Lean Transformation in Healthcare

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Excellence in Healthcare Delivery

Robotics Process Excellence in Healthcare

We have combined Lean Management, Process Re-engineering and Robotics Process Automation (RPA) into a powerful approach to eliminate waste, improve productivity, and reduce the cost of doing business.    Robotics Process Excellence (RPEx) services help organizations:

  • Ensure process performance exceeds business goals.
  • Measurably increase productivity by more than 25%.
  • Enhance the quality of customer care and ease of doing business.
  • Streamline processes and measurably reduce the cost of operating.
  • Eliminate slow, tedious, time consuming, wasteful tasks with Robotic Process Automation (RPA).

Lean management is a proven method for eliminating waste and the cost that comes with it.  RPA  is an inexpensive software-based technology. It sits on top of other applications, requires no special hardware, and works well in almost any IT environment.  That’s not all,  you also get highest level of enterprise grade security.

 


Our Approach

Through a simple seven step process, TPMG delivers a low-cost solution for process improvement along with a simple and inexpensive software-based technology. It sits on top of other applications, requires no special hardware, and works well in almost any IT environment.

RPA COE Process 4.0

 


Cafeteria of Process Excellence Consulting  Services

We view our process excellence services as the backbone of our business improvement practice.   Our consultants provide first hand knowledge of best practices and a deep understanding of high performance organizations.   We deliver top-quality  services that guarantee your organization become more productive, cost effective and customer driven.  Those services include:

  • Lean Management
  • Activity Based Costing
  • Non-Value Added Analysis
  • Business Process Re-engineering
  • Operational Assessment and Redesign
  • Value Stream Mapping and Improvement
  • Rapid Improvement Events (Kaizen)
  • Business Transformation
  • KPI’s and Metrics
  • Robotic Process Automation (RPA)

 

Project Description:  What is your process improvement?

 

Robotics Process Automation – Demo

Robotic Process Automation (RPA) is an affordable solution for organizations to streamline their operations and maximize efficiency. Robots used in RPA interact with applications to perform many mundane tasks such as re-keying data, logging into applications, moving files and folders, copying and pasting and much more. RPA is particularly suitable for processes with high human error rates. It’s an inexpensive software-based technology that sits on top of other applications. It requires no special hardware, and works well in almost any IT environment. That’s not all, you also get highest level of enterprise grade security.


Improving Productivity with RPA

We have combined  Lean Management, Process Re-engineering and Robotics Process Automation (RPA) into a powerful approach that eliminates waste, improves productivity, and reduces the cost of doing business.    Our Operational Excellence (OpEx) services help organizations:

  • Ensure process performance exceeds business goals.
  • Measurably increases productivity by more than 25%.
  • Streamline processes and measurably reduce the cost of operating.
  • Automate slow, tedious, time consuming, manual tasks.

 

 


Demo – Revenue Assurance

This demo explores how robotics process automation and artificial intelligence are continually redefining the future of work. One minute of work from RPA translates to 15 minutes of human activity. RPA also provides stakeholders with additional flexibility, enabling them to focus on more demanding and value added tasks.

 


Demo – Customer Account Details

Robotics Process  Automation is an affordable solution for organizations to tackle repetitive, low – value added work.  Robots used in RPA interact with applications mimicking human actions and can perform many mundane tasks such as re-keying data, logging into applications, moving files and folders, copying and pasting and much more.  RPA has been adopted in industries with intense, manual, and administrative processes, such as financial services, insurance and health care.   (The information in this demo has been blurred to preserve confidentiality)

 


 

Project Description:  What is your process automation project?

Robotics Process Automation

Robotic Process Automation (RPA)

Robotic Process Automation (RPA) is an affordable solution for organizations to streamline their operations and maximize efficiency.  Robots used in RPA interact with applications to perform many mundane tasks such as re-keying data, logging into applications, moving files and folders, copying and pasting and much more.

  • In banking, simple processes like deposits and transfers are perfect for RPA.
  • In insurance, filing and processing claims, underwriting and countless other tasks.
  • The administrative side of healthcare can measurably reduce cost by more than 35%.

RPA is particularly suitable for processes with high human error rates by helping to avoid rework and other error implications like reputational or regulatory risks.   We can help you explore the opportunities!

 


RPA Delivery Framework

Through a simple seven step process, TPMG delivers a low-cost solution for process improvement along with a simple and inexpensive software-based technology. It sits on top of other applications, requires no special hardware, and works well in almost any IT environment.

RPA COE Process 4.0


Robotics Process Automation Center of Excellence

The TPMG RPA Center of Excellence (CoE) functions as a Global Shared Service Center  flexible enough to fit with your firm’s business model.  Your company can rely on it to perform functions such as:

  • assessing and prioritizing processes to be automated
  • developing RPA bots and putting them into production
  • developing and implementing change management programs
  • performing the required process re-engineering before the selected process is automated
  • making sure the robots run without any issues
  • performing security and compliance (e.g. audit trails)
  • That’s not all,  you also get highest level of enterprise grade security

Given your needs, our CoE can centralize an RPA team in one location and deploy efforts remotely.  Our team can also perform in a managed services framework and deploy RPA developers across global functions and/or geographies.  Either way, we are structured to maintain constant interaction with your business in order to understand and respond to your needs.

