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Kanban India 2023 |Gopal Devanahalli | Modern Work Management in Healthcare.pptx
- 1. Modern Work Management in Healthcare in India December 1st, 2023 Gopal Devanahalli
- 2. Public Health Infrastructure is below WHO norms Rajasthan 2849 46778 68548 0.68 Tamil Nadu 2507 99435 72147 1.38 Madhya Pradesh 465 31106 72627 0.43 Uttar Pradesh 4683 66700 199812 0.33 Gujarat 2245 29402 60440 0.49 Karnataka 2842 70474 61095 1.15 India 41245 825234 1210855 0.68 States Total Hospitals - Govt Total Beds Govt Population (000) Govt Hospital Beds per 1000 people WHO Guideline 3.5 Source : Central Bureau of Health Intelligence
- 3. IMR (Infant Mortality Rate) & MMR (Maternal Mortality Rate) disparate across States Male Female Rajasthan 2.4 32 67.2 71.6 67 113 Tamil Nadu 1.4 13 70.1 74.0 24 54 Madhya Pradesh 2.6 43 65.2 68.5 75 173 Uttar Pradesh 2.7 38 65.4 67.6 75 167 Gujarat 2.0 23 68.9 73.1 49 57 Karnataka 1.6 19 68.7 72.1 40 69 India 2.0 28 68.4 71.5 50.9 97 States Life expectancy at Birth Total Fertility Rate Infant Mortality Rate(per 1000 births) Under 5 Mortality per 1000 live births Maternal Mortality Rate(per 100,000 live births) Source : Central Bureau of Health Intelligence
- 4. Government Initiatives • Overall Government Spend in Healthcare was 2,26,000 Crores in FY2020 - around 1.5 % of GDP • Ayushman Bharath • Addressing Primary Health Care – Health & Wellness Centers • PM JAY – 5 lakhs coverage for inpatient for around 100 Million Citizens • Digital Health • Health Registry, Health Exchange, PHR • India led the world in Covid Vaccination
- 5. Shifting Disease Burden • Transition from Communicable to Non-Communicable Diseases (NCDs): • Communicable Diseases Control: Progress in controlling infectious diseases such as malaria, tuberculosis, and certain vaccine-preventable illnesses • Improved healthcare interventions • vaccination programs • public health initiatives. • Rise in Non-Communicable Diseases(NCDs): Cardiovascular diseases, diabetes, cancer, respiratory illnesses, and mental health disorders. • Aging Population: The population of elderly individuals in India is growing. With aging comes an increased susceptibility to chronic health conditions, contributing to the rise in NCDs. • Urbanization and Lifestyle Changes: Urban areas witness lifestyle shifts characterized by unhealthy diets, reduced physical activity, stress, pollution exposure, and other risk factors associated with NCDs. • Increasing Focus on Preventive care is a must
- 6. The Healthcare Imperatives •Major spend through personal finances (53% Out of Pocket) •Limited health insurance and other risk pooling measures •Additional cost on transport/lodging reaching healthcare destinations •Gaps in infrastructure •Cutting edge medical protocols •Initial and continuous training •Regulations enforcement •Achieving Millennium Development Goals (MDG)
- 7. Healthcare System is Complex Patients, Family Members Healthcare Providers: •Hospitals (Public & Private) •Clinics & Healthcare Centers •Diagnostic Laboratories •Home Healthcare Pharmaceuticals: • Manufacturers • Retailers Healthcare Payers: •Insurance •Government Schemes Healthcare Professionals : • Doctors • Nurses • Paramedics Regulators : • Government • Regulatory Bodies Education : • Medical, Dental, Nursing Colleges • Training Medical Equipment & Consumables • Manufacturer s • Retailers
- 8. Important to improve Healthcare Efficiency Patients Reduce wait times – O/P and I/P Improve outcomes Reduce cost to the patient Providers More patient throughput Better utilization of assets improve profitability Better outcomes will improve reputation Healthcare Professionals Focus on clinical rather than administrative overheads Reduce work overloads Public Health Better Utilization of Funds More Coverage of patients
- 9. Illustrative Examples – Outpatients(O/P) Huge wait times for doctors in many hospital in-spite of appointments Wait times for diagnostic procedures like CT/MRI Wait times at pharmacies; stockouts at pharmacies Wait times for reports leading to poor satisfaction A patient/family member – no unified journey – can be sent from one counter to another leading to longer times, frustration
