How to achieve higher quality and productivity
Introduction
Organizations dedicated to health services are exposed to the continuous pressure of higher costs, and at the same time to the ever-increasing demands on the part of patients, social works, state agencies and society as a whole.
The constant advances in technological and scientific matters oblige both the acquisition of new equipment and the continuous education and training of medical and paramedical personnel.
The entry of new competitors forces to improve the profile in the offer of services. Thus, marketing and innovation are becoming more essential every day. Already, it is not enough to own a building and place the plates of the professionals.
On the other hand, the decoupling between the time of generating income and expenses leads to the urgent need to achieve a better synchronization in the flow of these, since it is of little use to generate services and account for profits, if later it is not possible to have sufficient liquidity and solvency to deal with debts and outflow of funds.
The XXI century company, and with much greater reason those dedicated to an activity as special as health services, require maximum effectiveness and efficiency in each and every one of its activities and processes.
In the last decades, a series of tools have emerged that, properly applied and interrelated, give the company that applies them significant competitive advantages.
The problem is in those companies that, despite the years that have passed, completely omit the need to conveniently update their management systems. Annex 1 presents a questionnaire with 30 questions to which you must answer YES or NO about whether your Clinic or Sanatorium is applying a series of tools or systems. From the percentage of positive responses will arise the commitment that managers have to the competitiveness of their organization, and how much their company responds to new management concepts.
Total Quality Management (TQM) applied in healthcare companies
The Total Quality Management must include from the quality of the benefits and services to the quality of the administration, recognizing for this as the first objective the urgent need to know the needs and requirements of both internal and external customers to the organization.
It must be clearly understood that when it comes to total quality it is talking about quality in each and every one of the entity's activities and processes.
In a health entity, quality is imperative, quality in the provisioning or purchasing processes, quality in the reservation of shifts to patients, quality in services, quality in food services, quality in services for companions, quality in internal information systems, quality in equipment maintenance, quality in emergency services. All these processes constitute links in the services that the health company provides, and as it is already known "a chain is as strong as its weakest link", which is why the detection of faults or defects must be systematically pursued, for its prevention and eradication.
Continuous quality improvement has an important effect on productivity, and consequently on costs. Regarding quality levels, such as those corresponding to productivity and cost levels, these can be monitored and controlled by using Statistical Process Controls (CEP).
The CEP applied to business management allows visualizing the capacity of the system to operate within certain levels of quality, productivity, costs and profitability, distinguishing the own variations of the process from those that are special, in such a way to apply the corrective measures that are necessary according to their characteristics.
For the area of surgeries or treatments it is essential to use this formidable tool that allows us to know the average cost, but also the maximum and minimum levels within which the system is operating, allowing the application of a series of tools and methodologies. that allow the reduction in cost levels.
The identification of the factors that affect costs, the use of the various management tools by the work teams, combined with the CEP, allow through the PREA process to systematically improve cost performance.
Continuous Improvement as a strategic objective
It is the continuous improvement in each element and process of the organization, which will allow:
- A greater motivation of the staff. Constantly improve performance levels. Achieve a high performance level. Generate a greater added value for each of the sectors interested in the entity, call them patients, social works, professionals, associates, staff of the company, owners, and society as a whole. A higher degree of customer loyalty.
All these elements are associated, generating a synergy that significantly increases the ability to generate a better strategic position in the market.
Provisioning "Just in Time"
Improving the procurement system, paying due attention to the total cost, rather than the price of the product or service, allows a significant cost reduction. The total cost includes not only the price of the purchased good or service, but also its financing, delivery times, quantities supplied, and quality and quantities delivered.
Providing just in time implies avoiding expensive security inventories to start working with minimum inventories in order to save financial costs, handling, insurance, space and obsolescence, among others.
Just-in-time provisioning works on one of the main wastes that Just in Time tries to eliminate.
Improve maintenance
This means trying to reach a level of zero breakdowns, leaving to repair facilities and equipment in reaction to various types of problems, to implement and plan autonomous, preventive and predictive maintenance.
This type of maintenance reduces the total cost of maintenance, notably reduces waiting times, eliminates breakdowns, avoids problems in the provision of services, improves the quality of the latter, increases the useful life of equipment, machines and facilities.
