Power Point Project (Healthcare Management)

Running head: LEAST WASTE METRIC 1 Least Waste Metric Name Institutional Affiliation Date LEAST WASTE METRIC 2 Executive Summary The management teams of various hospitals across the nation and beyond are currently embracing the lean management framework that necessities them to eliminate various forms of waste in a manner that is meant to pave the way for the increased profits and sustainability prospects. This is the operational framework that Gilchrist has adopted in the present moment where the lean daily management (LDM) board is overseeing all required obligations. The relative value units (RVUs) is being used by the management as a measure of productivity and determinant of the compensation of the physicians. However, there is a problem based on the manner in which the RVUs are being processed in the geriatrics section of the hospital. This is the situation that has prompted the formulation and undertaking of this project that has established the manner in which the number of the RUVs processed in November has been comparatively low. Such a situation denies the hospital a clear framework of determining performance and thus shows not facilitate the attainment of the minimal waste obligations of the lean management framework. It is recommended that the facility has to address the current situation by enhancing the number of RUVs processed each day to reduce congestion in the concerned department. This will eventually lead to the maximum utilization of the resources via the imm

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unization of overproduction. LEAST WASTE METRIC 3 Introduction An increased number of hospitals have been working on a framework that is meant to necessitate the formulation and application of the lean business and management strategy that has been made famous by the Toyota company of Japan. The rationale has been trying to figure out the manner in which they can promote the continuous transformation of waste into value from the client’s perspective. A hospital like Gilchrist has also adopted the same model that has necessitated it to increase the levels of productivity and cut costs based on the requirements of the lean operational model. As an intern at Gilchrist, I have been part of the staff members that have been determined to ensure that the facilities undertake its activities in a lean manner that reduces costs and enhances the profit margins. In this report, the emphasis is laid on the analysis of the manner in which the Lean Waste Metric RVUs project achieved its set obligations under my stewardship. Background Information The rationale of formulating the Least Waste Metric RVU’s project was to facilitate a mechanism that would address the lean requirements that have become part and parcel of the operational and strategic underlining of Gilchrist that is determined to evolve from being an ordinary healthcare facility to an institution that avail wholesome and top quality healthcare to the patients and their families at any given moment. The goal of the project is to have a situation where there is going to be a limited amount of waste that is associated with the hospital across the various department. The metric that is covered by the project is the collector elder medical care RVU’s where the goal is to ensure the establishment of the baseline data that will facilitate the increased LEAST WASTE METRIC 4 quality of the decisions that will be made by the facility moving forward. The logic for having this project was to ensure that emphasis is laid on the situation of having the elderly patients in the hospital for an extended period. It is a situation that leads to congestion and increased use of the hospital facilities that is a negation of the lean management and operational framework that the management has been focusing on for the last couple of years. The aim, therefore, was to come up with the project that could inform the manner in which some an issues can be addressed by the facility moving forward. Lean Daily Management Gilchrist as a healthcare facility has an enhanced and organized lean daily management (LDM) board that is charged with the responsibility of overseeing all the activities that are undertaken in the hospital with the intention of addressing the waste issues. The goal of the board is to ensure that there is the complete minimization of the waste in each given process, task and procedure via the ongoing system of improvement. These are the obligations that are usually undertaken by focusing on the use of the lean principles where each member of the organization both in the medical and non-medical roles have to combine effort in such a way that is meant to address the waste issues (Penner, 2013). In addition, there is a motivation among the staff members to always focus on the mechanism that will necessitate them to identify any pending areas of waste. It is for the sake of formulating and implementing the ways in which such issues can be addressed especially if they are not adding value to the quality of the healthcare services that are offered to the patients. The operations of the LDM board are based on the trends that have continued to be observed nationally and internationally. Research has demonstrated that various hospitals have LEAST WASTE METRIC 5 been facing crises that are brought about by the uncertain nature of their operations that seem to be unsustainable (Barnas & Adams, 2014). It is a phenomenon that has informed the decision that has led to the 5.5% per year projected growth in the national health expenditures where governments and the other stakeholders have been concerned about the operations of the healthcare institutions. In that regard, there have been increased cases where the