Monthly Archives: August 2017

Careers in Healthcare Administration

The thought of a career in healthcare may conjure up images of doctors, nurses, and other direct healthcare providers rushing in their scrubs from one emergency situation to another.

While there is little doubt that these direct patient care providers are the key to healthcare delivery, many others are working behind the scenes to ensure the entire process is smooth and seamless throughout the system.

Among these healthcare professionals are health services managers, also known as healthcare executives or administrators.

Healthcare Administration: The Profession

According to the U.S. Department of Labor, the primary job of a healthcare administrator is to plan, direct, coordinate, and supervise the delivery of health services in a healthcare facility. A healthcare administrator may manage:

  • An entire healthcare facility

  • A specific clinical department

  • The medical practice of a group of physicians

  • Typically, a healthcare administration degree is required for the job. Depending on the level and type of degree they have, health services managers can find career opportunities in any of the following positions.

  • Hospital administration: The job of a hospital administrator is to make sure the hospital they manage runs smoothly and healthcare is efficiently delivered to those who need it. They coordinate day-to-day administrative activities such as creating work schedules, handling finances, maintaining records, managing inventory, etc. to ensure the business of healthcare continues uninterrupted.

  • Nursing home administration: Nursing homes are residential facilities for people who require constant nursing care. The challenges of managing a nursing home are quite different from those of managing a hospital. Part of a nursing home administrator’s duties is also to take care of the resident patients in addition to managing staff, finances, admissions, and the property itself.

  • Clinical administration: The responsibilities of a clinical administrator depend on the specific medical specialty department he or she manages. They are responsible for formulating and implementing policies for their clinical department, monitoring the quality of care provided to patients in that department, creating budgets, and preparing reports.

  • Health information management: Health information managers have the important task of maintaining and safeguarding patient information from unauthorized access. They work with the latest technologies in information management and security to handle hospital databases. It is, therefore, vital for health services managers in this field to keep themselves updated on evolving technologies.

Healthcare Administration: Training

Individuals interested in this profession are typically required to have a Bachelor’s in Healthcare Administration degree for entry-level assistant roles. Bachelor’s degree programs in health information management are also available for individuals interested in managing this aspect of healthcare.

Some employers, however, may insist on a graduate healthcare administration degree for the role of health services manager. A Master’s in Healthcare Administration degree may also be required for advancement from assistant roles to positions with more responsibility and a higher salary.

For healthcare administrators seeking advancement without having to take a sabbatical from work, an online Master’s in Health Care Administration program may be an ideal fit. An online healthcare administration degree can provide them the flexibility to continue their education and while still working full time.

Meet the Challenges of Healthcare Industry

The healthcare industry is going through a dramatic transformation. This transformation though challenging offers great prospects to improve efficacy and patient outcomes. Amidst several challenges, service providers are finding it difficult to provide quality care and services to patients. The role of IT in augmenting an organization’s efficiency while addressing current healthcare challenges is of paramount importance.

Healthcare software development refers to tools or software that can meet the growing needs of the healthcare industry, i.e. clinics, doctors, hospitals etc. A majority of healthcare companies look for solutions that can provide them with reliability, accuracy and time bound results. This will ensure proper maintenance of medical records.

Healthcare software solutions have changed the way workload was managed earlier. Considering the increasing demand and workload, software development companies have started devising solutions that can automate things and processes. These software development firms are equipped with state-of-the art infrastructural facilities. They make use of the latest systems, software and other advanced technologies to create the best customized healthcare solutions.

Some specific objectives that every healthcare service provider would like to fulfill include:

  1. Augmenting patient outcomes and methods to reduce waiting cycles
  2. Fulfilling significant use and other such regulatory requirements
  3. Improving communication between patient and service provider
  4. Mitigate risks by enhancing processes and quality assurance

Companies offering healthcare software development services constantly track, anticipate, evaluate and implement appropriate end to end solutions.These solutions can be utilized across different verticals such as Enterprise Application Development, Hospital Management System (HMS), Practice Management System, Billing & Coding Solution, Electronic Health Records Systems, Blood Bank Management Systems, Patient Management and Information System, and few more.

These solutions help patients and service providers to connect, communicate, and conform across functional, technical and regulatory aspects. In fact, many such companies are developing customized solutions for their clients depending on their needs.

