Blog posts on health carePosts selected fromManagement Blog - Engineering Blog - Investing Blog and other blogs - US Fish and Wildlife Service Plans to Use Drones to Drop Vaccine Treats to Save Ferrets
 To date, SPV has been applied by hand with people walking pre-defined transects and uniformly dropping single SPV baits every 9-10 meters to achieve a deposition rate of 50 SPV doses per acre. Depending on vegetation and terrain, a single person walking can treat 3-6 acres per hour. All terrain vehicles (ATVs) have been considered but have various problems.
If the equipment and expertise can be developed as proposed here, a single UAS operator could treat more than 60 acres per hour.
If the equipment can be developed to deposit 3 SPV doses simultaneously every second, as they envision is possible, some 200 acres per hour could be treated by a single operator. continue reading: US Fish and Wildlife Service Plans to Use Drones to Drop Vaccine Treats to Save Ferrets - 2015 Health Care Price Report – Costs in the USA and Elsewhere
The damage to the USA economy due to inflated health care costs is huge. A significant portion of the excessive costs are due to policies the government enacts (which only make sense if you believe the cash given to politicians by those seeking to retain the excessive costs structure in the USA the last few decades buy the votes of the political parties and the individual politicians).
In 2015, Humira (a drug from Abbvie to treat rheumatoid arthritis that is either the highest grossing drug in the world, or close to it) costs $2,669 on average in the USA; $822 in Switzerland; $1,362 in the United Kingdom. This is the cost of a 28 day supply.
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The report also includes the cost of medical procedures. For both the drugs and the procedures they include not only average but measures to show how variable the pricing is. As you would expect (if you pay attention to the massive pricing variation in the USA system) the variation in the cost of medical procedures is wide. For an appendectomy in the USA the 25th percentile of cost was $9,322 and for the 95th was $33,250; the average USA cost was $15,930. The average cost in Switzerland was $6,040 and in the United Kingdom was $8,009. continue reading: 2015 Health Care Price Report – Costs in the USA and Elsewhere - USA Health-Care System Ranks 50th out of 55 Countries
None of these rankings are perfect and neither is this one. But it is clear beyond any doubt that the USA healthcare system is extremely costly for no better health results than other rich countries (and even more expensive with again no better results than most poor countries). It is a huge drain on the economy that we continue to allow lobbyists and special interests to take advantage of the rest of us... continue reading: USA Health-Care System Ranks 50th out of 55 Countries - Burning Toast: American Health System Style
 Democrats and Republicans have created a health care system in the USA over the last 40 years that “burns toast” at an alarming rate. As the symptoms of their health care system are displayed they call in people to blame for burning toast.
Their participation in the “you burn, I’ll scrape” system is even worse than the normal burning then scraping process. They create a bad system over decades and ignore the burnt toast just telling people to put up with it. And when some burnt toast can’t be ignored any longer they then blame individuals for each piece of burnt toast.
They demand that those they bring before them to blame, scrape off the burnt toast. And they act shocked that the "toaster" burns toast. It is the same "toaster" they designed and maintain at the behest of those benefiting from burnt toast and of course it burns toast (those results are the natural outcome of the system they designed and maintain). continue reading: Burning Toast: American Health System Style - Looking Back at "Some Notes on Management in a Hospital" by W. Edwards Deming
The head nurse returned to say that the nurse that was to give the infusion had recorded the infusion as given. It is possible that she recorded it in advance, with the intention to give it, and did not correct the record. Is this the regular procedure, to record intentions? Who would know? An unsuspecting physician, looking at the record for his patient, would assume that the infusion had been given, and could draw wrong inferences about how the patient had been doing on the drug. In my case, as it turned out, no harm. But how would he know? A nurse, or a physician, has a right to suppose that the medication was delivered as ordered and as recorded.
What is the purpose of the record? To inform the physician about intentions, or to tell him what happened?