members of the healthcare insurer gave been implementing the Principles of Lean Manufacturing in the operational frameworks of their facilities to ensure that they reduce the costs and add value for their esteemed patients. It is documented that the prospect of eliminating waste at each level of the organization tend to be fundamental to the lean operations where the members of each organization are required to, first of all, buy in the idea from the onset for the institution as a whole to be increasingly successful. This is a situation that eventually ensures that once the culture has been perfected by the staff member and the other stakeholders, then innovation is witnessed at each level. In addition, the prospect of addressing the lean healthcare requirement leads to increased levels of patient satisfaction based on the fact that the decisions and processes become increasingly patient-focused. As an organization that is geared towards greatness as far as the quality of services is concerned. Gilchrist, via the LDM board, has formulated a Lean Six Sigma framework that is geared towards the idea of addressing the quality requirements of healthcare to the patients. The motivation of the board is to ensure that there are suitable mechanisms that are meant to facilitate the elimination of any kinds of waste that might affect the quality of the healthcare services both at the moment and moving into the unforeseeable future. LEAST WASTE METRIC 6 In the healthcare context, the Lean Six Sigma framework is used for the sake of eliminating waste via a number of mechanisms. In the context of Gilchrist, the emphasis has been laid on the idea of trying to cut out the eight wastes in the best ways possible. The first waste that the LDM board is determined to address is the issue of reducing the waiting/idle time. It is an aspect that is being addressed in line with the requirements of the lean principles where patients are not supposed to wait for long hours since such a situation is associated with the idea of facilitating the increased waste. In this regard, the motivation is to ensure that there is a reduction in the number of the patients that tend to sit in the waiting areas, appointment waiting lists and the idle high-tech equipment issues among others. The second form of waste that the LDM board has been focusing on in the recent past is the one linked to the minimization of inventory. According to Penner (2013), there are cases in which companies including those in the healthcare industry are faced with the situations where lots of funds are tied-up in the form of the stocks that also consume increased costs as a way of trying to cater for the storage fees. There are surplus supplies and medications, extraneous days and other issues that tend to translate to the inventory waster. Further, it has to be noted that the presence of the excessive inventory at the disposal of the hospital tends to increase the risks of loses that can emanate from the theft cases or even becoming obsolete in the process. In that regard, the board has been appealing to the employees across the facility to be vigilant and ensure that the inventory at their disposal is utilized to avoid cases of the excess inventory. Third, the lean framework is meant to address the issue of eradicating the defects for the sake of improving the quality of care as well as increasing the levels of reimbursement. In this regard, the LDM board has been keen on the idea of addressing the process, and system failures misdiagnosed cases and the medical mistakes in general among other obligations. It has emerged LEAST WASTE METRIC 7 that the quality of healthcare is a crucial concern among the patients and their families in such a way that any given health facility has to be vigilant on the manner in which such an aspect has to be addressed at any given moment (Glass, 2014). Moreover, there has emerged a trend where the payers have been moving towards the utilization of the performance models that are meant to reward/penalize medical outcomes. It is a situation that has forced various facilities to leverage lean principles as a way of avoiding such situations. Transport is another area that is widely covered in the lean operations of the healthcare facilities that Gilchrest has also adopted in the recent past. It is meant to operate in such a way that makes it mandatory that the organizations should decrease the movements of patients, equipment, and supplies for the sake of enhancing the patient flow. The rationale of this line of thinking is to address the issue that transportation wastes tend to include the idea of moving people, equipment and medical supplies at any given moment. The idea of transporting patients across the departments as well as getting the supplies and medical equipment from one location to the other within the hospital is a form of waste that the LDM board has been trying to address in the recent past. In this regard, the management of the hospital has been trying to implement a mechanism that would reduce such movements across the hospital as a whole. The LDM board has addressed the prospect of preventing injuries in the hospital setting as well as saving time by recognizing motion in a manner that can be regarded as fairly satisfactory in the recent past. However, a close analysis at the current situation at the facility indicates that a lot has to be done moving forward to address these issues comprehensively. The idea of reaching for the frequently used equipment like the wheelchairs and the transfer of the patients between beds among others are regarded as the forms of motion waste. LEAST WASTE METRIC 8 The sixth aspect of the framework that has been formulated and is being implemented by the management is the idea of maximizing