The World’s Cheapest Hospital Has to Get Even Cheaper.

Cancer surgery for $700, a heart bypass for $2,000.

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This is particularly interesting to me as it is managed differently from lean healthcare and still profitable. I’m curious how adding an element of cross training to increase staff flexibility would affect it. For those who think lean is the answer, stay open minded, there may be much to learn here.

Points for my notes:

“A pulmonary thromboendarterectomy. in the U.S., the procedure can cost more than $200,000. Shetty did it for about $10,000 and turned a profit.”

“outcomes for patients meet or exceed international benchmarks. Surgery for head and neck cancers starts at $700.

Endoscopy is $14;

a lung transplant, $7,000.

Even a heart transplant will set a patient back only about $11,000.”

“investment bank Jefferies estimating that it can profitably offer some major surgeries for as little as half what domestic rivals charge.”

“In 10 years, India will become the first country in the world to dissociate health from affluence.
India will prove that the wealth of the nation has nothing to do with the quality of health care its citizens can enjoy.”

“he learned that the cause of their complications was simple:
The patients couldn’t afford the protein their bodies needed to mend.
So he began handing out hard-boiled eggs;”

“upskilling or task-shifting.”

“the average Narayana surgeon performs as many as 6 times more procedures annually than an American counterpart.”

“surgical gowns are procured from a local company for about a third of the cost of international suppliers.
The tubes that carry blood to heart-and-lung machines are sterilized and reused after each surgery; in the West, they’re thrown away.
The machines themselves, along with devices such as CT and MRI scanners, are used well past their warranties, kept running by a team of in-house mechanics.”

“Whereas preparing a U.S. surgical theater for the next patient can take 30 minutes or more, Narayana has gotten the process down to less than 15

“in part by keeping turnaround teams with fresh instruments, drapes, and other supplies on immediate standby, ready to roll the moment a room is available.
Even patients’ families are part of the upskilling model. Narayana trains them to bathe patients and change bandages in the hospital, as they’ll do when they get home.”

"the retail cost of a heart bypass, its most common operation, down to $2,000, about 98% less than the U.S. average."

“mortality rates are comparable to or lower than those in the developed world, at least for some procedures.”

“also outperforms Western systems in results for valve replacements and heart-attack treatment”

“it may become a model not only for competitors in India but also for Western health-care operators, which are trying desperately to contain costs. Nowhere is this more true than the world’s most expensive health-care market, the U.S.”

Full article link: https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper

Barilla Pasta’s Turnaround From Homophobia to National Pride

Reputational corporate turnaround

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“After chairman Guido Barilla rebuked gay families on national radio, his CEO spent five years cleaning up the company’s reputation.”

my notes:

“Because the bigger preoccupation for consumer brands tends to be cachet—an abstraction valued in the tens of billions of dollars on their balance sheets as “intangible assets”—
irrelevance can have worse financial consequences than brief buffers in a company’s revenue streams.”

“Colzani said that during his six years at the helm, he’s never had a conversation with the Barillas about boosting profit. Instead, discussions have revolved around environmental efforts, such as hiking the company’s costs by about €40 million ($45 million) a year to rid its supply chain of palm oil, which it did in 2017.

“Barilla is also working with the farmers who supply the durum wheat for its pasta to end their use of glyphosate-based herbicides, which the World Health Organization classifies as probably carcinogenic to humans.”

“We were simply trying to be a good citizen. Now, we’re trying to be a role model.”

“I got a lot of grief from the LGBT community when I agreed to help him out,” Mixner said. “But I told them that the purpose of a movement is to change minds.”

Full article link:

https://www.bloomberg.com/news/features/2019-05-07/barilla-pasta-s-turnaround-from-homophobia-to-national-pride

Covid19 Cases Jump in Calgary - July 20 update

Calgary zone covid19 cases Jul 20.jpg

Last weekend confirmed cases increased 104, +35/day average

This weekend confirmed cases increased 311, +103/day average, 199% higher than last weekend.

