1. Med Health Cairo 12-13 March 2014
How Sourcing Excellence Can Rationalize Hospital Costs
Med Health Cairo March 2014
Ashraf Ismail, MD, MPH, CPHQ
Managing Director, Middle East Region
Joint Commission International

2. consistently meet and manage patient expectations
Service Excellence
Ability of the provider to
consistently meet and manage patient expectations

3. Key Elements of Service Excellence
According to Robert Johnson (Institute of Customer Service), service excellence has four key elements:
Delivering the Promise (of quality healthcare)
Providing a personal touch
Going the extra mile
Resolving problems well

4. Reducing the Drivers of Dissatisfaction, & Providing Exceptional Healthcare
In order to achieve key elements of service excellence, healthcare institutions, in particular, must be concerned with reducing the drivers of dissatisfaction, and providing exceptional healthcare.
According to the federal Agency for Healthcare Research and Quality (AHRQ) exceptional healthcare is defined as “doing the right thing, at the right time, for the right person, and having the best quality result [outcome]”

5. What are the drivers of Patient Dissatisfaction

6. Evidence of Quality Problems
Several types of quality problems in health care have been documented:
Variation in services
Underuse of services
Overuse of services
Misuse of services
Disparities in quality

7. Waste And Variation In Health Care
According to the Institute of Medicine, 30 to 40 cents of every dollar spent on health care is for costs associated with: Overuse, misuse, underuse, Duplication, System failure, Unnecessary repetition, Poor communication, and Inefficiency, all of which can be described as “waste.”

9. The proportion of waste in health care has been estimated in a range from 30% to 60%.

10. Poor Quality/ Waste In HealthCare
Failure to provide effective treatments
Overuse of certain treatments and underuse of others,
Use of ineffective tests or service
Misdiagnosis and poor coordination and communication.
Inefficiency
Poor Quality/ Waste In Healthcare

11. Poor Quality/ Waste In Healthcare
Duplicate Or Repeat Testing/Procedures
Delays In Care,
Failures of care coordination
Inefficient Use Of Clinician Time,
Improper Documentation/Record Keeping,
Iatrogenesis, And
Patient Injuries
Poor Quality/ Waste In Healthcare

12. Waste Can Include—but Is Not Limited To
Waiting; Barriers To Flow;
Handoff Breakdowns; Errors And Mistakes;
Correcting, Revising, Or Reevaluating;
Inaccurate Information; Inaccessible Information;
Shortage Or Lack Of Tools Or Equipment; Incorrect Or Inappropriate Equipment;
Inefficient Motions, Unnecessary Movement;
Inaccessible Tools Or Supplies; And
Inflexible Processes (Inability To Quickly Improvise).

13. What is the Most Cost Effective Way For Providing Exceptional Healthcare? Does Improving Quality Save Money?

14. Quality Can Be Improved By
Safe Health Design
Accreditation
Evidence Based Medicine
Quality Can Be Improved By
Lean, Six Sigma
Effective Utilization Management

15. How Lean Works for Health Care

16. Lean in Health Care
Lean is a compilation of world-class practices that can improve a health care organization through an evidence-based methodology.
Lean health care strives to be patient-centric and to always serve the patient
It is not always easy to implement in health care
Barriers include
Natural Human Desire To Cling To The Familiar,
Fear Of Change,
A Lack Of Understanding Of How Lean Works

17. The Case for Lean in Health Care
Lean practices help a health care organization run as a successful business, focusing on achieving a positive return on investment (ROI) by eliminating, or at least minimizing, non-value-added activities.
Conti..

18. The Case for Lean in Health Care
Practices might include the following:
Improving employee retention
Reducing adverse events
Reducing re-admission rate
Reducing length of stay
Better leveraging available resources
Improving employee and physician satisfaction and physician/nurse relations
Increasing nurses’ direct patient care time, which will result in improved patient perception of care

19. Results of 175 Rapid Process Improvement Weeks at A Medical Center in United States – Published by IHI

20. Joint Commission International Standards
Lean Thinking Principles directly or indirectly facilitate their compliance with many of the Joint Commission International standards
Standard QPS.5
The data analysis process includes at least one determination per year of the impact of hospital wide priority improvements on cost and efficiency
Standard FMS.9
The hospital establishes and implements a program to ensure that all utility systems operate effectively and efficiently

21. Joint Commission International Accreditation Potential Return on Investment
Improved care – fewer complications
Better reputation -- increased number of new patients
More satisfied staff – better retention and lower recruitment and training costs
More efficient, cost effective work processes
Better preventive maintenance program – longer life of biomedical equipment
Better safety management, and risk reduction – reduced liability exposure
Greater clarity to leadership structure and quality oversight
Special recognition from payment sources and insurance companies

22. Impact of Safe Health Design

23. Standards-based design incorporates elements of the JCI standards into the built environment

24. Evidence-based Design Features And Effects
Evidence Based Design Principles Have Shown Return On Investment In Many Ways
All reducing operational cost!!

25. You can’t manage what you don’t
Engaging patients and their families in care decisions and management of their conditions leads to better outcomes and can reduce costs
Introducing evidence-based concepts into policies, regulations
Identify opportunities to reduce overused and misused
Services, Take action
Measure performance, Reports should be shared
You can’t manage what you don’t
Measure,”

27. Quality improvement programs often do save money
Effective quality improvement strategies require continued nurturing
Despite challenges, hospitals should be committed to
improving patient care and make steady progress
Better Outcomes For Patients And Meaningful Cost Savings For The Health Care System

28. شكرا Thank you Dr. Ashraf Ismail, MD,MPH,CPHQ
Managing Director, Middle East Region