resources courtesy of minimizing what can be generally referred to as the healthcare overproduction. In this regard, it can be realized that the overproduction waste includes issues like redundancies and creating an increased number of various obligations within the facility (Barnas & Adams, 2014). The increased cases of duplication of tests or even extending the hospital status beyond what can be regarded as the medical necessity can all categorized into the overproduction issues that the hospitals have to be looking forward towards addressing in the best ways possible. Removing waste from the aspect of over-processing is also regarded as one of the ideal ways of upholding the lean requirements within the organizations. Over processing is regarded as the aspect that is likely to be witnessed when there are cases of the unnecessary work extending into the treatment of the patients. These may include the needless tests and the id ea of filling out various forms with the same information as well as trying to perform data entry in more than one system to serve the same obligation. Finally, efforts have also been made by the LDM board to ensure that there is a clear understanding of the manner in which the healthcare waste tend to lead to the untapped human potential which is regarded as being the most crucial issues in the increased cases of waste in healthcare. In this regard, the emphasis is laid on the analysis of the manner in which the seven other wastes are facilitated with the aim of trying to figure out the ideal mechanisms of addressing each of them in the best ways possible. Least Waste Metric LEAST WASTE METRIC 9 The efforts that have been made by LDM board have to be lauded since they have ensured that the operations of Gilchrest are taken to a higher level than it was the case in the previous years. However, the analysis of the efforts that have been made in the past and currently by the LDM board has led to the identification of the operational gap in the lean management framework that is being pursued at the moment. This is an aspect of doing with the failure by the hospital to comprehensively address the issue of maximizing the resources via the minimization of the healthcare overproduction and specifically the problem of having the elderly patients to overstay in the hospitals beyond what can be regarded as the medical necessity. The project has thus identified the issue of having elderly patients overstay in the hospital as an issue that has to be looked into since it is contributing to the situation where the lean management obligations of the hospital are not being attained. The research that has been undertaken has concentrated on the observations that focus on the use of the relative value units (RVUs) as a measure of the value of the Medicaid reimbursement formula meant for the physician services. As a hospital, Gilchrist has to be focusing on the mechanism in which the payers have to be availing increased amounts of funds that are meant to cater for the medical services that are offered by the physicians and the facility as a while. It will be noted that the fees that are attached to any given services have to be used on the relative value units (RVUs) that focus on the resources that have been used to provide each care service (Lindenau-Stockfisch, 2015). At the moment, the elderly patients are staying in the hospital for considerably longer periods than it would have been envisioned. This is a situation that stretches the resources at the disposal of the hospital since most of the payers might not honor some bills that they believe are not authentic. LEAST WASTE METRIC 10 In the project, there was a fact-finding mission that was undertaken to facilitate the understanding of the least waste obligations in the geriatrics section of the facility that concentrates on the analysis of the situations of the elderly individuals. Data was collected for the number of the RVUs that were processed each day to facilitate the understanding of the number of the patients whose medical situations were being completed to enable them to go back to their respective homes. It was established that the number of processed RVUs were between 3 and 18 for the covered days. Out of the 30 days for November 2018, only 13 days were characterized by the cases of the processing RVUs to facilitating the payments for the medical conditions of the elderly patients. A formulation and presentation of the data regarding the data for paper submissions indicate that the goal for establishing the baseline where the collective elder medical care RVUs was the baseline led to the realization that only 13 out of the 31 days had their targets met. This is to indicate that the remaining 17 days were characterized by the situation where the department and the facility at large failed to achieve the goal of processing the RVUs that signal the end of the idea of having attended to the health concerns of the patient at any given moment. The logical implication in this regard is that the hospital is facilitating a situation where it is taking a considerable amount of time to release the elderly patients from the wards and other areas so that they can be discharged and allowed to go home. The case where the RUVs processed has not been up to the expected standard s negates the lean managerial framework that has been formulated by the LDM board. In such a case, the facility is failing to ensure that it maximizes the utilization of the resources at its disposal by ensuring that it minimizes the healthcare overproduction. According to Graban (2017), it is a LEAST WASTE METRIC 11 situation that indicates that there are cases of redundancies and creating too much of issues that are not economical. There seems to be a situation where Gilchrest