[View Robotics Process Automation Demo]

What is your process automation project?

Contact us today to schedule a cost benefit analysis.  We can help you explore the opportunities!

TPMG RPA Center of Excellence (CoE)

 

 

The Process Guy

Stream Lining Processes

I am the Process Guy.  For more than 15 years, I have used best practices like lean, six sigma, and process re-engineering to streamline processes.  To date, I have saved regional, national and global companies more than an estimated $100 million dollars.  The range of industries I have consulted in include financial services, healthcare, technology, supply chain, energy & utilities and telecom.

Cost Savings

In a recent consulting engagement, I used a combination of organizational re-design, process re-engineering and six sigma to generate an FTE savings of 57%.  This happened not only through the use of traditional streamlining methods, but also through the use of a new technology made available to the process man – Robotics Process Automation (RPA).  Robots used in RPA interact with applications to perform many mundane tasks such as re-keying data, logging into applications, moving files and folders, copying and pasting and much more.  It is a simple and inexpensive software-based technology that sits on top of other applications.  It requires no special hardware and works well in almost any IT environment.  That’s not all,  you also get highest level of enterprise grade security.

The Pitch

This may sound like an advertisement, and to an extent, this is true.  But this is more than an advertisement, this is a continual posting for those companies who seek a consultant who guarantees measurable improvements.

I have combined Lean Management, Process Re-engineering and Robotics Process Automation (RPA) into a powerful approach to eliminate waste, improve productivity, and reduce the cost of doing business.    The services I provide are guaranteed to ensure:

  • Measurable improvements in productivity by more than 25%.
  • Streamlined processes and measurable cost reductions of more than 27%.
  • A significant reduction and elimination of slow, tedious, time consuming, and wasteful tasks.

If you are a Chief Financial Officer, VP of Operations, General Manager or merely a responsible leader who wants to improve your company’s return on capital invested – contact me today!

Like I said, my services are guaranteed.  Ask me about that!

You can reach me at:  The Process Guy Email

I look forward to hearing from you!

Six Modest Proposals for Health Care Measurement

 

1. The Streetlight Effect and Measuring What Matters

It was dark and a man lost his keys. He searches for them under a streetlight, and a friend comes over to help. Eventually, the friend asks, “Are you sure you lost your keys here?” The man says, “No. I lost them in the park.” So the friend asks, “Why are we looking here?” The man answers, “Because this is where the light is.”

This story describes a form of observational bias called the streetlight effect, in which we look for things where it’s easy, not where it’s important.

“I would argue that we do this all the time in health care measurement,” says Ari Robicsek, Chief Medical Analytics Officer for Providence St. Joseph Health.

Every hospital measures length of stay, for example, and many use this measure as a surrogate catch-all for quality and efficiency. “But let me ask, who really cares about length of stay?” says Robicsek. “Is it patients? Is that the first metric that comes to mind when a patient is thinking about hospital quality? Is it doctors? Probably not. Is it administrators? Even from an administrative point of view, you’re not going to realize the financial benefit of reduced length of stay, unless at the same time you reduce labor, or you find ways to fill those empty beds with paying customers, which is a much more complex measure than simply looking at length of stay.”

Length of stay may not be a great measure, but if we have to start somewhere with health care measurement, what’s the harm in tracking it? “If we assign resources to working on the wrong problem, those resources aren’t working on the right problem,” warns Robicsek.

Additionally, with length of stay specifically, a big push to get patients out the door risks sending them home before they’re ready — and when that happens, those patients may end up with complications and get readmitted. “We see one streetlight metric, length of stay, giving birth to another streetlight metric, 30-day readmissions, and so on,” he says.

“My modest proposal: We should measure the things that matter,” says Robicsek. “Yes, sometimes that’s going to mean that we need to collect data differently than the way we do today, or, said another way, sometimes we’re going to have to put up some lights in the park.”

2. Balancing Risk Adjustment

Map Showing Distribution of Glycemic Control in Diabetic Patients on Chicago North Shore

Map showing distribution of glycemic control in diabetic patients on Chicago’s North Shore. Click To Enlarge.

Robicsek shares a map showing distribution of glycemic control in diabetic patients on Chicago’s North Shore, where green is good and red is bad. The map overlays closely with an income map.

If we set up a bonus program for primary care doctors where they receive more money if their patients have better glycemic control, it’s easy to guess where most physicians will want to practice. This is why we need risk adjustment.

“Absent good risk adjustment, physicians working in disadvantage geographies are going to have the worst-looking outcomes,” Robicsek explains. “They’re going to get paid less. The poor get poorer, etc. Absent good risk adjustment, physicians are going to have an incentive to cherry-pick, that is, focus on the patients who are going to make them look good.”

