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    Misc

    Right-brained cost cutting

    February 9th, 2009

    by Nick Jacobs

    Last week it was my privilege to spend a few hours with an entrepreneur who compiled every quality indicator published by all 20 organizations that list themselves as having a mission that is directed toward "healthcare quality." I can't remember if there were 20 or 30,000 of them, but it was a boatload.

    The entrepreneur then had a software expert create grids and graphs and quantitative tables in relational databases that would compile all of the related indicators, cross reference them, and pull them together into the appropriate job descriptions. This system was constructed to enable employers to objectively quantify these job descriptions and thus to evaluate the employees in a more appropriate, efficient, and comprehensive manner.

    All of this would lead to higher quality care, reduce costs normally created from employee turnover, and lead to a better workplace and better patient care.

    [More:]

    After my meeting with the aforementioned entrepreneur, I explained that we too had cut costs, produced higher quality, and moved organizations forward exponentially, but that we had done that without using any of the quantitative grids listed above. We did it by being nice, but firm. We did it by creating a culture of caring. The two of us are currently meeting to determine how these two similar left- and right-brained ideas can be merged.

    Regardless of that outcome, it is clear that the way to reduce costs in any healthcare facility is to show the employees, patients, and staff that you really, sincerely do care about them and about their world. It's not enough to give these issues lip service; you must create a culture that does not tolerate bullies, that does not embrace anything crude, rude, or insensitive, and that rewards and reinforces appropriate behaviors and attitudes.

    A major solution to our healthcare cost issues could stem from this culture. If your employees are respected, they will not throw away or disrespect resources; they will not disrespect rules, guidelines, or opportunities to make patients better or happier. All of these things will result in lower employee turnover, lower readmission rates, lower infection rates, lower lengths of stay, lower lawsuit rates, lower restraint rates and lower costs.

    It's NOT rocket science or brain surgery. It is, however, not easy. It requires a complete top-to-bottom culture change. If you want to know more, don't hesitate to ask.

    Comments:

    Comment from: Gardog [Visitor]
    This is good advice, sound business advice which in the long run will help that organization offer more value to their customers. It is also incomprehensible to most managers at most organizations. One amusing proof is to hang around a classroom in an MBA program while the professors try to explain those sorts of concepts. The sea of blank faces and slack jaws is either hilarious or frightening, depending on how you look at it. You are correct that it is not easy. Easy, quick, and simplistic enough to display on a spreadsheet or a PowerPoint graphic is a prerequisite for anything to occur in most business settings, healthcare or otherwise. Acceptance of an idea by the truly left brained manager requires a trail of large, evenly spaced, contrasting color breadcrumbs on a flat, featureless surface. A culture of caring requires mutual respect, which is way too complex to put into any number of spreadsheets.
    Permalink 02/09/09 @ 17:29
    Comment from: Anthony Cirillo [Visitor] · http://www.4wardfast.com
    The employee experience fuels the patient experience that fuels word of mouth. As you say, not rocket science.

    Anthony Cirillo, FACHE
    Permalink 02/09/09 @ 22:34
    Comment from: Crusty Curmudgeon [Visitor]
    In the early 1970s, a Kansas City consultant named William Christopher developed a program to align Needs, Objectives and Work (NOW). I was tapped to lead the effort in the hospital where I was working.
    We solicited needs from five groups of stakeholders, sponsoring agency/board, employees, volunteers, patients and community. After verifying that the submitted needs were applicable to the hospital, a master list was compiled, and the administrative council wrote and prioritized objectives that, when achieved, would satisfy the needs. These objectives were then justified with all job descriptions in the organization in conjunction with representatives of the employees working under those descriptions. If work existed that did not relate to an objective, either an objective was missed, or the work was not necessary.
    This painful exercise yielded a singularity of purpose for management and employees that fostered growth and development of a catchment network among smaller institutions. It also boosted employee morale, presumably because each employee knew his/her part in fulfilling the mission of the hospital.
    Because of the provenance of the needs, the left-brain requirements were included as organizational objectives.
    The point of all this is that it takes more than 20,000 indicators to change the culture of an organization. It takes the buy-in of the employees and a management at all levels shares a mission and set of objectives. I’m certain this can be done in a more efficient and less plodding way than I described, but it’s a worthy goal.
    Permalink 02/11/09 @ 10:05
    Comment from: deborah kearney [Visitor] · http://www.jobsmartsystem.com
    I agree with Crusty C. that the buy in , especially with the bargaining units is very important. The eye on the prize of course is patient centered care that is evidenced based and as the King would say etcetera, etcetera , etcetera

    We need all of the contributors from the boiler room to the board room to feel valued as contributors and then given the freedom to take actions promote quality
    Permalink 02/12/09 @ 11:42
    Comment from: John Lyons [Visitor] · http://represolutions.com/aboutus.aspx
    Soliciting the involvement of all the stakeholders is, I agree, crucial. Key to the overall success of any 'culture change' is the passionate involvement of the most senior individuals on both the financial and clinical sides of the field. Employees on the 'front lines' need to see this level of support in order to know that the extra effort they are spending (to identify opportunities for application of best practices and to follow rules that may not have been the norm) will be appreciated not derided.
    Permalink 02/24/09 @ 12:23
    Comment from: Opinionator [Visitor]
    It is my hope that this open communication and evidence of respect for all of the stakeholders involved also extends to the time when cost-cutting decisions are being made, before they happen and not when they are just a fait accompli.
    Permalink 02/26/09 @ 15:30
    Comment from: Ken Cohn [Visitor] · http://HealthcareCollaboration.com
    Thanks Nick for another great post.

    A few months ago, in Collaborative Culture (http://healthcarecollaboration.com/collaborative-culture/), I wrote about the paradox of culture.

    Executives make time to shape organizational culture because a strong culture allows leaders to delegate tasks and become more productive.

    However, most physicians enjoy bottom-up processes more than top-down edicts. They have told me that they much prefer being inspired to being supervised. The only way that I know to develop a common culture is to allow physicians to play a role in shaping it.

    It sounds like your right-brained approach not only made people feel respected but also created a safe environment for reflection and learning that helped people feel like owners and not just shift workers.
    Permalink 02/26/09 @ 21:28
    Comment from: ruchi [Visitor]
    its a true advice often in health care industry employee turn over is the biggest problem as wel as to maintain quality of work.in hospital u have various type of ppl workin fr u if any organization could develope a system where gud work is honstly appriciated and emplee feel more participtaing
    Permalink 02/26/09 @ 23:20
    Comment from: Lavinia Weissman [Visitor] · http://www.laviniaweissman.com
    Hey Nick,

    This is a great post. Health Care to me is filled with a lot of good intentioned people who walk around with lists of ideas on what can change.

    Our conversations are exceptional when we have time to talk. Like me you understand it is not about your ideas, it is about how to get people to think about what you say and from that thinking- act on it while doing there job.

    Change comes with a lot of hard work putting a few good ideas in to practice everyda.
    Permalink 03/06/09 @ 00:46
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    Most men have different criteria in choosing eyeglass frames for women . According to a survey conducted by the Vision Council, a majority of respondents put comfort and fit first, followed by cheap eyeglass frames and flexibility.
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    Comment from: Skolresa [Visitor] · http://www.delikatesskungen.se/pages.aspx?r_id=47279
    The entrepreneur then had a software expert create grids and graphs and quantitative tables in relational databases that would compile all of the related indicators, cross reference them, and pull them together into the appropriate job descriptions. This system was constructed to enable employers to objectively quantify these job descriptions and thus to evaluate the employees in a more appropriate, efficient, and comprehensive manner.
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