is extending the hospital stays of the elderly patients beyond what can be regarded as being a medical necessity. The situation has been demonstrated by the fact that in most of the day of November, the facility has been unable to process the RVUs that could have led to the discharge of the patients waiting for the relevant payers to process and remit the payments for the services that have been offered by the physicians and the facility at large. It will be noted that the owners of the medical facilities normally rely on the relative value unit (RVU) system to undertaken the estimation and deamination of the productivity of the physician and ensure that it sets the compensation. Any given facility will be determined to ensure that the productivity of the physicians at its disposal is judged based on the collections that have been availed by the various distinct payers. Net collections are mostly used to refer to the actual cash that is normally received for the services that have been rendered to the patients (Cohn & Hough, 2008). In most cases, the cash that has been received is normally regarded as the actual revenue thus tying this mechanism to the bottom line. In the analyzed and considered case of Gilchrist, it is evident that the assessment of the productivity based on the collections will give a negative impression since the RVUs that have been processed in this month are not up to the expected standards. The results that have been obtained in this research activity can be interpreted based on the lean management aspects where costs have to be reduced , and productivity increased to lead to the facilities that are profitable and sustainable in the long run. RVUs are normally used to facilitate the determination of the physicians’ compensation, and if they are not being processed LEAST WASTE METRIC 12 in the right way, then it becomes difficult for the management to have a better framework that can be used to determine and measure productivity. As indicated by Reiboldt, Chamblee & Coker Group (2014), RVUs can be used as a tool that is meant to enable the multi-physician facilities to determine how much they have to be paying their physicians. They normally rely on such information in two broad ways. The first one is the analysis of straight productivity. This is undertaken by the prospect of multiplying the number of work RVUs the given medic has generated by its own conversation factors that eventually arrives at the compensation figure. The conversation factor in question is normally determined by the idea of dividing the national medium compensation associated with the specialty by the given median number of work RUVs for that specialty. Moreover, the factor tends to act as the market rate that underlines the manner and figures that the doctors have to be paid based on the extent of the medical services offered including other factors. The second approach is to ensure that a given physician is paid a salary and a bonus that has to be tried on the number of work RVUs generate over a based number that has already been determined. Gilchrist, just like any other hospital system across the country is determined to grow and become sustainable moving into the unforeseeable future. In that regard, TVUs can be regarded as being among the tools that can be used to decide whether to sell. That is because an increased number of large hospitals tend to us the RVUs for the sake of setting the physician compensation as well as the productivity bonuses. This is a reality that makes it logical for them to analyze their practices from an RVU standpoint to ensure that they are benchmarked at given figures per year for their evaluation and management services since they will be aware that such figures are a realistic number for them to attain. LEAST WASTE METRIC 13 In the case of Gilchrist, the situation that has been witnessed via the month-long analysis of the RVUs processing rates has indicated that in 17 days of November, there was no processing that was undertaken by the hospital. This is a worrying trend bearing in mind that the LDM board has worked extremely hard to formulate a formidable lean management framework that is meant to reduce waste. The elderly patients are not having their RVUs processed in a speedy manner indicating that they are spending too much time at the hospital which is unnecessary. It is therefore recommended that the management has to intervene and ensure that an increased number of RVUs are processed on a daily basis to release and discharge most of the elderly patients from the hospital. They need to go home and reduce the congestion which will enable the number of the RUVs processed to increase thus leading to the attainment of the lawn operational management goals. LEAST WASTE METRIC 14 References Allen, John I, and Mark DeLegge. Health Care Reform and Gastroenterology, an Issue of Gastrointestinal Endoscopy Clinics – E-Book., 2012. Print. Barnas, K., & Adams, E. (2014). Beyond heroes: A lean management system for healthcare. Appleton, WI: ThedaCare Center for Healthcare Value. Cohn, K. H., & Hough, D. E. (2008). The business of healthcare. Westport, Conn: Praeger. Glass, K. P. (2014). RVUs: Applications for medical practice success. Dubuque, Iowa: Kendall/Hunt Pub., Co. Graban, M. (2017). Lean Hospitals: Improving quality, patient safety,and employee engagement, third edition. S.l.: CRC Press. Lindenau-Stockfisch, V. (2015). Lean Management in Hospitals. Hamburg: Diplomica Verlag. Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders. New York: Springer Publishing Company, LLC. Reiboldt, J. M., Chamblee, J., & Coker Group. (2014). RVUs at work: Relative value units in the medical practice. Phoenix, MD: Greenbranch Publishing.
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