Total productive maintenance is not something that can only be applied in factories, it is also very useful in sanatoriums and hospitals, especially when we consider:
1. The extremely high cost of machinery.
2. The damage that can be caused by the interruption of services.
3. The impediment to perform certain benefits.
It is also feasible to apply the SMED
The SMED is a methodology that was first created to be used in factories in order to minimize preparation times and / or the times necessary for tool changes, it can also be used to improve productivity in sanatoriums in a way that so as to improve the flexibility of certain machines or equipment, or to minimize the preparation time of operating rooms between one operation and others.
This implies the possibility of increasing the number of surgeries, making better use of the performance capabilities.
When it comes to security, let's talk about the Poka-Yoke
Poka-Yoke is a method that means "error-proof" in Japanese. We all know very well about the mistakes that can be made in the administrative sectors, but much more do we know about the very serious consequences that in the service area implies the commission of the slightest mistake. These errors are possible to avoid. The Poka-Yoke has the answer. An answer that will not only save lives, but will allow the entity to offer a level of excellence.
Becoming aware of the existence of this type of tool will allow the entity's professionals to develop mechanisms and methodologies to avoid making mistakes. It is in the training showing this type of tools, where the consultant in kaizen has his reason for being.
Benchmarking. What is it and what is it for?
Benchmarking is the search for those best practices that will lead to the excellent performance of a company, becoming a positive, proactive process to change operations in a structured way to achieve excellent performance. Setting operating goals based on the best possible practices in the industry is a critical component in the success of any business. Traditional goal setting methods have not worked for managers, leaving them vulnerable to more sophisticated competitors.
The benefits of using benchmarking are that companies are obliged to research the best practices of companies, which carry out the same activity or not, and then include them in their operations, leading to the generation of profitable entities, with high use of assets that meet the needs of their patients and that have a clear competitive advantage.
Learning from the leaders and from the competition is essential. If they are strong in certain areas it must be discovered why this is so and how they did it. Such best practices should be found wherever they exist, and then hesitate to copy, modify, and incorporate them into the practices.
If the best practices have been carefully investigated and, if these have been suitably incorporated into the administrative, logistical, financial or service operations, then the existing strengths will have been taken advantage of and the weaknesses will have been overcome, thus generating a superior position in the market.
Benchmarking can be useful to an entity in many ways:
- It allows to creatively incorporate the best practices of any industry to the processes of the function to which benchmarking is applied. It can provide incentives and motivation to professionals whose creativity is required to carry out and put into practice the benchmarking findings. Benchmarking exceeds the reluctance to change embedded in operations. People have been found to be more receptive to new ideas and more open to creative adoption when those ideas do not originate out of necessity in their own industry. Benchmarking allows for the identification of technological discoveries that would not have been recognized and therefore not I would have applied in own activity for some time.People who actively participate in the benchmarking process find that their professional contacts and interactions from benchmarking are invaluable for their future professional growth, as it allows them to expand their knowledge and experiences, making them more useful for the organization in future tasks.
Be aware of waste
What are the various types of waste? How and why do they take place? How to prevent and detect them? How to remove them? These are the questions to which the Kaizen system answers.
Being aware of the different types of waste that prevent the company from reaching its maximum potential, knowing how and why different wastes take place is essential when it comes to improving services, increasing productivity and consequently being more competitive.
Reducing waste not only allows greater profits in the present and future, but also to shape those savings in funds that will make it feasible to face the falls caused by the economic crises. The question is: why produce profits for 90 if it is feasible to achieve it for 100 ?. Many excited about high profits, do not see the full potential of profits that are left on the road, and that tomorrow can and will surely be necessary to face a crisis or seize an opportunity.
Do you know your learning curves?
The concept of the learning curve has been well documented in the production of goods and services. Now studies indicate that even the medical profession can look at learning curves to predict the success of surgeries. And today, as more and more hospitals face pressure from welfare, pre-paid health and government systems to accept fixed-price negotiations for their services, their ability to learn from experience will be critical.
Researchers at Temple University Hospital (USA) evaluated the effects of learning for heart transplants. An expensive operation, with an average cost of US $ 60,000 for the hospital. A transplant requires precise and complex coordination from a large team. Furthermore, hospitals or sanitariums that perform heart transplants rarely recoup the full costs of these operations and therefore have a strong incentive to reduce these costs whenever possible.
The results of a three-year study of a total of 62 transplant recipients revealed a learning curve of 79%, measured by the 1-year mortality rate (i.e., the number of patients who die in the first year of operation). In this case, every three operations resulted in a 50% reduction in the mortality rate. This last measure of improvement estimates not only the lives lost, but the loss of a scarce and valuable medical resource - the donated heart.
