Achieving Patient Flow Efficiency in the ED - Brigham and Women’s Hospital - Founded in 1913. Teaching affiliate of Harvard Medical School. U.S.
News and World Report “Top 10” Hospital. 793 inpatient beds. Core service lines include oncology, cardiovascular.
The Emergency Department at BWH - ..
Why focus on the ED? Front-door to the hospital, ED cannot refuse or divert patients, Strategic imperative to improve access, Impact on outcomes. Where was our ED in 2009? Process improvement in the ED - Surveying the landscape.
Common themes - Redesign team, Emergency Department flow. Impact-effort matrix. Process mapping, Non value added steps, Serial processing, Redundancy, Bottenecks.
Top 3 opportunities identified 15 (1)Bedside registration (2)Eliminating triage A.“Any patient, any bed” B.“Bed ahead”C.“Clinical greeter (3) Accountable systems. Bedside registration, Simple check-in function on front-end, One less reason for triage! Reprioritize patients for full registration on the back-end. “Clinical greeter” (No risk), Initially instituted as a transitional role, Impact on quality measures (e.g., “door-to-EKG”), Can also do “check-in” (parallel processing), Huge patient satisfier! New process ...Please navigate Paper pages for more details.
rob halkes's insight:
Just happened to stumble on this. Practical information to co-creative (re)design of emergency department processes. Show how reflection on assumptions and routines opens windows to really define improvement in caring routines.
Researchers at Johns Hopkins analyze recent trends in digital health care, concluding that health-related apps and electronic health records will dramatically reduce in-person doc visits.
n the not-too-distant future, it is quite likely that most interactions between patients and the health care system will happen online, according to researchers at the Johns Hopkins Bloomberg School of Public Health, who partnered with The Commonwealth Fund to review recent trends in digital health care as well as scientific literature.
Thanks to consumer-directed health apps, electronic health records (EHRs), telemedicine, and the like, researchers say that patients are going to dramatically change the way they interact with their doctors. They report their findings in the November issue of the journal Health Affairs.
The researchers estimate that when EHRs are in use in just 30 percent of community-based physicians' offices, the increase in efficiency will:
Enable doctors to meet the demands of between 4 and 9 percent more patients than they can todayHelp delegate care to physician assistants and nurse practitioners, resulting in 4 to 7 percent fewer visits with doctorsReduce the demand for specialists by another 2 to 5 percent since roughly that percentage can stick with generalistsDeliver care to meet 12 percent more of current demand thanks to telemedicine and digital communication with doctors and nurses
If doctors and patients adopt e-health tools more widely, the group says, these forecasts could be far higher. "When all of these likely effects are added together, it is clear that health IT will help resolve future physician shortages that many believe are around the corner," said the study's lead author Jonathan Weiner in a school news release.
.. read on!
rob halkes's insight:
The question whether ehealth will impact cost of care, for instance by reducing amount of face to face visits, will still remain in vain. Despite positive and negative results, it depends dominantly on how actual changes in care behaviour, doctor - patient interaction and interactive, multidisciplinary use of data is actually realised. However, we are just beginning to understand how these changes ought to be. To plan this innovative development in a programmatic way, will help to reduce investments and create successful projects. Clearly, a condition to sustain enthusiasm and motivation!
So why do less than half of U.S. hospital workers report being highly engaged?
Hospital systems in the U.S. are at a crisis point. Among the many changes ushered in with the new health care law is the shift to value-based purchasing, which ties a system’s Medicare and Medicaid reimbursements to the quality of the services it provides. For many systems, the mandate will now be to improve clinical processes and ensure a high-quality patient experience — an outcome highly dependent on the commitment, dedication and skills of a hospital’s employees who have an enormous impact on the overall patient experience. In fact, with a potential 2% loss in reimbursements for hospitals that cannot meet specific patient satisfaction and quality of care outcomes, the link from employee actions to patient experience to financial results could not be more direct. Losses amounting to millions of dollars for many hospitals and systems that receive half or more of their funding from government reimbursement are possible. It is, quite literally, a make-or-break moment for financial sustainability.
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In other industries, this service-profit chain (first articulated in a classic 1994 Harvard Business Review article and recently updated) has been recognized for decades. Now, hospitals have little choice — and much to gain — from embracing it themselves.