It is even more difficult than usual to avoid blaming people when you are being forced to suffer. But even in this situation Dr. Deming understood the problems were a natural result of poor processes not of failures by individuals to do their best. continue reading: Looking Back at "Some Notes on Management in a Hospital" by W. Edwards Deming - Drug Prices in the USA
There is the contention that without the ability to overcharge American’s the drug companies won’t invest in Research and Development. This is such a poor argument I can’t believe people can make it without suffering a big blow to any credibility they had. Obviously drug development has a very high cost (creating a high fixed cost) and often drug manufacture has a small marginal cost (though at times the marginal cost is also high). Right now the companies count on the American market to provide funds for much of the research, development, marketing and profits. Then they sell the drugs in other markets only looking to maximize profits looking at marginal costs. Obviously, if they no longer could count on excessive prices in the United States they would have to spread the fixed cost over the rest of the world. The argument that they won’t invest in research and development without excessive costs in America is false. They would adjust their pricing structures around the world based on losing the cash cow of the American consumer. That should be obvious to anyone who even took one economics course. continue reading: Drug Prices in the USA - Control Charts in Health Care
The point of using a control chart, and many of the management improvement tools, are to improve the efficiency and effectiveness of resources spent improving. The trick is not really to improve (that is pretty easy) the trick is to improve quickly and effectively (and in a competitive marketplace to improve more quickly than competitors). Where improvement resources are targeted is critical. In deciding which improvement options to explore it is important to understand the impact on the outcome (in this case the health of the patient). continue reading: Control Charts in Health Care - W. Edwards Deming’s Seven Deadly Diseases
Seven Deadly Diseases
- Lack of constancy of purpose
- Emphasis on short term profits (Overreaction to short term variation is harmful to long term success. With such focus on relatively unimportant short term results focus on constancy of purpose is next to impossible.)
- Evaluation of performance, merit rating or annual review (see: Performance Without Appraisal: What to do Instead of Performance Appraisals by Peter Scholtes).
- Mobility of top management (too much turnover causes numerous problems)
- Managing by use of visible figures, with little of no consideration of figures that are unknown or unknowable.
continue reading: W. Edwards Deming’s Seven Deadly Diseases - Management Improvement in Healthcare
Health care (and especially M.D.s) have always been seen as among the most difficult environment to introduce new management principles (universities are another). It was surprising to me since so much of management improvement is largely about using the scientific method, but it seems to be a reality. It seems these highly educated people are used to having huge freedom to act as they wish, and seem to resist participating in a system to improve rather than doing as they wish.
To improving results in health care I strongly recommend looking at the work of the Institute for Healthcare Improvement. continue reading: Management Improvement in Healthcare - PBS Documentary: Improving Hospitals
This rare good news documentary reports on a surprising solution to escalating costs, unnecessary deaths and waste in America’s hospitals. Doctors and nurses tell how they did their best, working overtime, while hospital conditions worsened. They were delighted to learn a new way to improve patient care dramatically and reduce unnecessary deaths, suffering, errors, infections and costs without additional resources or government regulations. continue reading: PBS Documentary: Improving Hospitals - Lean National Health System
This is an example of focusing on improving the system which will then result in improved measures (cost savings for example). This systems approach contrasts with cutting costs by cutting every budget by 5% across the board which often fails. Without improvements in the system reducing budgets just reduces capability. continue reading: Lean National Health System - Thoughts on Hospital Management by Deming
A physician cannot change the system. A head nurse cannot change the system. Meanwhile, who would know? To work harder will not solve the problem. The nurses couldn’t work any harder.
continue reading: Thoughts on Hospital Management by Deming - Management Improvement History and Health Care
I think it is wise to think about what improvement methods were tried in the past and try to understand why they failed in order to improve the chances of success today. I think the many of the things which tripped up TQM, Six Sigma, re-engineering… efforts in the past are waiting to do the same to those efforts today, including lean thinking efforts. continue reading: Management Improvement History and Health Care - Evidence-based Management
It is not easy to get people to change their habits. You often need creativity to give power to the data...
this story, to me, is another sign that focusing on managing the system is more important than devoting excessive energy to bringing in star talent
continue reading: Evidence-based Management - Epidemic of Diagnoses
It sure seems to me this tendency to “over-diagnois” leads to Tampering. Lets assign a special cause to some instance and then implement a counter-measure (it seems to be “take this drug” is a common one). And just as tampering in the management world the “solutions” then create all sorts of problems.
For me, when I read:
But the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms
I just think: tampering! continue reading: Epidemic of Diagnoses
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