This experience at Temple University Hospital places the learning curves for heart transplants on the same level as what has been found almost universally in industrial production.
The Balanced Scorecard as a management tool
Today as never before, computer technology allows us to significantly improve the management method, providing us with programs that combine information online with planning and budgeting. In this way, the managers of a hospital or sanatorium can count on information in real time about the progress of the company, its indexes, the variation in its ratios, and the fulfillment of the objectives set.
The Balanced Scorecard allows you to quickly have information by exception, thereby improving the response time to the necessary decision-making.
Activity Based Costing (ABC) - Your reason for being
The application of Statistical Process Control in terms of costs, allows us to know the capacity of the system to generate services within certain limits, but this alone is not enough. It is also essential to know the costs of each service, and even more so for each operation, in order to have better information both when making decisions and when negotiating the prices of the different services.
The ABC costing system not only allows the aforementioned, but also due to its approach makes it feasible to systematically evaluate the added value of the different activities that make up a process and its reason for being, for the purposes of its subsequent elimination, correction or improvement.
ABC is a methodology to assign the costs and expenses of a company. The same, is based on the fact that a company to produce products or services requires to carry out activities that consume resources, so first the activities are paid for, and then the cost of the latter is assigned to the different objects of cost (service provision, patient groups, social works, etc.) that these activities demand; With this, a much higher degree of precision is obtained both in the calculation of costs and profitability.
Continuous Redesign of Services (RCS) as a strategic weapon
The RCS is both a philosophy and a methodology that pursues a constant rethinking, evaluation and creative modification of the different services, both in their content and in their implementation.
Constantly improving the characteristics of the services allows the company to always be ahead of its competitors. Today in a time of rapid change and consequent copying, getting ahead with enough flexibility and speed allows a service company to have a hard time bringing in its competitors.
Seeing what possibilities scientific and technological progress gives us, analyzing how to improve relationships and alliances with suppliers, especially laboratories, improving the offer through a change in the point of view of marketing, are all things that allow an entity dedicated to health benefits, achieve important strategic advantages and be positioned in the minds of users as an advanced organization.
Poor Quality Cost
Both budgeting and the continuous calculation and analysis of quality and non-quality costs are essential in order to be able to monitor the levels of quality and productivity of the system and its activities.
This cost of quality or lack of quality is constituted by the sum of the:
- Prevention costs Assessment costs Costs for internal failures Costs for external failures
The objective is to effectively increase prevention costs in exchange for a more than proportional reduction in costs, especially related to failures.
This costing system and its corresponding analysis is but unknown, practically very little used by Latin American companies. When it is not known how much our costs amount to quality factors and / or lack thereof, we lack the elements to know how well we are doing it, what our objective should be and how to get there, and the subsequent control and evaluation of values.
Conclusions
The objective of any company beyond its mission, which in the case of companies dedicated to health is to improve the quality of life of their patients and the community, is fundamentally to obtain economic benefits, especially when you have Take into account the risks of participating in an economic activity, the needs to improve benefits every day and the material needs of all those who in one way or another participate in benefits, either directly or indirectly.
For this reason, it is essential for the purposes of improving benefits, gaining greater market shares, achieving competitive strength, and obtaining a reasonable return on investment, implementing a series of management tools and systems that effectively and efficiently allow achievement. of the goals and objectives set by the management.
Running the company with the same instruments as a decade ago, it is as if the aircraft carriers were guided at sea with the same navigation instruments as Columbus' caravels. Adapting quickly to the new times is the watchword. To do so is to increase profit potential, not to do so is to create problems and be part of them.
Annexes
Annex 1 is a self-assessment questionnaire that aims to recognize the level of updating in health management, and therefore its level of competitiveness.
While Annex 2, although repeating the questionnaire, aims at the weighting that each company gives to each tool, method or system, with a total of 100 weighting points. On the other hand, it should be rated how well it is being applied, being:
Zero: When it is not applied
One: When it is deficient
Two: When it is classified as regular
Three: In case it is considered good, and
Four: When it can be classified as very good.
