Wednesday, July 02, 2014

He makes it sound so straightforward

Richard Corder started life in the hospitality business and has made a successful transition to the world of health care.  He now assistant vice president at CRICO Strategies, a subsidiary of the Harvard hospitals' captive insurance company.

In this short video from the Beryl Institute, he presents a lovely list of things health care can learn from the hotel world.  Well worth watching.  As Richard might say, it's simple, but it's not easy.  In Lean terms, he is presenting important ideas of standard work for the leaders of an organization.

Check out Richard's blog, too, for other thoughtful insights.


Barry Carol said...

I can think of at least five important differences between hospitals and hotels. They are: (1) patients don’t “buy” medical care because they want to but because they have to, (2) many doctors, who are the most important people providing actual care, are often not hospital employees but independent contractors with practice privileges, (3) too often the hospital sees the payer as the customer and not the patient, (4) hospitals claim they lose money on most or all Medicaid patients, many Medicare patients and, of course, the uninsured so they may not even want much of that business and (5) hospitals are job shops, not focused factories which means patients will have far different experiences depending on both the complexity of their issues and the ability of the hospital and its personnel to handle them.

As a patient, I appreciate pleasant nurses but I hope they’re also competent while good food and flat screen televisions are nice but hardly critical. What I would like most is straightforward and transparent information about risk adjusted outcomes, infection rates and, of course, actual contract reimbursement rates as opposed to the absurd chargemaster prices.
For those who wind up needing emergency services but find themselves out-of-network, the hospital and other providers should not be able to charge more than the in network rate at most. West Virginia has already legislated that rule.

Paul Levy said...

I think you are missing a major point, Barry. The issue covered by this post is about how to encourage and drive process improvement throughout a hospital. In that regard, it doesn't matter if they are like hotels or not, in terms of the types of services offered. Richard's prescriptions are applicable to any organization that delivers services -- or indeed -- products to the marketplace. (GM might have avoided a lot of its problems, for example, if it had this kind of standard work in place among their top managers.)

Of course, the points you raise in the second paragraph would would helpful in a number of respects, especially the environment within which hospitals have to operate. But those hospitals that follow Richard's ideas or others like them find that they are able to give better care at lower cost to all patients, regardless of payer,

nonlocal MD said...

I agree with Paul, Barry; in that the real shame is that hospitals (indeed, our entire industry) feel that they are so unique that they don't need or want to look at other industries for inspiration and knowledge. The woeful error of their ways is only now becoming clear in the complete unreliability of their 'processes' and the high failure (death/morbidity) rates of their product. Don't fall for the 'unique' excuse any more. And btw, the U.S. is not alone in that particular regard, despite our poor relative performance to the rest of the world (different issues than process).

Richard said...


Thank you for your comments, I do think you missed the point I was trying to make though.

I am not suggesting that we add amenities, smile training and other oft confused solutions (flat screen TVs) when we hear that healthcare might learn a thing or two from others. In fact I’m with you in that I want (and expect) competent, safe, timely, harm free care that is consistently delivered by well resourced, well trained, high functioning, reliable teams.

Many of our nations hospitals are far from delivering this kind of care.

What I'm proposing is that we stop trying to convince ourselves how unique we are from other complex, service delivering orgnaizations and start learning a thing or two from the lessons and experiences others.

In US hosspitals and clinics, we are still promulgating, promoting and repeating approaches to education, communication, training, learning, reward, recognition and process improvement that are quite frankly broken.

It's time to learn from those that are desperately willing to share.

Barry Carol said...

I’m all for streamlining and improving processes ranging from the use of checklists to consistent hand washing to collaboration among staff members. I’m just expressing some skepticism around whether or not such improvements will be recognized and rewarded by patients unless they translate into improved outcomes, fewer infections and other complications and lower prices.

When patients are insulated from all or most of the costs due to third party payment, they are much more likely to prefer the hospital that looks and feels like a Four Seasons vs. the one that has the feel of a Motel 6 even if the latter has comparable or even better outcomes at significantly lower cost.

Process improvement also requires physician buy-in which is much harder to achieve when the doctors are not hospital employees but independent contractors with practice privileges. Personally, after a 40 year career in the money management business, I have no problem with copying good ideas from anywhere I can find them.

nonlocal MD said...

Barry, I see the obsession with flat screen TV's and parking as part and parcel of the money-driven mentality now where you concentrate on all the wrong things. Combined, of course, with the wrong-headed interpretation of the patient satisfaction scores which are part of government incentives now. Just think if a hospital had a video or internal TV program educating their patients in realtime on what to look for (clean rooms, good communication from providers, answers to their questions etc) rather than nice amenities. Left to their own devices, patients have no idea what 'satisfaction' with a hospital SHOULD mean.

Anonymous said...

Paul, I am flabbergasted by the comments already posted. I suspect there is something profoundly difficult for the "American mindset" to apprehend about systemic QI initiatives. This in turn renders your post vulnerable to the a foregoing critiques. Our caring for each other is what Isaiah refers to as " the work of our hands". G-d bless you

Anonymous said...

When I was preparing a piece on how the healthcare industry could learn from aviation with respect to safety, I called an internationally regarded expert in human factors engineering and aviation safety. I asked him what similarities and differences he saw between aviation and healthcare safety. He said: "Overwhelmingly the biggest similarity is that when we the aviation safety revolution started out in the 1970s and we tried to bring safety engineering methods from other industries into aviation, aviation said 'this doesn't apply to us, we are different.' "

Terry Fairbanks
National Center for human factors in health care MedStar Health