“But with good risk adjustment, we have the opportunity to identify those providers who are outperforming expectations, who are doing a great job with the difficult-to-manage patients, and we can learn from them.”

There are disadvantages to risk adjustment, however, when done poorly. The most common problem is doing little more than creating the illusion that risk adjustment has occurred. “A lot of the risk adjustment models in use are lousy, including some of the ones used by CMS (Centers for Medicare and Medicaid Services),” Robicsek says. “I would argue that those do very little other than creating the patina of fairness, and I would argue when that happens, we’ve probably done more harm than good with risk adjustment.”

Another concern is that sometimes risk adjustment can justify outcome disparities that are amenable to management. A blood-pressure management metric risk-adjusted on race, for example, could remove the incentive for physicians to determine how to manage blood pressure in African-American patients, perversely promoting or entrenching existing inequalities.

“My proposal here: For every new measure that we build, we need to have a conversation about what amount of risk adjustment is enough,” says Robicsek.

3. Measuring to Learn

How much is enough? When we can learn from the measure, he explains. “So much of the health care measurement that we do is for the purpose of rank-ordering or some form of reward or punishment. I would argue that most of the measurement that we do should be taking into account the fact that, as humans, we’re curious and we’re altruistic — most of it should be to learn.”

Providence St. Joseph Health Total Knee Replacement Direct Variable Cost per Case - Ratio of Cost Doctor to System

Providence St. Joseph Health total knee replacement direct variable cost per case and ratio of cost, doctor to system. Click To Enlarge.

In a graph of total knee replacement at Providence St. Joseph Health, each circle represents one high-volume orthopedic surgeon. Each of these surgeons performs high volumes of elective primary unilateral total knee replacement, and they all have great outcomes. But the difference between them is cost.

Every circle above the line represents a surgeon whose cost per case is high. Every circle below represents a surgeon who cost per case is low relative to their colleagues.

Are the doctors low on implant costs consistently low across other elements of care? Not necessarily. “In medicine, variation is the state of nature,” says Robicsek. “There are almost no clinicians who are consistently high cost, or consistently low cost across these elements of care. My takeaway from this is that we all have an opportunity to learn from each other.”

“My modest proposal: Most of the health care measurement that we do should not be for reward or punishment. It should be to learn.”

4. Whose Patient Is It?

Providence recently evaluated OPPE (Ongoing Professional Practice Evaluation), which the health system uses, and found that it was assigning 40% of hospital patients to the wrong doctor. “Who can blame them?” Robicsek asks. “It’s easy in a hospitalization for a patient to have three different, or five different, attendings of record. How do you know who to assign that patient to?”

“In a world where we’re measuring for reward and punishment, we feel obligated to assign one outcome or one hospitalization to a single clinician, but imagine if we were able to move away from that and we were measuring to learn,” he says. “Then we would have the ability to do things like ignore who the provider was and ask ourselves what specific elements of care, what specific combinations of behaviors, lead to the best outcomes.”

“Or we could recognize that medicine is a team sport,” he adds. “Let’s ask the question, can we tie outcomes to teams rather than to individuals? My modest proposal here: We practice in teams. Let’s recognize that in the way we measure.”

5. Metrics Aren’t Free

“To anyone who has ever said, ‘Let’s just add one more thing to this dashboard’: Metrics are not free.”

“Every time we build the metric, if it is done correctly, somebody needs to build business specs, technical specs. Someone needs to do data governance, coding. Somebody needs to do validation, automation, documentation, visualization, and then somebody needs to maintain the thing moving forward. Easily that’s a cost of $10,000,” says Robicsek.

6. The “Give a Darn” Test for Health Care Measurement

When measuring what matters, how do we know what that is? Robicsek describes a thought experiment where he sits with a small group of physicians considering a metric. “Imagine I told you that you’re doing better than your colleague on this measure,” he says to them. “Would you feel good about yourself? Imagine I told you you’re doing worse than your colleagues on this measure. Would you feel motivated to change your practice?”

“If the answer to both of those questions is not yes, let’s not build this measure. It’s not worth our time. We’ll go focus on something else.”

Providence St. Joseph Health Give a Darn Test for Health Care Measurement - Reviewing One Measure in a Small Group

  Click To Enlarge.

“Sitting at the front of this room is my partner in crime, Dr. Caleb Stowell, looking like the cat who ate the canary. He’s showing [the surgeons] the results of the process that I’ve described. They’re measuring to learn. He’s identified a measure that passes the ‘give a darn’ test for them, and some of those surgeons are literally leaning in. I work for 51-hospital system, but where this change happens, where you win hearts and minds, is in rooms like this.”

Robicsek’s final proposal: Try the “give a darn” test for health care measurement. And note that in many “give-a-darn” conversations, one metric that comes up as incredibly important to physicians is patient-reported outcomes.

From the NEJM Catalyst event Provider-Driven Data Analytics to Improve Outcomes, held at Cedars-Sinai Medical Center, January 31, 2019.

 

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