We Need Lean, Not Cost Cutting


Guardian Unlimited Politics | Special Reports | Overseas transcription errors ‘putting patients' lives at risk'

It's not news that many hospitals are strapped for cash. It's frustrating to see hospitals take the traditional “mass production” mentality of focusing on cost cutting as the way to fix their financial situation. The cost that's typically obsessed over is labor cost, the way you cut that cost is outsourcing. Granted, labor cost is usually a higher percentage of cost than it is in manufacturing, but there is a better way — lean thinking.

Offshoring is often the wrong business decision in manufacturing (this article points out some “common sense” on the topic. There are always tradeoffs. Unfortunately, the tradeoff in healthcare may be errors and, ultimately, patient safety.

You might ask, “What do you mean, offshoring healthcare? That's not possible, my doctor needs to be right there with me.” True, unless that doctor is a radiologist. With digital imaging, it's easy for someone to do that work in India at 10% of the cost. Medical transcription is another task that's easy to outsource, the technology makes it “easy” at least. Just because the technology is there doesn't mean that we have the process completely worked out.

The article linked above highlights some of the potential errors that can occur. These errors can occur when the transcriptionist is down the hall, rather than across the globe. But, when uncertainty occurs, how is the uncertainly resolved? Someone doing work at 3 AM in India can't just call up the Doctor to make sure they heard them right.

Regardless of offshoring, let's focus on the error-proofing aspect of this. We need systemic changes to make sure there's no room for misunderstandings and transcription errors (it reminds me of the systemic change to make sure micrograms and milligrams don't get confused).

Possible errors include:

  • “Hypo” vs “Hyper” (can have fatal consequences)
  • “Known malignant” and “Non-malignant”
  • “Urological” instead of “Neurological”

If there's any doubt by the transcriptionist, you'd think the record would be flagged for extra review by the doctors so that no mistaken medical decisions are made based off of faulty transcription. You'd think that would be the process whether or not the work was offshore or in house.

Thinking to my earlier post on root causing these decisions, why do hospital administrators feel pressured to reduce costs by offshoring the transcription work? I'd say one reason is that they don't know enough about lean healthcare and how it can cut costs while improving patient and employee satisfaction. They don't know how lean improvements can allow them the “luxury” of keeping transcrption in house.

Either way, error proof it! Think lean. Don't learn lessons from the old mass production factory world.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.



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