Comments on: Lean Thoughts on "Sicko"

By: Dar

Dar — Sun, 01 Jul 2007 14:53:00 +0000

I had breast cancer. Choice of doctors? I went to the first surgeon who would take me within a week. I would call and get 3 month waits for an appointment! Cancer progresses in three months! Duh! This is in America!

I have since treated myself with diet, and I sought help from aalternative practitioner and not only am I cancer free but I LOOK much healthier and feel much healthier. My body looks better at 51, than it did at 21! There is no focus in this country on preventative care or true HEALTH care. It is SICK care. If it is true that doctors in the UK get bonuses for IMPROVING the health of patients –that is the way to go. Our S.A.D. (standard American diet) is killing us! AND there is so much known about prevention of things like breast cancer that is not common knowledge in mainstream America–like there is a simple urine test that can predict risk, and if found to be at risk, dietary changes can shift that risk! I did it! Yet my GYN put her hand up to me and wouldn’t look at my test results! After all, let’s keep people sick–give them drugs that make them sicker and dependent on the doctors.

All other problems aside, first, we need a shift toward PREVENTION in this country. That is where we need to change and the rest may follow suit!

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By: Dean Bliss

Dean Bliss — Fri, 29 Jun 2007 20:37:00 +0000

Mark, as usual, you nailed it. And Katherine’s comment of needing kaikaku is right on the money. Here’s the open question – how can we bring the key players together, when we’re all in different places? The insurers are making money, the hospitals are scraping by, the docs are seeing their reimburement decrease and their malpractice insurance climb – where can we create the mandate to make real change happen???

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By: andrewmc

andrewmc — Fri, 29 Jun 2007 11:05:00 +0000

Firstly, I dont think that Socialised medicine hospitals are any dirty than those that are privately run. The clear difference is that within a socialised medicine system that data is made available to all. See the Health Care Commisions website for info on the UK. I am not sure that hospitals in the US or privately in the UK are quite so ready to publish that information.

As to wait times. I completely accept the failings of the systems both public and private. I also accept that in a private system where treatment is approved, access is almost certainly faster.

However for those in a private system with coverage but denied access they are worse off than any wait in a socialised system.

I was with two orthopods yesterday afternoon working on fractured neck of femurs and we were discussing a 83 year old lady suffering from dementia who had fallen and the operation they had done. How does that improve her quality of life? They are not necessarily happy about having to provide care because it means some people will get treated inappropriately.

Waiting times. By November 2008 no patient in the UK will wait more than 18 weeks from referral to treatment (at least thats the plan).

At present the data indicates less than 50% wait more than 18 weeks.

Suspected cancer patients wait no more than 2 weeks, the majority will wait hours or a couple of days. The longest wait is 14 days.

In the UK same day mammography scanning, reporting and referral to treatment was pioneered. I was in a large world class US teaching hospital last October and they have only been achieving this within the last year, the UK has been doing this in some places for more than a decade.

I agree with Mark that there are 2 problems and that they are access and quality.

Having experienced both systems, the quality is pretty poor in both, the conference we were at has simply reinforced that belief.

Speed of access for those with coverage is probably on balance faster in the US, but access for the majority has to better in Canada, the UK and NZ and OZ where it is not dependent on ones ability to pay.

Andrew

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By: Andy Wagner

Andy Wagner — Fri, 29 Jun 2007 00:34:00 +0000

Mark & I grew up on the west side of Detroit, but my brother works for a non-profit hospital system over on the east side. Despite the title “non-profit,” he points out over and over again that the nuns can only give away so much money. If the system doesn’t continually bring in 2-3% margins each year, there won’t be enough money to keep the buildings standing.
Economics, the science of scarcity, teaches us that the two problems of access to care and delivery of care will always be with us under any scheme.
Lean teaches us how to optimize systems, end to end to get the best quality to the most people at the lowest cost.
It’d be nice if more could work like Mark and my brother, in the trenches apply lean to healthcare…then we won’t have to keep listening to folks like Michael Moore.

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By: curiouscat

curiouscat — Thu, 28 Jun 2007 23:15:00 +0000

Some of my thoughts:

1) health care is an extremely important, costly and complex area. Given the difficulty even Toyota has after decades of applying their ideas to producing cars it is no surprise there is tons of room to criticize any country’s health care systems – they all need a lot of improvement.

2) Thankfully you, IHI, Management Wisdom, St Mary’s, Theadacare, LEI, Group Health Cooperative… are making great efforts. There is still plenty of room for way more to join all of you.

3) If you want to learn about the health care system take the points out of the context of Roger Moore. As I posted yesterday, I find many people ignore the content and just focus on the messenger to determine how they will respond). Even more true with polarizing figures (on the big national stage or within an organization). If you find the content of Sicko invalid even if it were spoken by someone you are biased toward (say James Womack – for lean blog readers) – fine.

4) A study I ran across this week shows the USA well down the wait time list (of countries). Interesting given the almost universal first objection (to the fact that the USA spends far more than any other country on health care and has far from number one outcome measures) is that all those other countries take away your freedom – you will be waiting for some bureaucrat to ok your medical treatment not like here where we can get treatment whenever we want. Argh: I can’t find it now – I will see if I can find it and post a follow up. My guess is everywhere has a problem allocating resources – health care costs a lot of money.

5) We need to improve the system. Applying lean thinking is a great way to do this.

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By: Katherine Radeka

Katherine Radeka — Thu, 28 Jun 2007 17:27:00 +0000

I like your argument that there are really two problems with health care: access and quality of care. As a sole proprietor the first issue hits close to home. My husband has a job with good health insurance – it’s the only way I can afford to do the work I do.

Eliminating hospital waste under the current system may improve the quality of care but does not solve the problem of access to care. If a hospital spends 30% less, a good chunk of that money is going to flow to insurers (if not hospital investors) as profit rather than provide care to more people. Ditto for eliminating waste at insurance companies inside the current paradigm of health insurance.

To solve the access problem, we need kaikaku here, not kaizen.

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