced practice nurses, clinical pharmacists, physical therapists, clinical psychologists, and other advanced practice (AP) health professionals who now rival physicians in scientific knowledge and caregiving skills within well-defined scopes of practice regulated by state governments.
While there are a growing number of books based on the Toyota Production System, or lean, focused on healthcare, there are very few that detail the tools that make lean more than just a way of thinking and put the methodology into practice. Based on Hiroyuki Hirano's classic 5 Pillars of the Visual Workplace and modeled after the Shingo Prize-winning Shopfloor Series for Lean Manufacturers, 5S for Healthcare adopts a proven reader-friendly format to impart all the information needed to understand and implement this essential lean methodology. It provides examples and cased studies based on the experiences of the principals involved with the Rona Consulting Group, who were responsible for the groundbreaking implementation of the Toyota Production System at the Virginia Mason Medical Center. Written to readily assist with hands-on implementation efforts, this volume offers innovative features designed to improve understanding and support application. This includes helpful how-to-steps and practical examples taken directly from the healthcare industry.
Healthcare in the U.S. is a critical juncture. We face a sharp upward rise in the number of people with chronic diseases and disabilities. As demands on our current health system grow, so will costs. But as a society we are approaching the upper limit of how much we are willing (or able) to spend on health care. Health care policy makers know this. That is why major health reform measures are focused on population health and value-based care. These are the so-called second curve objectives. But these initiatives are doomed to failure. We are asking a system to do things that it was not designed to do. In fact, we don’t have a health care "system" as such. We have a parts bin of disconnected silos. Fragmented delivery systems. Specialized caregivers. Professional groups. Trade associations. All with distinct cultures. Each with their own motivations and agendas. Our payer and regulatory structures have evolved over the decades in response to political and policy initiatives. However well intentioned (or not), these structures defy logic. They reward and reinforce counter-productive industry behaviors. They pose formidable roadblocks to achieving needed changes. Current reform initiatives are an implicit recognition that our health model is flawed. The attitude seems to be, "Yes, we know the overall health system is a problem, but we can make failure less severe if we implement these measures." We are at a critical juncture. We can continue to place additional demands on an industry model that has outlived its functional utility. Or we can take more of a clean slate approach and move toward a model that is in keeping with today’s needs. The outlook is not good if we stay on the current curve. The demands on resources will continue their upward trajectory. The default scenario will be one of rationing and less to invest in new cures and new technologies. The good news is that we are within sight of a future state of health care that can really work. In this future state, we have gotten rid of the artificial barriers to effective and efficient patient care. Physicians and other health professionals work in a coordinated, inter-disciplinary fashion. They have accountability for the whole care cycle. Caregivers have both the flexibility and encouragement to innovate and come up with optimal delivery approaches. And because they are in a risk-reward relationship with payers, they have the incentives to provide true value. Patients feel intimately connected to a system that is focused on their specific needs. The key to this future state is good old-fashioned market discipline. Other delivery models must either improve or get out of the way. The market will demand cost-efficiencies and won’t tolerate waste. Much of our regulatory structure will be rendered unnecessary. There will be not rewards for poor performance. This book takes a unique macro-level perspective of clinical, economic, and regulatory problems and possible solutions. It takes an objective and something scathing look at current industry structure: a silo-driven culture and entrenchment that is driven by self-interest; as well as the complicity of government in preserving the status quo through regulations, licensure, payment systems, etc.
Winner of a 2013 Shingo Research and Professional Publication Award This practical guide for healthcare executives, managers, and frontline workers, provides the means to transform your enterprise into a High-Quality Patient Care Business Delivery System. Designed for continuous reference, its self-contained chapters are divided into three primary sections: Defines what Lean is and includes some interesting history about Lean not found elsewhere. Describes and explains the application of each Lean tool and concept organized in their typical order of use. Explains how to implement Lean in various healthcare processes—providing examples, case studies, and valuable lessons learned This book will help to take you out of your comfort zone and provide you with new ways to extend value to your customers. It drives home the importance of the Lean Six Sigma journey. The pursuit of continuous improvement is a journey with no end. Consequently, the opportunities are endless as to what you and your organization can accomplish. Forty percent of the authors’ profits from this book will be donated to help the homeless through two Baltimore charities. Praise for the book: ... well-timed and highly informative for those committed to creating deep levels of sustainable change in healthcare. — Peter B. Angood, MD, FACS, FCCM, Senior Advisor – Patient Safety, in National Quality Forum ... the most practical and healthcare applicable book I have ever read on LEAN thinking and concepts. — Gary Shorb, CEO, Methodist Le Bonheur Healthcare ... well written ... an essential reference in the library of all healthcare leaders interested in performance improvement. — Lee M. Adler, DO, VP, Quality and Safety Innovation & Research, Florida Hospital, Orlando; Associate Professor, University of Central Florida College of Medicine ... a must read for all Leadership involved in healthcare. ... I can see reading this book over and over. — Brigit Zamora, BSN, RN, CPAN, CAPA, Administrative Nurse Manager, Florida Hospital, Orlando