Increased Demand on Public Hospital and Health Systems in California

It likely comes as no surprise to you because you are delivering the service, but I thought you may like to see the numbers from the California Association of Public Hospital and Health Systems (CAPH) February 2009 Report. The report is based on data from October 2008 compared to October 2007. The report also notes that the number of unemployed and uninsured in California has been growing at an even faster pace in late 2008.

Here are some highlights:

Public hospital systems represent the core of the health care safety net in California. Though just six percent of all hospitals statewide, these 19
Public hospitals:

• Are located in counties where 81% of Californians live
• Provide nearly half of the hospital care to the state’s 6.6 million uninsured
• Operate 54% of all top-level trauma centers
• Operate 43% of all burn units
• Deliver 10 million outpatient visits a year
• Operate more than 100 outpatient clinics
• Train nearly half of all new doctors in California

Adding to the challenge:

• The number of uninsured in public hospital emergency rooms increased by 19%.
• Santa Clara Valley Health System reported a one-third increase in the number of new patients in its emergency room
• Contra Costa Regional Medical Center saw a 12% increase in the number of patients in its ER
• Los Angeles County also saw a 12% increase for its four hospitals’ ERs

You can find the report here.

So what can we do?

Our redesign efforts are being examined and shifting focus to support Lean thinking. We will develop increased capacity in innovative ways. We will work smarter, not harder. Our Lean efforts will help us to capture capacity that already exists in our system but is buried underneath complex layers of process. We believe that not only do many of these processes add no value to the patients experience; they have no value for those of us who work in the system as well.

How will we do that?

You may already be seeing teams forming around the medical center who are planning to 5S their work areas. Here’s what they’re doing.

Seiri (整理) Sorting
Going through all the tools, materials, etc., in the plant and work area and keeping only essential items. Everything else is stored or discarded.

Seiton (整頓) Straighten
A key distinction between 5S and "standardized cleanup" is Seiton. Seiton is often misunderstood, perhaps due to efforts to translate into an English word beginning with "S" (such as "sort" or "straighten"). The key concept here is to order items or activities in a manner to promote work flow. For example, tools should be kept at the point of use, workers should not have to repetitively bend to access materials, flow paths can be altered to improve efficiency, etc.

Seisō (清掃) Sweeping
Systematic cleaning. At the end of each shift, the work area is cleaned up and everything is restored to its place. This makes it easy to know what goes where and have confidence that everything is where it should be. The key point is that maintaining cleanliness should be part of the daily work - not an occasional activity initiated when things get too messy.

Seiketsu (清潔) Standardizing
Standardized work practices or operating in a consistent and standardized fashion. Everyone knows exactly what his or her responsibilities are to keep above 3S's.

Shitsuke (躾) Sustaining
Maintaining and reviewing standards. Once the previous 4S's have been established, they become the new way to operate. Maintain the focus on this new way of operating, and do not allow a gradual decline back to the old ways of operating. However, when an issue arises such as a suggested improvement, a new way of working, a new tool or a new output requirement, then a review of the first 4S's is appropriate.

If you would like to get involved please let me know.

Teams plan to give a report on April 20th as we begin Value Stream Mapping at CCRMC and at the Pittsburg Health Center.

We will report out to the medical center and health centers when all the 5S reports are in.

More soon…