Overprocessing in Healthcare
Ark. Hospital, Surgeon Sued For Performing Unnecessary Heart Surgeries
When I teach lean overview training in healthcare settings, it's often tough to find examples of the Waste of “Overprocessing,” one of the types of waste that Toyota has defined and popularized as lean has spread.
The article I linked to above is a sad example of a doctor doing more work than the customer needs or values., the definition of overprocessing.
“A federal lawsuit filed by a heart patient and a doctor accuses Saint Edward Mercy Medical Center and a surgeon of performing unnecessary heart surgeries to defraud Medicare and other federal health programs.”
When our health care system (“disease care” as some call it) pays doctors and organizations for the work they do, isn't this just like “piece work” pay in the manufacturing world? The temptation is there to do unnecessary work — thankfully, most doctors don't succumb to that temptation, right?
I recorded a future LeanBlog Podcast interview with David Mann (author of the outstanding book Creating a Lean Culture) on Sunday and he talked about how Steelcase moved away from piece work pay. Paying employees for what they produce (as opposed to what customers need) leads to overproduction and all sorts of waste (inventory, defects, waiting, etc.). Piece work isn't a lean method and most lean companies move away from piece work pay to hourly pay (with bonuses and variable compensation for company performance and/or reaching operational goals).
I guess it's too hard to pay healthcare providers for their results (you being healthy), rather than paying them for the things they do and the things they use in the course of treating you and your ilnesses. A doctor doesn't get paid for PREVENTING illness. It seems like moving away from piece work healthcare would sure help (even if it's a Quixotic goal).
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I wonder if having to make a visit in to the doctor to get a prescription renewed isn’t a prime example of overproduction within the medical community.
If I’ve been taking the same meds for several years and when I do show up at the doctors office I get a quick question on how I’m feeling and the prescription is doled out. I’ve wasted an hour and the doctor has wasted 10 minutes but fattened his/her wallet for the patient visit.
Perfect example of Overproduction, especially when you need a prescription renewed.
Plenty of examples of over treating and over diagnosis.
Breast Cancer Screening, study out today indicating that perhaps screening is leading to overtreatment and over diagnosis.
Lots of people in middle age have cancerous cells within them that are not malignant. If you never screedned, you would never know and therefore never treat. However by screening even if they are benign as soon as you see them you treat therefore there is an argument that by screening we will inevitably over diagnose and over treat.
Clearly the ideal metric to be used in healthcare is some form of outcomes per pound / dollar spent. This is fairly intuitive, the issue comes when you work across organisations and through the community. I dont think anyone has an issue with the fact that health care works on a per piece costing system, I think the problem is that no health care system globally has come up with a practical viable alternative.
Take one value stream, the breast cancer value stream I put in above is a classic which will involve primary care, outpatients, perhaps acute secondary, counselling, daignostics and perhaps some sort of acute intervention. The process is ripe with potential pitfalls and exceedingly difficult to cost in the NHS which is one large organisation let alone in the US system where providers are commisioned independently by insurance companies. In the UK we have one large organisation commissioned through one body, in the us its one commissioner (insurance) dealing with a variety of independent contractors who’s individual goals are profitability and a responsibility to share holders.
I like the blog. Its interesting, more information on our work can be found at http://www.swlia.nhs.uk/View.aspx?page=/home.html
We work with 13 organisations including primary care, secondary, mental health and London Ambulance and I work with organisations in areas as diverse as call handling (ambulance service), pathology and reducing length of stay in general medicine.