Healthcare software development services include the following:

  1. Operational analysis and documentation of custom healthcare applications
  2. Technical architecture and designing of user-interface
  3. Development, testing and deployment
  4. Support and Maintenance

The objective of healthcare software development is to make the medical records manageable and accessible. The healthcare software solutions provide the capacity to store, manage and retrieve records for healthcare companies. They also provide solutions for streamlining numerous processes, to ensure hassle-free monitoring of patient’s health information.

Bringing Lean Healthcare

Starting Blocks

Without a doubt, Lean is set to make a big impact on the Healthcare sector over the next few years and many Healthcare organisations in both the public and private sector are already exploring how they could apply it to their patient pathways and administrative processes.

Whilst many of the tools of Lean are familiar to the people in the Healthcare sector, particularly aspects of Process Analysis, the real difference that Lean will bring is a change in the way that improvements activities are implemented rather than the use of the tools themselves.

Many people in the Healthcare sector are looking to people with Lean skills gained in manufacturing to help guide them through the maze of implementing Lean, including helping the organisation to prepare for Lean as well as undertake the specific improvement activities, including Value Stream Events, Rapid Improvement Events etc. Running alongside this is the need to develop the internal capacity of organisations to lead improvements themselves, which is achieved by developing internal Lean facilitators (or Change Agents).

However, as we already know, not every problem in Healthcare can be related to a problem encountered in Manufacturing and there are some significant differences in approach required to make for a successful improvement programme for people more familiar with leading Lean improvements in Manufacturing.

In this article we review some of the key differences that we have found in pioneering Lean transformation in Healthcare and share the structure to Lean activities that we have been developing to ensure that the organisations make sustained improvements rather than isolated Lean ‘ram raids’.

Interestingly, our work to date is also providing some useful learning that can be applied in reverse – from Healthcare back into Manufacturing!

The Same, But Different

As we have already said, Lean will make a big difference to Healthcare and will help them achieve their operational and financial targets but it needs to be applied sensitively within organisations that have been ‘pummelled’ by initiatives and legislation and have a not unreasonable cynicism towards ‘this new initiative called Lean’.

Like in many manufacturing businesses first embarking on an improvement journey, Healthcare employees are concerned about Lean being a vehicle to cut jobs. This feeling has not been helped by the recent NHS guide issued about Lean Healthcare which has chosen to use a Chainsaw as their main logo and was referred to by a Service Improvement Lead within an SHA (Strategic Health Authority) as the ‘Slash & Burn’ guide to Healthcare.

Issues such as this, along with the use of manufacturing focused terminology, photos and case studies when working with employees in Healthcare, has the effect of building up internal resistance and leads to comments such as “My patients are not cars” made by a Renal Consultant we encountered recently.

Additional differences can be seen in the attitude towards risk in Healthcare. In Manufacturing, if you make a mistake with Lean you may increase the risk of accidents but it is more likely it will just reduce productivity or profits. In Healthcare, similar mistakes can impact on Patient Safety (including increasing Morbidity or even Mortality) and can attract significant media attention.

Making this scenario even more complex is the fact that the ‘care pathways’ that patients experience often interact and overlap in a way that Manufacturing value streams do not, with patients switching between pathways and specialities dependent on their specific needs and treatment plans.

Management of these processes and pathways is complicated by the need to balance clinical concerns (such as patient safety and medical best practice) with ‘business’ concerns (availability of resources and finance), and the often uneasy balance that has to be struck between senior clinicians and organisational managers on these issues.

Whilst this sort of complexity is not alien to manufacturing, where there is a constant need to balance cashflow against sales (for example), the fact that this balancing and the resulting management of risk in Healthcare is so prevalent leads to a very different style of management – being more consultative and inclusive than Manufacturing, which slows decision making and involves a lot more analysis than many Manufacturing decisions, and the need to prove things first to sceptical clinicians.

This constant need for balance between clinical and operational concerns leads to one of the biggest differences we encounter, namely the difficulty in engaging the right people for the right amount time to make the improvements sustainable. This is not a new problem in Healthcare with many improvement initiatives having fallen foul of changing priorities, the allocation of insufficient people to an improvement process or simply having failed to move from discussion into action quickly enough.

One final difference between Manufacturing and Healthcare that we thought useful to highlight is simply the differences between what ‘customers’ think of as Value Adding in the two sectors. Giving comfort and advice to a patient is highly valued (for example, a nurse accompanying a patient being taken to theatre) but does not translate easily into a manufacturing equivalent activity.