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Currently, however, creating such an experience is a challenge for many hospitals. In Towers Watson’s most recent global workforce study, less than half (44%) of the U.S. hospital workforce overall was highly engaged. That leaves a large proportion of employees across all workforce segments feeling somewhat disconnected from their hospital system and its goals, and unsupported to some extent in doing their jobs well. The study also shows a strong relationship between employees’ level of engagement and their likelihood to remain with their employer,
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So what can the industry do to raise employee engagement and lay the groundwork for its own service-value chain? First, hospitals need to accurately diagnose the issues through research techniques that measure levels of engagement and identify the specific drivers that affect those levels for different groups within the system. Second, they need to translate those drivers into a set of actions and behaviors that are realistic, meaningful and sustainable. As with medicine itself, diagnosis without corresponding “treatment” will not bring about lasting improvement.
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Many hospitals .. struggle to get approval for the soft-skill development needed to strengthen engagement amid tightening budgets and increased cost scrutiny. One effective approach we’ve found is to first measure engagement, then demonstrate the link between employee engagement and the patient experience, and then lastly tie it to financial returns.
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We’ve worked with several systems to analyze patient and employee data and validate the link between higher engagement and a better patient experience, and we’ve seen firsthand how powerful that demonstration can be.
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Engaging those employees around the behaviors and skills that drive clinical excellence and a positive patient experience is going to be a key factor in determining whether a hospital thrives – or even survives – in this new environment.
rob halkes's insight:
Health care is a human's job. Here it shows how both care employees and patients are in the very same service chain. The quality of it determines outcomes of both medicine, satisfaction and business. Partnerships within and to this service chain is key to all.
Co-creation, technology across the care continuum and engagement is key to this. We have that experience!
The personal health budget (PHB) is the most revolutionary expression of personalisation ever introduced to the NHS. It embodies and epitomises the Government’s vision of a patient-centred NHS, summed up by the often quoted edict ‘no decision about me, without me’. Yet it is impossible to ignore professional concern and disquiet around the implementation of PHBs. This report responds to some key fears and objections with learning and best practice emerging from the pilot programme.
This report was funded by an unrestricted educational grant from Denplan. We are indebted to Denplan who enabled this research to be undertaken, and to all our sponsors. As well as driving our on-going work of involving frontline professionals and the public in policy ideas and development, sponsorship enables us to communicate with and involve officials and policymakers in the work that we do. Involvement in the work of 2020health is never conditional on being a sponsor.
Also download reference to the report. DO!
rob halkes's insight:
The Ministry of Health in the Nehterlands has also great experience with personal health budgets. Personal Health Budgets have the attraction that people will get more aware of costs of care and might probably be more decisive of what or not to do. Of course, not everyone will be automatically be keen in going about thier budgets. Spome might need initial guidance. There are however indications that speding wisely will also have a svaings expect. In the perspevtive of patient empowerment it seems to be a great concept. I'm going to read this.
This PwC Health Research Institute (HRI) report looks at the projected increase in the cost of medical services for 2014. Read how medical cost trends affect your business.
For 2014, PwC's Health Research Institute (HRI) projects a medical cost trend of 6.5%.
Defying historical patterns—and placing added tension on the health industry—medical inflation in 2014 will dip even lower than in 2013. Aggressive and creative steps by employers, new venues and models for delivering care, and elements of the Affordable Care Act (ACA) are expected to exert continued downward pressure on the health sector
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Healthcare organizations, hurt by a squeeze on reimbursements and what might best be described as a recession “hangover,” have spent the past few years adapting to more modest growth rates. The industry will continue those efforts in 2014, including pushing care to locations and personnel that cost less...
rob halkes's insight:
It is not just in the US that health system suffer from rising costs. All over the world (desperate) attempts are being made to save costs. However from political perspectives these can often only be based on direct savings. "Save as savings can be" seems to be the catchcry, instead of looking for sensible reduction of investements (not just budget). At least an experimental set up for finding balances between rearrangements of medical, patient and financing factors might create better results (with less costs).
In its new research brief, "Thinking Outside the Pillbox," NEHI addresses the root causes of poor patient medication adherence - a significant contributor to overall health care waste - and offers promising solutions to improve adherence, particularly among chronic disease patients.
