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PubMedDate not supplied

Saving money, saving lives.

In 1996, Duke Children's Hospital was in serious trouble. Its $11 million annual operating loss had forced administrators to make cutbacks. As a result, some caregivers felt that the quality of care had deteriorated. Parents' complaints were on the rise. Frustrated staff members were quitting. In this article, Jon Meliones, DCH's chief medical director, candidly describes how his debt-ridden hospital transformed itself into a vibrant and profitable one. The problem, he realized, was that each group in DCH was focusing only on its individual mission. Doctors and nurses wanted to restore their patients to health; they didn't want to have to think about costs. Hospital administrators, for their part, were focused only on controlling wildly escalating health care costs. To keep DCH afloat, clinicians and administrators needed to work together. By listening to staff concerns, turning reams of confusing data into useful information, taking a fresh approach to teamwork, and using the balanced scorecard method, Meliones and his colleagues brought DCH back to life. Developing and implementing the balanced scorecard approach wasn't easy: it took a pilot project, a top-down reorganization, development of a customized information system, and systematic work redesign. But their efforts paid off. Customer satisfaction ratings jumped 18%. Improvements to internal business processes reduced the average length of stay 21% while the readmission rate fell from 7% to 3%. The cost per patient dropped nearly $5,000. And DCH recorded profits of $4 million in 2000. This first-person account is required reading for any executive seeking to revitalize a sagging organization. Meliones shares the operating principles DCH followed to become a thriving business.

Clinical Competence↗
PubMedDate not supplied

The lean team.

Explore the source record for details and available documents.

Cooperative Behavior↗
PubMed2000

Lightening the load.

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Hospital Restructuring↗
PubMed2000

The Innovative Ward Project: promoting innovation in health service delivery.

An Innovative Ward Project was undertaken as part of the planning for redevelopment of the Princess Alexandra Hospital. Two inpatient units (one medical and one surgical) became pilot areas for developing, implementing and evaluating innovative approaches to service delivery. The project focused on the key areas related to structural environment, information technology and redesign of work practices. This paper provides an overview which includes the key elements utilised to foster innovation. The challenges of disseminating and adopting successful innovations beyond the Innovative Wards are discussed.

Communication↗
PubMed2001

Wills Eye Hospital and surgical network: successful pre-positioning strategies for payment reduction and managed care pressures.

Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment.

Feedback↗
PubMedDate not supplied

[Process re-engineering in public hospitals: re-inventing of the wheel?].

The purpose of this paper is that of analyzing the hypothesis that, as originally stated by its creators, the reengineering methodology for the improvement of efficiency and productivity, cannot be successfully implemented in Spanish public hospitals, and in fact, the so called experiences do not keep with the basics of such an approach. The technique employed for this study consisted, on one hand, of reviewing and comparing the literature published on this subject and, on the other, on experimentation by means of a case study conducted at a public hospital for the purpose of testing out the outlined hypothesis. The review and comparison of works previously published on this subject revealed that the technique for improving on-the-job efficiency according to the theory-based concepts of the process reengineering approach is not adaptable to public hospitals in Spain. The case study supported this finding, additionally highlighting the fact that in order for any relatively major changes in the working processes at public hospitals to be recommended, a number of organizational and human factors must be taken into consideration as aspects involved regardless of the methodological approach taken. The indiscriminate implementation in public hospital administration of trends currently fashionable in the business administration field may defeat its own purpose if these trends are not previously evaluated prior to being implemented. An assessment must first be made as to their being suited to the intended purpose.

Efficiency, Organizational↗