A Holistic Approach
To counter these issues, introducing Lean into Healthcare requires a holistic approach that takes into account the following points:

1. Understanding Customer Value

Whilst the patient is the obvious (and most important) customer in a process, they may not be the only customer in a Healthcare environment; with others including (say) a Primary Care Trust that has commissioned a Hospital to undertake some activity on a patient and which will be invoiced for the activity.

However, in exploring what customer think of as value adding we do find some customers (patients) in Healthcare have become conditioned by their experiences to date. In one example we were speaking to a patient who attended clinics weekly as part of their treatment plan and was required to wait at every appointment for up to two hours. When we discussed what they valued and whether a reduced waiting time would be beneficial, they said they had come to expect the wait and would place more value on access to free coffee and better magazines to read!

2. Scoping Effectively

Identifying a compelling need for the improvement process is absolutely essential. The need to improve productivity or finances are often driving improvement initiatives in Healthcare but a compelling need based on saving money will rarely engage people from across the pathway.

Often a successful compelling need will focus on improving patient outcomes and achieving the statutory targets within public Healthcare (such as achieving an 18 Week maximum lead-time from referral by a GP to the start of treatment) as well as the need to achieve best practice rates for activity. Because of the importance of this step in the process, we have shown what we believe are the key elements required to successfully scope an improvement project in the text box opposite. It is worth stating that to be truly successful, the scoping of Lean improvements relies on having representation from across the pathway – even if, as is so often the case, that means including people who have never considered themselves as co-workers before, such as the GP and the Hospital Porter we had sitting next to each other at a recent Scoping session.

3. Effective Sponsorship

Leading a Lean project that spans such broad patient pathways requires a high degree of influencing skills. Even seeking to improve a simple administrative process like a Patient Discharge for example, could require the Project Sponsor to liaise, cajole and drive change across several stakeholder groups including GPs, consultants (the real custodians of the NHS), ward staff, medical secretaries, pharmacy staff, IT, social services and porters!

The Sponsor’s belief in Lean will be tested daily by such a large group of interested parties and so their capacity to maintain enthusiasm and motivate the Change Agents is vital. The secret weapon at their disposal, once the Scoping session has been completed is that an agreed Compelling Need will create “clarity of purpose”. Ultimately, if they engage enough people with the same message enough times, the followers will start to assemble.

4. Building Awareness & Capacity

Given the concerns of many in Healthcare that Lean is going to be used to shed jobs, it is essential that there is thought given to the communication of the ‘Compelling Need’ – what Lean is, what it is not and what will happen. Running alongside the raising of awareness will be the need to focus on developing the capacity of individuals within the organisation to enable them to lead Lean improvements.

In addition to initial awareness activities, there is also a need to build on-going communication activities to report on progress, involve others in the design of new processes and ensure that the organisation embeds the improvements achieved before (or alongside) moving onto the next challenge.

Our experience of this shows that at the start of the process a lot of people think of Lean as being just about ‘Process Mapping’ and there is a certain cynicism about it in many areas. This is quickly overcome but can be quite demoralising when first encountered and this confusion about Lean underpins the need to develop broad awareness within the organisation of what Lean truly can deliver.

In terms of capacity, many Healthcare bodies are keen to build internal capability to develop themselves as Lean organisations. Performance Improvement Teams are popping up all over the place and we have found that a large part of our work has been focused on helping these teams of change agents develop the facilitation skills and leadership attributes that will enable them to not only deliver change but make it sustainable.

5. End 2 End Understanding

We mentioned earlier that one of the ways that Lean in Healthcare is different to Lean in Manufacturing is that the pathways (value streams) interact in a different way. Another problem is often encountered through isolated events in one area having an unexpected (and often negative) impact either upstream or downstream in the pathway. Given the risk associated with making changes in different parts of Healthcare, we believe it is essential to develop an understanding of how the pathway operates from End 2 End and to review its critical constraints, current operating performance and the impact that likely changes might have elsewhere before seeking to create a suitable ‘Future State’ and implementation plan.

6. Embedding the Change

Much like Manufacturing, a large percentage of Lean projects in Healthcare are going to fail to deliver the results that organisations hoped for and many of these problems are related to the challenge of embedding the changes. So, having gathered support for an improvement programme and achieved the changes (through Focused Improvement Teams, Rapid Improvement Events etc), it is critical to also conduct the activities that will assist the embedding of the changes including

Healthcare Proposals Impact Medical Travel

American Healthcare & Medical Travel

Today, more than 48 million Americans are uninsured, while millions more learn they are underinsured when they become sick. America spends more than $2.3 trillion, or 16% of GDP, annually on healthcare costs. By the year 2016, U.S. Department of Health and Human Services forecasts that health spending will be $4.3 trillion or 20% of GDP.