(For some reason AHS has stopped reporting weekend #’s also, so they’re averaged over the weekend)

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Active cases started climbing again July 10 when they had been steady around 228;

on Friday they were 385 and today (Monday) 553.

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AHS reported #’s show new cases have jumped in Calgary zone from 75 during the week July 7-10 to 166 new cases during last week, a 121% increase.


Adopting Toyota Philosophy Saves Healthcare Business

My summary notes, link to article below

2001 startup Nurse Next Door (NND)

  • patient care demands zero tolerance for cracks "If you're a manufacturer and you mess up, you could lose money or even go out of business; but we take care of people's lives. We could seriously hurt someone if we mess up, so something has to change."

  • Most organizations tend to create practices and processes that increase over time in complexity, but have less and less importance to the customers.

  • NND identified these processes through a customer survey that asked two questions:

  1. On a scale of one to 10, how would you rate our services?

  2. What is your biggest reason for giving us this score?

  • feedback helped NND recognize

  • many of its practices were a waste of effort "We used to think customers wanted our caregivers to show up in uniform" The company provided home-care staff with a uniform allowance, paid for cleaning the uniforms, and was about to draft policies governing the wearing of uniforms, as well as an enforcement protocol. "Then we found out our customers didn't care"

  • A bigger concern proved to be that the company's invoices were too confusing - a 45-minute fix that improved its customer satisfaction score by 20%.

http://www.vancouversun.com/life/adopting+toyota+philosophy+saves+healthcare+business/5633334/story.html

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Corporate Strategy execution example

Pivoting Just-In-Time with Hoshin Kanri at Toyota

by Mark Reich

5/26/2020

a management system that allows the organization to quickly and effectively adjust its priorities while engaging the team

article here:

https://www.lean.org/common/display/?o=5248&utm_campaign=Hoshin%20Online&utm_content=130204140&utm_medium=social&utm_source=linkedin&hss_channel=lcp-91948

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Dairy Farmer Decides to Bottle His Own Milk Rather than Dump It. Sells Out in Hours.

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Great story, hoping more farmers & producers can do the same:

“a 300-year-old, cream-line dairy farm, where a farmer is working around the clock to bottle his own milk after his processor told him to dump it. Locals are lining up to support him.

full story here:

https://returntonow.net/2020/05/04/pennsylvania-dairy-farmer-decides-to-bottle-his-own-milk-rather-than-dump-it-sells-out-in-hours

When Is The Best Time To Implement Profit Sharing?

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Great article by CFO Orry Fiume who administered Wiremold’s plan for his entire tenure learning the following 10 elements of a successful profit-sharing plan.

He found that any plans violating these principles run the risk of them becoming entitlement programs at best, or at the worst, de-motivators that generate the opposite effects that they are designed for.

Read here: https://www.lean.org/LeanPost/Posting.cfm?LeanPostId=1165

Calgary zone covid19 cases

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Data based on Alberta daily reports containing Calgary new & total for that day. 

Where new is not reported, the previous days total is subtracted. 

Results averaged for Apr 15-17 due to fire.

Please send additional links to confirmed numbers for previous dates, particularly missing dates for new cases March 19, April 4 & 11 in comments or tweet @ryancartiers.

Learning fast in the crisis

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- Buying a company is never an easy step just 1 month ahead of a pandemic and lockdown. Results from a CEO spending time in the business instead of the office.
.
to learn about problems, find and face.

Organizational changes can be tempting when a new owner steps in, but they seldom help.
.


Lean thinking rather teaches us to focus on the flow of products and services to customers and observe what hinders the work of those operating along that flow.
.
They managed to reduce the lead-time for stainless steel trolleys 66% from 6 weeks to 2 weeks.

With overall volume of sales decreasing, the lockdown seems to be the perfect opportunity to revamp the workshop and learn how to better organize it.

read full article:

https://planet-lean.com/lean-learning-covid19