| QUESTIONS | YES | NO | |
| one | Has a Total Quality Management System - TQM been implemented? | ||
| two | Has a productivity measurement and control system been developed? | ||
| 3 | Has a Continuous Improvement System been implemented? | ||
| 4 | Do you have your services Certified according to ISO 9001 Standards? | ||
| 5 | Do you have a system in place for measuring and monitoring the satisfaction levels of your patients? | ||
| 6 | Do you know the level in Sigma of its different services? | ||
| 7 | Are you applying Suggestion System (by employees)? | ||
| 8 | Do you have activities of Improvement Teams or Quality Control Circles implemented? | ||
| 9 | Do you have a Just in Time supply system? | ||
| 10 | Do you systematically practice benchmarking? | ||
| eleven | Do you proceed to detect, prevent and eliminate waste in a systematic way? | ||
| 12 | Do you have Poka-Yoke systems implemented? | ||
| 13 | Do you control and improve productivity in the office area? | ||
| 14 | Do you use Budgetary and Management Controls? | ||
| fifteen | Are you using the Balanced Scorecard? | ||
| 16 | Do you have a Total Productive Maintenance system implemented? | ||
| 17 | Do you apply methods to reduce operating room preparation times? | ||
| 18 | Do you know what your Learning Curve is for the different activities? | ||
| 19 | Do you have Statistical Process Controls in operation? | ||
| twenty | Do you use the Internet as a means of obtaining competitive advantages? | ||
| twenty-one | Do you use Activity Based Costing (ABC) as a means of knowing the costs of different services, sectors, and benefits? | ||
| 22 | Do you have implemented Treasury Management software? | ||
| 2. 3 | Does the Strategic Administration put into practice? | ||
| 24 | Does Target Cost Management Apply? | ||
| 25 | Do you carry out a paretian analysis of income and expenses? | ||
| 26 | Do you have empowerment installed? | ||
| 27 | Have you established the Continuous Redesign of Services (RCS)? | ||
| 28 | Do you outsource non-strategic services? | ||
| 29 | Do you regularly calculate the Economic Added Value? | ||
| 30 | Do you use the concepts of Operations Management and Research? | ||
| Total positive and negative responses |
| REPLY | QUANTITY | PERCENTAGE |
| YES | ||
| NO | ||
| TOTAL |
Annex 2 - Weighting of Competitive Management
| QUESTIONS | Calif. | Pond. | Score | |
| one | Has a Total Quality Management System - TQM been implemented? | |||
| two | Has a productivity measurement and control system been developed? | |||
| 3 | Has a Continuous Improvement System been implemented? | |||
| 4 | Do you have your services Certified according to ISO 9001 Standards? | |||
| 5 | Do you have a system in place for measuring and monitoring the satisfaction levels of your patients? | |||
| 6 | Do you know the level in Sigma of its different services? | |||
| 7 | Are you applying Suggestion System (by employees)? | |||
| 8 | Do you have activities of Improvement Teams or Quality Control Circles implemented? | |||
| 9 | Do you have a Just in Time supply system? | |||
| 10 | Do you systematically practice benchmarking? | |||
| eleven | Do you proceed to detect, prevent and eliminate waste in a systematic way? | |||
| 12 | Do you have Poka-Yoke systems implemented? | |||
| 13 | Do you control and improve productivity in the office area? | |||
| 14 | Do you use Budgetary and Management Controls? | |||
| fifteen | Are you using the Balanced Scorecard? | |||
| 16 | Do you have a Total Productive Maintenance system implemented? | |||
| 17 | Do you apply methods to reduce operating room preparation times? | |||
| 18 | Do you know what your Learning Curve is for the different activities? | |||
| 19 | Do you have Statistical Process Controls in operation? | |||
| twenty | Do you use the Internet as a means of obtaining competitive advantages? | |||
| twenty-one | Do you use Activity Based Costing (ABC) as a means of knowing the costs of different services, sectors, and benefits? | |||
| 22 | Do you have implemented Treasury Management software? | |||
| 2. 3 | Does the Strategic Administration put into practice? | |||
| 24 | Does Target Cost Management Apply? | |||
| 25 | Do you carry out a paretian analysis of income and expenses? | |||
| 26 | Do you have empowerment installed? | |||
| 27 | Have you established the Continuous Redesign of Services (RCS)? | |||
| 28 | Do you outsource non-strategic services? | |||
| 29 | Do you regularly calculate the Economic Added Value? | |||
| 30 | Do you use the concepts of Operations Management and Research? | |||
| Total points | 100 |
| points | Percentage | |
| Score obtained | ||
| Maximum Score |
Bibliography
Deming's 14 Points Applied to Service - AC Rosander - ASQC Quality Press - 1991
The Management of Health Services - José María Corella - Editorial Díaz de Santos - 1996
Source: David Smith and Jan Larsson, "The Impact of Learnning on Cost: The Case of Herat Transplantation," Hostital and Health Service Administration (Spring 1989).