Though America spends more than any other country on healthcare, it is ranked 37th in overall quality among the world’s healthcare systems by the World Health Organization. According to the Organization for Economic Cooperation and Development, healthcare spending accounted for 10.9% of the GDP in Switzerland, 9.7% in Canada and 9.5% in France, all countries ranked higher than the U.S.

A recent Wall Street Journal-NBC Survey reported that the cost of healthcare is Americans’ number one economic concern. Growing numbers of underserved patients are turning to healthcare delivery alternatives such as traveling to foreign hospitals for necessary treatment. While the medical travel phenomenon started with cosmetic surgery, successes have emboldened patients who need joint replacements, cardiac surgery, spinal fusions and bariatric surgery to reach beyond America’s borders for alternatives. At the same time, health insurers and employers are noticing the opportunities for cost savings by outsourcing and the ability to reach new markets with tailored healthcare products.

Republicans and Democrats agree that current trends in healthcare are not sustainable. Not surprisingly, both presidential candidates, Senators Barack Obama and John McCain, have proposed equally radical remedies for America’s broken healthcare system. Though neither candidate addresses medical travel specifically, their healthcare plans suggest the likely impact on the medical travel market.

McCain’s Healthcare Plan

Sen. McCain would ask Americans to take on greater personal responsibility for their healthcare choices and rely on market forces to meet today’s healthcare challenges. According to Sen. McCain, increased competition and less government involvement will improve the quality of health insurance with greater diversity among plans, lower prices and portability.

Specifically, Sen. McCain would seek to make insurance more available by increasing variety and affordability of private plans. The Senator’s revolutionary idea is to eliminate the tax break that workers receive from employer-sponsored health plans, treating the benefit as taxable income, offset by a new tax credit of $2,500 for individuals and $5,000 for families. If the tax credit is more than the amount a person spends on healthcare premiums, the excess can be placed in a health savings account.

Sen. McCain believes that people who are covered by employer health benefits consume more healthcare services than is necessary. Presumably at least some of those excess services that can be redirected to the uninsured population. Putting patients in control their health spending will encourage competition among providers and insurers, reduce costs and improve the quality and portability of coverage.

Sen. McCain has proposed several policy initiatives to lower healthcare costs. These include: (1) greater competition in the pharmaceutical market; (2) improved systems for chronic disease prevention and management; (3) coordinated care among providers to render better outcomes at lower cost; (4) improved access through walk-in clinics in retail outlets; (5) use of information technology; (6) reforming the Medicaid and Medicare payment systems to pay for diagnosis and prevention but not treatment made necessary by preventable medical errors or mismanagement; (7) anti-smoking programs; (8) state spending flexibility; (9) tort reform to reduce frivolous lawsuits; and (10) improved transparency with better public information on treatment options, doctor records, outcomes, quality of care, costs and prices.

The Impact of Sen. McCain’s Plan on Medical Travel

The impact of Sen. McCain’s healthcare plan is to de-emphasize the employer-based health insurance system that currently covers 158 million Americans. Sen. McCain’s plan will likely encourage Americans to avoid taxation of health benefits and use their new tax credit to purchase health insurance on the open market. Young healthy people would likely be the first to switch from their employer plans and find cheaper alternatives in the open market.

Conversely, sicker older workers may initially choose to stay with the security of their employer-based plans. As the risk pool of employer-based plans becomes older, sicker and more expensive to insure, more employers will stop providing health benefits. Eventually, all workers will likely move to individual health plans.

Due to its focus on competition and free market solutions, Sen. McCain’s plan may encourage the medical travel market. Thus far, medical travel has been a completely consumer-driven phenomenon. By placing patients in control of their healthcare spending, and eliminating the tax incentive for workers to rely on their employers for coverage, patients will be encouraged to pursue treatment alternatives that maximize their healthcare dollars.

Let’s use the average American family as an example. The average employer-sponsored family health plan currently costs about $12,000 in annual premiums. On average, employers contribute $9,000 and workers contribute $3,000 to pay the premiums. Under McCain’s plan, workers will be taxed on the employer’s $9,000 contribution as income (as if the employer paid the $9,000 to the employee as wages), thereby eliminating the tax incentive for an employer-sponsored plan. Instead, the family gets a $5,000 annual tax credit.

