applied Value Based Healthcare

Ownership To ‘Own’ a process means to understand it’s concepts well enough, and to have the latitude to improve it through adjusting its parameters and learning through feedback. In healthcare, it’s an iterative process that requires years of clinical experience  along with basic industrial engineering concepts  (database design and evaluation, graph design and analysis, Lean, TQM, tactical and strategic scheduling, capacity utilization optimization, Constraint Theory, clinical risk analysis) and the appropriate accounting and finance concepts (throughput, marginal costs, step costs, financial risk analysis, etc.) to make it sustainable.

The most difficult goal for a leader who has all these abilities is to teach the operators (people doing the actual work) the concepts so they can integrate and apply this knowledge from the ground up and continue positive iterations within their own groups and between groups within the organization.

Designing and tailoring a structure that permits the different departments to ‘own’ their processes while integrating with the rest of the enterprise is possible, although existing culture, policy, incentive and ignorance may be formidable barriers.

Social Engineering The competitive advantage of ‘ownership’ can be significant. Unfortunately, what many operators intuitively know is inhibited by non-appropriate accounting systems and poorly designed decision support systems (often due to non-ideal choice of data collection) that both mislead higher management and fail to give the operators and their immediate supervisors actionable information in a form they can readily use. The resulting integration and coordination of activities within and between areas is often misaligned or non-existent.

Transparency Internal transparency (reliable information availability) is necessary to be competitive in a world  of external transparency. A deep, integrated understanding of accounting models, finance, clinical processes and collaboration is necessary for that internal transparency to work.

The articles on this website come from an anesthesiologist who acquired  an MBA in risk management, finance, and data at the beginning of his career, and has practiced for over twenty  years since in multiple hospitals and countries. These are  the nuts, bolts, and concepts that actually work – some are taught in business school and to industrial engineers, some should be. They help you safely control operations and work flow while recognizing the  profit and cost shifting to all parties –from small decisions at the operational level, to larger choices made by administration and the board of directors.

All simulations and most graphs are done with proprietary scheduling software that can be used in real time for simulation– it is strategy based, adaptable  and leverages local data and knowledge with non-local concepts and experience. Other scheduling software is available and adaptable to permit local control, yet integration among nodes (hubs or departments) with adjustable degrees of activity, assignment permissions and visibility – a neural network with learning capabilities.