See pdf of full report
rob halkes's insight:
It is a little bit dated, yes. But I haven't seen yet a more clearly, rightly conceived overview of the issue of patient adherence. Since 2009, we have moved on and know more of patient adherence and (self) support (on line). But his pictures a complete picture to ground it all!
t is a little bit dated, yes. But I haven't seen yet a more clearly, rightly conceived overview of the issue of patient adherence. Since 2009, we have moved on and know more of patient adherence and (self) support (on line). But his pictures a complete picture to ground it all!
There's scant evidence that these programs improve outcomes.
While health spending in the United States far surpasses that in other industrialized nations, the quality of care in the US is no better overall, and on several measures it is worse. This stark fact has led to a wave of payment reforms that shift from rewarding volume (as fee for service does) to rewarding quality and efficiency. Such pay-for-performance schemes seem to be common sense and are now widely used by private payers and Medicare. But astonishingly, there’s little evidence that they actually improve quality.
What do we really know about the effectiveness of using financial incentives to improve quality and reduce costs in health care? There is robust evidence that health care providers respond to certain financial incentives: medical students have a higher demand for residencies in more lucrative specialties, physicians are more likely to order tests when they own the equipment, and hospitals seek to expand care for profitable services at the expense of unprofitable services. It would seem that increasing payment for high-quality care (and, conversely, lowering payment for low-quality care) is an obvious way to improve value in health care. But evidence suggests that health care is no different from other settings where similar payment incentives have been tried, such as education and private industry. Not only do these payment policies often fail to motivate the desired behaviors, they may also encourage cheating or other unintended responses.
Overall, evidence of the effectiveness of pay-for-performance in improving health care quality is mixed, without conclusive proof that these programs either succeed or fail. Some evaluations of pay-for-performance programs have found that they can modestly improve adherence to evidence-based practice.
There is little evidence, however, that these programs improve patient outcomes, suggesting that to the extent that health care providers have responded to pay-for-performance programs, that response has been narrowly focused on improving the measures for which they are rewarded — such as making sure patients receive recommended blood tests if they have diabetes or the right cocktail of medications if they are hospitalized with a heart attack. Although these measures are important for patient care, it may take a full reengineering of the health care delivery system to broadly improve patient outcomes.
..read on..!
rob halkes's insight:
Very inspiring to see a evaluative text on the effect of "pay for performance" systems in Health care. There's experimentation on it in the Netherlands, but I cannot see that these are going to devliver what they really should be about impriving outcomes for less costs... Not just savings! In health care, there's a dlicate balnce to be reached between: medical, patient and financial factors. Take just one of the balance and the system gets bust.
Watch a demonstration of the future of healthcare. Learn about the proof of concept for IntelliVue Solutions built in conjunction with Accenture.
Today Philips and Accenture announced the creation of a proof-of-concept that uses a Google Glass head-mounted display for performing surgical procedures. The demonstration connects Google Glass to Philips IntelliVue Solutions and proves the concept of seamless transfer of patient vital signs into Google Glass, potentially providing physicians with hands-free access to critical clinical information. Additional ideas:
Accessing a near real-time feed of vital signs in Google Glass;Calling up images and other patient data by clinicians from anywhere in the hospital;Accessing a pre-surgery safety checklist;Giving clinicians the ability to view the patient in the recovery room after surgery;Conducting live, first-person point-of-view videoconferences with other surgeons or medical personnel; andRecording surgeries from a first-person point-of-view for training purposes.
This is interesting but proof of concepts have already been happening like the surgeons we covered in August.
What innovations lie in store for health care in 2013? Two visionaries driving innovation in the industry, Daniel Kraft, of the FutureMed Program, and Esther Dyson, of EDventure Holdings, discuss new technologies and innovations in health care in a discussion with The Economist's Charlotte Howard, at The Economist's World in 2013 Festival on December 8th 2012.
One in three Brits visit the doctor less often than normal thanks to health and fitness gadgets, a survey has found.
A third of people credited devices like pedometers and heart rate monitors with improving their health and decreasing their need to seek medical help.
The finding suggests modern technology could play a crucial role in easing the financial pressure on the NHS as the Government looks how to tackle the impact of an ageing population...
rob halkes's insight:
I was always convinced that social media are the tools in hands of patients to do more for themselves and bby so doing lower the pressure of demand for formal medical activities.. This proves I'm right. Imagine how many could be saved if we would follow this immanent policy explicitly!
The world is aging so fast that most countries are not prepared to support their swelling numbers of elderly people,
The world is aging so fast that most countries are not prepared to support their swelling numbers of elderly people, according to a global study to be released today by the United Nations and an elder rights group.