- 10. Challenges A lot of time goes in first time registration (Fill it before you come to the hospital) Many Doctors are not employees/full-time in hospitals – they have limited slots for seeing patients When you are referred to go to another doctor in a different specialty – you may not get a slot immediately When you are referred to get a scan – already there is a queue No Sharing of health records across the system EMR is not very prevalent – so Doctors still write out the prescriptions • Imagine if the prescription is digitally sent to the pharmacy and by the time you reach the pharmacy – it is ready to be picked up
- 11. Appointment Management for O/P……….. 1/2 Implemented an appointment and queuing management system Got access to the doctor calendars of each department of each hospital in the system Set-up a centralized call center and also introduced online appointment system Introduced reminders for appointments Tracked data on adherence to appointment schedules
- 12. Appointment Management for O/P……….. 2/2 Improved patient satisfaction – wait times reduced Reduced crowding and smoother flow of patient footfalls Patterns on appointments – which departments, which days of week, preferred time-slots etc – new concepts like evening O/P clinics could be launched Data gave visibility on where we had to get additional doctors for O/P Better utilization of O/P consultation rooms
- 13. Illustrative Examples – In Patients(I/P) Waiting for a bed for admission Operation Theater Usage Waiting for Discharge
- 14. Discharge Process ………………….. 1/2 It can take many hours for the patient to get discharged after the Doctor gives the OK More than 1 doctor involved – everybody needs to sign off Any extra drugs & other hospital items needs to be returned to Pharmacy If the patient is under an insurance policy – the complete patient file needs to be sent to the insurer/TPA A lot of duplicate work happens at both ends of the chain – because of health records not being standardized/dig ital The TPA/Insurance company needs to cross check
- 15. Discharge Process ………………….. 2/2 IMPLEMENT A SOFTWARE TOOL TO MONITOR THE DISCHARGE ACTIVITIES SHOWCASE WHERE EACH DISCHARGE IS STUCK HAVE HOURLY MEETINGS TO TAKE STOCK OF ALL DISCHARGES HAVE TEAM MEMBERS TO ADDRESS THE POINTS WHERE THEY ARE STUCK IDENTIFY BIGGEST CHOKE POINTS AND COME UP WITH LONGER TERM SOLUTIONS SIGNIFICANT REDUCTION IN DISCHARGE TIMELINES AND IMPROVING PATIENT SATISFACTION, BED UTILIZATION(NEW ER PATIENTS) ETC
- 16. Modern Work Management Practices is a need of the hour in Healthcare Patient Experience Admissions to Discharge Healthcare Claim Processing Post discharge care Chronic Disease Management Operations Increase utilization of Beds, OR, Labs, OP Consultation rooms Lab Test & Result Proceasing Improve procurement, warehousing especially in Pharmacy Clinical ER Triage Access to Longitudinal Health Records(across providers) Precision Medicine AI assisted diagnostics and care
- 17. Structural Changes India is implementing PHR – Personal Health Records thru ABHA Increasing adoption of EMR Creation of claims exchange to improve data visibility across providers and payers Increase of health insurance Newer digital healthcare players are removing information asymmetry and forcing established players to become efficient Patient advocacy is increasing and there is demand for more efficient and affordable healthcare
- 18. Conclusion • There is a huge opportunity for improving efficiency in Healthcare • Come up with ideas on how Kanban can be used in Healthcare • Look for opportunities to implement them in Public as well as Private healthcare
Editor's Notes
- Overview of challenges: Highlight key challenges faced in the Indian healthcare sector (e.g., accessibility, affordability, resource constraints). Statistics and data: Use impactful visuals to showcase statistics illustrating the existing inefficiencie
- Engaging opening: Share a thought-provoking statistic or a personal anecdote related to healthcare inefficiencies in India. Set the stage: Discuss the importance of efficient healthcare systems for better patient outcomes and overall societal well-being.