A typical high-deductible, low-premium family plan on the open market costs about $10,000 annually ($2,000 less than the average employer-sponsored plan). Workers may use the $9,000 that their employer would have used to purchase coverage, (about $6,000 after taxes) and the $5,000 tax credit ($11,000 total) to pay for health coverage. Money left over after buying health insurance can be put in a Health Savings Account.

Insurers are finding that high-deductible, low-premium plans incorporating foreign providers can be offered to previously uninsured markets. These cheaper plans attract cost-conscious patients or patients with cultural ties to featured providers in Latin America and Asia.

Informed healthcare consumers will demand choice, transparency, high quality and reasonable prices from their providers and insurers. Consumers who receive more complete information and better prices from foreign providers may be persuaded to go abroad for treatment. McCain’s plan encourages consumer-driven market responses.

Obama’s Healthcare Plan

The central tenant of Sen. Obama’s healthcare plan is that everyone should have quality, affordable and portable coverage. His plan reflects the philosophy that government should guarantee affordable healthcare to all Americans. While Sen. Obama would mandate that every child be covered, he would seek to cover adults through a combination of employer and government programs.

Sen. Obama’s healthcare plan encompasses two revolutionary initiatives. First, Sen. Obama would require all employers to “pay or play.” All employers, except small businesses, must either provide quality health plans to employees or contribute (a new tax) to the cost of a public plan available to all Americans. The public plan would be similar to Medicare and provide coverage similar to that given to federal employees.

Sen. Obama’s second revolutionary idea is to create a National Health Insurance Exchange (“NHIE”) where insurers would sell coverage to small businesses and individuals. To participate, insurers would have to disclose costs and benefits of various plans and the percentage of premiums that go to patient care as opposed to administrative costs. The goal is to create a transparent market for health insurance that will improve quality, efficiency and value.

Notably, small businesses are exempt from Sen. Obama’s “pay or play” plan. Instead, small businesses receive a refundable tax credit of up to 50% on paid employee benefit premiums. The Small Business Health Tax Credit is meant to incentivize small businesses to offer quality health plans without hampering their ability to compete in the global marketplace.

Sen. Obama also proposes that hospitals and providers be required to publicly report data on preventable medical errors, nurse staffing ratios, hospital acquired infections and disparities in care. Transparency is required of both insurers and providers and is meant to help patients make better choices. Finally, Sen. Obama’s healthcare plan would allow Americans to purchase medicine from other developed countries offering safe products at lower prices.

The Impact of Sen. Obama’s Plan on Medical Travel

The immediate impact of Sen. Obama’s plan would be to bring millions of uninsured Americans into government sponsored managed care. Sen. Obama’s plan may also encourage employers to avoid the financial risks of raising healthcare costs and opt to pay into the public plan instead. Workers may get better benefits under the government’s plan than their employers can afford. If healthcare costs continue to climb unchecked, under Sen. Obama’s plan, employer plans may disappear.

Under Sen. Obama’s plan health insurers will need to look for ways to reduce the cost of covering previously the previously uninsured. Medical travel offers quality treatment at a fraction of the cost of similar care in the U.S without sacrificing quality. Some may argue that sending a patient abroad for care is itself a reduction in quality. However, foreign providers can demonstrate international accreditation and credentials that rebut such criticism.

Sen. Obama’s 50% tax credit for small businesses may encourage medical travel. Often small businesses operate in local, often demographically homogenous, communities. People with cultural ties to provider destinations may be more likely to travel for care. Small business and insurers can team up to offer customized plans that enhance care while reducing the cost.

In his calls for transparency, Sen. Obama’s plan echoes the philosophy of medical travel. Patients who travel for care demand information about surgeon success rates, infection rates, and nurse to patient ratios. The information empowers patients to make informed decisions. American providers often resist collecting this information to avoid it being used against them in a malpractice lawsuit. Sen. Obama’s transparency initiative encourages consumer-driven demands for more and better information.

Notably, Sen. Obama calls for all health plans to resemble the coverage offered to federal employees. The directive may limit the flexibility insurers need to introduce innovative cost cutting solutions like medical travel. If the government decided that traveling abroad for treatment reduced quality, insurers would have to eliminate medical travel from plans. Further, Sen. Obama has spoken out repeatedly against outsourcing. Medical Travel is the newest form of outsourcing. Given the reluctance of American doctors to embrace this trend in healthcare, it is unlikely that Sen. Obama would openly support medical travel.