The report ranks the social and economic well-being of elders in 91 countries, with Sweden coming out on top and Afghanistan at the bottom. It reflects what advocates for the old have been warning, with increasing urgency, for years: Nations are simply not working quickly enough to cope with a population graying faster than ever before. By the year 2050, for the first time in history, seniors over the age of 60 will outnumber children under the age of 15.
rob halkes's insight:
We need to create speed on health systems reforms. It cannot be that politicians seem to be the last ones that recognize this need.
So much is possible, yet so less seems to be able to make it true..
Speech by OECD Deputy Secretary-General Yves Leterme:
Our Health, Our Economy, Our Society, our Future: A Brave New World
At the EPHA 4th annual conference 2013 on The future of public health: policy decisions today for tomorrow’s populations. Brussels, Belgium, September 4th 2013.
Twelve emerging technologies—including the mobile Internet, autonomous vehicles, and advanced genomics—have the potential to truly reshape the world in which we live and work.
rob halkes's insight:
Great report and insights about the upcoming developments to social business, also in health care. Follow for instance the topic "the internet of things"..
It will not all be pleasant surprises and easy to go on developments. That's also the meaning of disruptive. For health care we need to care to adapt systems and developments in a constructive way: focusing on developments at the patient's side of care. By helping patients to adopt technologies and support them to adopt and adapt their behaviour, things might go more smoothly than just "disruptive".
The challenge for all involved has to do with the willingness and competence to work multidisciplinary together to design improved care processes and the very change process itself. "Traditional","hierarchical" thinking from an idea of dominance of medical theory, will not help. Not to say, of course that medical knowledge should be aborted. Instead, it will inspire new ways of developing therapies, along with social, informational, etc. and specifically behavioural sciences with insights from patients' behaviour.
It awaits to be seen how the professionals' attitude will be disruptive or facilitative ..
This started as an internal project I wanted to do for myself and my team, but later decided to share it. It represents the current and future state of healthcare, based on perspectives and infographics gathered from industry expert sources (each cited with a url to the original source of the image or chart) - with commentary in headers created by me to help put things into perspective. I also tried tried to provide a view of current and future states, including implications to varying stakeholders including patients, physicians and pharma
rob halkes's insight:
Great Overview of Developments to the health care industry, not only the health care delivery but aspects of health industry, finances etc.!
Proper acknowledgement of the payer's perspective is necessary for successful drug development..
The escalating cost of medicines is forcing tough decisions on payers in Europe who are struggling to ensure drug availability while staying within government-dictated healthcare budgets. The resulting austerity measures and related drug price cuts have increased the pressure on pharmaceutical executives to sustain prices and avoid the problems associated with international price differences. However, these events are just the tip of the larger changes happening in healthcare globally...
To improve the financial success of a branded drug, manufacturers must embrace the needs of payers at every stage in a new drug's development and commercialisation process. Unfortunately, the industry's longstanding order of developing and launching drugs makes adopting such change an almost Sisyphean task...
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The general analytical process for a typical payer is exemplified by this series of questions: • Medical need: How strong is the need for a new drug treatment? • Effectiveness: Does the new treatment address the unmet medical need in a substantial way? • Evidence: Is the evidence of effectiveness and safety compelling? • Economic impact: How will the approval impact the budget? • Ability to control: Can the payer control prescribing volume once pricing and reimbursement is approved? • Political importance: Would a negative decision have public repercussions?
Considering the payer perspective and evidentiary needs for all payers in countries worldwide would be a complex undertaking. Figure 1 helps make sense of the global patchwork of healthcare systems and their requirements by classifying the world into four key global payer segments that represent different cost management philosophies.
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Read more on the website of PmLive..!
rob halkes's insight:
Great insights into payers perspectives on health care costs - you can imagine how the health care world will change..!
A new study finds that more patient input on medical decisions can lead to higher costs and longer hospital stays.
Does this mean we can’t have it both ways? As patients, we’d like more say in our medical care. We’d also like the astronomical costs of care to come down. But here’s the Los Angeles Times headline: Patients who helped with medical choices had higher bills: study.