- Define objectives: Discuss the specific objectives and goals aimed at enhancing healthcare efficiency. Link objectives to audience interest: Explain how achieving these goals can positively impact both healthcare providers and patients.
- Technology Integration: Explore the role of technology (EHRs, telemedicine, AI, etc.) in streamlining processes and improving healthcare delivery. Process Optimization: Discuss methods for optimizing workflows, reducing wait times, and enhancing resource utilization. Government Initiatives: Highlight key government programs, policies, or reforms aimed at improving healthcare efficiencies.
- Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings. Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
- Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings. Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
- Technology Integration: Explore the role of technology (EHRs, telemedicine, AI, etc.) in streamlining processes and improving healthcare delivery. Process Optimization: Discuss methods for optimizing workflows, reducing wait times, and enhancing resource utilization. Government Initiatives: Highlight key government programs, policies, or reforms aimed at improving healthcare efficiencies.
- Real-life examples: Present case studies showcasing successful implementations of efficiency strategies in Indian healthcare settings. Impact and outcomes: Discuss measurable outcomes, such as improved patient care, cost reduction, or enhanced access.
- Visualizing the Discharge Workflow: Create a Kanban board that represents the stages of the discharge process, starting from the decision to discharge to the actual departure of the patient. Stages might include "Discharge Order Received," "Medication Review," "Preparation for Departure," "Documentation," and "Patient Departure." Work in Progress (WIP) Limits: Establish WIP limits for each stage of the discharge process. For example, limit the number of patients being reviewed for discharge simultaneously or the number of patients in the documentation phase. This prevents congestion and ensures a smooth flow of patients through the process. Patient Cards: Each patient due for discharge is represented by a card on the Kanban board. Information on the card may include the patient's name, room number, discharge status, pending tasks, and any special requirements. Status Updates and Transparency: Hospital staff responsible for different stages of the discharge process update the Kanban board as tasks are completed and patients move through each stage. This allows for real-time visibility into the progress of patient discharge for all involved stakeholders. Coordination and Communication: Kanban promotes collaboration among staff members involved in the discharge process. It facilitates communication regarding patient readiness, pending tasks, and any special considerations that need to be addressed before discharge. Continuous Improvement: Regularly review the discharge process using the Kanban board. Identify bottlenecks or areas causing delays and brainstorm solutions to improve the flow. Encourage feedback from staff involved in the discharge process to implement improvements. Integration with Electronic Health Records (EHR): Integrate the Kanban system with the hospital's electronic health records or information systems. This integration allows for easy access to patient information, reducing manual efforts in updating the board and ensuring accuracy in patient status updates. Metrics and Performance Tracking: Measure key metrics such as discharge times, turnaround times for specific stages, patient satisfaction post-discharge, and any other relevant KPIs. Analyze this data to identify areas for further enhancement. Implementing Kanban in the discharge process can lead to a more organized, efficient, and patient-centered approach. It helps in reducing discharge delays, improving communication among staff members, enhancing patient experience, and ensuring a smoother transition for patients leaving the hospital.
- Addressing barriers: Acknowledge potential challenges and discuss strategies for overcoming them (e.g., funding, infrastructure limitations, resistance to change). Lessons learned: Share insights from challenges faced and how they can be valuable for future initiative
- Empowerment and action: Encourage audience involvement by suggesting actionable steps they can take to contribute to healthcare efficiency improvements. Inspiring conclusion: Summarize key points, leaving the audience with a strong and motivational closing statement.