The story describes a study just out in the journal JAMA Internal Medicine that found that involving patients more in medical decisions can lead to longer hospital stays and higher costs — quite a bit higher. (See the journal’s video interview with the author here.) The numbers:
"Analyzing the data, the researchers found that nearly all — 96.3% — wanted to receive information about their illnesses and treatment options, but that only 28.9% said they had a strong preference for making their own decisions about their care."
We keep on puzzling on contradictory perceptions and research data.
First of all study the data well! Look at their sources, than think: when we tap more into patients' personal thoughts and emotions, it might reveal that there is a world to discover that was not formerly disclosed to (formal) care providers. It might mean that we are all "whole" humans with a natural and self evident interplay between mind and body. We are only beginning to ascertain what effects this (should) has (have) on caring....
The latest edition of the annual Internet Trends report finds continued robust online growth. There are now 2.4 billion Internet users around the world, and the total continues to grow apace. Mobile usage is expanding rapidly, while the mobile advertising opportunity remains largely untapped.
The report reviews the shifting online landscape, which has become more social and content rich, with expanded use of photos, video and audio.
Looking ahead, the report finds early signs of growth for wearable computing devices, like glasses, connected wrist bands and watches - and the emergence of connected cars, drones and other new platforms.
rob halkes's insight:
A global perspective! Russia and China incorporated!
Promising perspectives for health support on line!
This post is part of HBR's Health Care Innovations Insight Center. Read a slideshow version of these 10 innovations If ever a field needed a makeover, it's medicine.
rob halkes's insight:
A makeover indeed. These 10 innovations really suggest the new world in medicine: it will be vcastly different. Let's work on the creation of such. But let's not think of it as a system that can be set and functions on governmental ruling. Competition between provider is the basic drive to development!
Mobile devices are everywhere in your healthcare organization, but without a complete solution in place, the strain on your IT staff can get out of control.
Mobile devices among healthcare professionals has exploded over the last few years. On average, clinicians use 6.4 different mobile devices in a day on average according to IDC Healthcare Insights Study. Mobile health devices provide healthcare professionals with the ability to facilitate smoother workflows and help boost productivity.
rob halkes's insight:
To the same issue: health, data and safety and privacy: an issue.
Databases offer a trove of medical information, without the cost of clinical research trials.
Over the past decade, nudged by new federal regulations, hospitals and medical offices around the country have been converting scribbled doctors’ notes to electronic records. Although the chief goal has been to improve efficiency and cut costs, a disappointing report published last week by the RAND Corp. found that electronic health records actually may be raising the nation’s medical bills.
But the report neglected one powerful incentive for the switch to electronic records: the resulting databases of clinical information are gold mines for medical research. The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.
rob halkes's insight:
It is not about personal patient data alone: privacy, data safety, data protection need to be sorted out before embarking on this new way of data exploitation. Many countries have specific data protection and personal privacy laws. Probably not so in ways that would facilitate an international standard. But realising the opportunity to use personal records would be a great step towards clinical and medical research. Not only so in ways of medical/physical research but also in ways behavioral and life stye characteristics might be added as fundamental variables to be used too.
For that end a patient personal record, in which the facility to register daily observations and perceptions will be a crucial add on facility. In the framework of a personal health record, the issue of basic consent might be more easily solved, by extending the medical record with the personal one.
But that is still a long way to go.. However, in my opion a crucial one!
This book provides a framework to understand why there are waiting lists for elective surgery in some OECD countries and not in others. It also describes how waiting times are measured in OECD countries and reviews different policy approaches to tackling excessive waiting times.
rob halkes's insight:
Great insight and overview. Now let's see hwt ato be done about it!
National Pharmaceutical Council Chief Science Officer Dr. Robert Dubois discusses the many considerations faced by accountable care organizations (ACOs) as they strive to meet cost and quality benchmarks, and in particular, how biopharmaceuticals will fit into those efforts.
rob halkes's insight:
There is an upheavel of discussions about reimbursement models for medical business and performances. Rober Dubois discusses the way Accountable Care Organizations get reimbursed on their performance for a defined population of patients..
PHILADELPHIA (May 6, 2013)— A subtle change to hospital data collection policies could make a big difference in preventing occupational health and safety hazards, according to workplace safety researchers at the Drexel University School of Public...
rob halkes's insight:
Too little is done to integrate workplace health with the health care system?
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Just happened to stumble on this. Practical information to co-creative (re)design of emergency department processes. Show how reflection on assumptions and routines opens windows to really define improvement in caring routines.