INCREASING SUSTAINABLE HOSPITAL PROFITABILITY -CASE …ahfonline.net/.../Increasing_Sustainable_Hospital_Profitability.pdf · INCREASING SUSTAINABLE HOSPITAL PROFITABILITY -CASE STUDY

INCREASING SUSTAINABLE HOSPITAL

PROFITABILITY -CASE STUDY

لة عمليةاح-زيادة ربحية المستشفيات بشكل مستدام

Adel Olleik

Medhealth Cairo 2017

March 1, 1:pm

www.gates-group.com +961 1 450270

Outline

A. Problem Identification

B. Choosing an effective methodology

C. SEAM Positioning

D. Research Hypothesis

E. Field Work Results & Impact

F. Conclusion

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Gates Research 2015 2

A- PROBLEM IDENTIFICATION



Problem Identification

1. Evolving Healthcare Systems with growing competition and challenges to meet more patient expectations and sustain profits.

2. Focus on cost control rather on smart Revenue Cycles (RC)

3. Poor management practices are masking inefficiencies and not sufficiently utilizing actors potential.

4. Sustainability! The day after accreditation! Quality Improvement Initiatives and Outcomes fade.



HCO Standards Compliance Virus: SCV

Visible Performance

Sustainable performance

Organizational Development

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6

1st SEAM Conference in Lebanon-University of Balamand

November 2014

CompaniesUS Dollars, per person and

per year% of the

payroll

-supermarket 19, 000 $ 84 %

-Notaries / lawyers 25, 500 $ 40 %

-Hospital 24, 000 $ 51 %

- Social security

organism

-Bank

22,500 $

24, 500 $

45 %

45 %

-metal working industry

- Glass industry

28, 000 $

54,500 $

80 %

150 %

-Electronics industry 70, 000 $ 220 %

The very high level of hidden costs

Some cases from the database of 1 350 organizations

7


November 2014

Visible

costs

2010 2011 2012 2013

Integral

costs

Hidden

costs

Classical policy to cut

down visible costs

Preferable policy : to convert

hidden costs into value added

Hidden

costs

Hidden

costsHidden

costs

Hidden

costs

Hidden

costs

Hidden

costs Hidden

costs

Visible

costsVisible

costs

Visible

costs

Visible

costs Visible

costs

Visible

costs Visible

costs

2010 2011 2012 2013

B. CHOOSING AN EFFECTIVE METHODOLOGY



Traditional consulting firms Focus on financial performance

Work with top management

Focus on audit

Don’t take into consideration the learning process of actors

Don’t take into consideration post implementation evaluation process

Don’t give a global solution

Don’t take into consideration social factors

Potential solutions: cutting costs and downsizing

9Patrick TABCHOURY-2014

1. All resources are Dead

except People, Bio

organizations Vs TWF

Virus

2. People have untapped

Potentials and could be

motivated

3. Change People from

Actors into Believers

and beneficiaries from

OD ,buy them in…

1. الناس هم المورد الحي

2. الناس لديها قدرات كامنة وقابلين

للتحفيز

3. تحويل الناس من ممثلين الى

مؤمنين بالرسالة ومستفيدين

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Research 2015

4. Facilitate people’s

ownership diagnosis,

planning ,

implementation and

improvement processes

5. No recipes for

customization

6. Financial Sustainability

is via Organizations’

Metamorphosis

4. للتغييروتيملكهم مشاركة الناس

5. االفكار الجيدة -ال وصفات حلول

اوالهي بذهن العاملين

6. هي عبر التحول ةاالستدامة المالي

الداخلي في المنظمات

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Research 2015

C. SOCIO ECONOMIC APPROACH TO

MANAGEMENT- SEAM



SOCIO-ECONOMIC PERFORMANCE

ECONOMIC PERFORMANCE

SOCIAL PERFORMANCE

- Working conditions

- Work organization

- Communication-

Coordination-Cooperation

- Time-management

- In-house training

- Strategic implementation

IMMEDIATE

RESULTSCREATION OF

POTENTIAL

© ISEOR 1997

13

14


November 2014

Socio-economic approach

= innovative management

Social performance*Economic

performanceand

deeply embedded

*SOCIAL = HUMAN AND SOCIAL

Integrating

15


November 2014

Individual

Organizational

Macroeconomic

Organizational behavior,

industrial psychology

Strategists

and

economists

Purpose : To link three performance levels

16


November 2014

ISEOR

SOCIO-ECONOMIC INSTITUTE

OF ENTERPRISES AND

ORGANIZATIONS

Non-profit organization

CREATED IN 1975

sponsor

UNIVERSITY

JEAN MOULIN LYON 3

1 POLE for 125 researchers

have carried out

1 700 000 hours of research

151 DOCTORAL theses in

MANAGEMENT SCIENCES of

which 126 have been defended

1/2 of the time inside

enterprises

90 000 pages de

publications

17


November 2014

Working conditions 578

Work organization 703

Communication-Coordination-

Cooperation 647

Time management 384

Integrated training 254

Strategic implementation 968

3534

Qualitative modelization of

dysfunction treatment

(expert system softwareSEAMES 1987-2014)

Knowledgebase

1 350 enterprises

37 countries

Number of generic dysfunctions 1-WORKING CONDITIONS 578 309 – Information transmission 132

101 - Layout and arrangement of the

premises 120 310 – Vertical 3C 108

102 - Equipment and supplies 235 311 – Horizontal 3C 93

103 - Nuisance 58 4-TIME MANAGEMENT 384

104 - Physical conditions of work 23 401 - Respecting deadlines 64

105 - Physical workload 6 402 - Planning, scheduling of activities 97

106 - Work hours 52 403 - Poorly-assumed tasks 180

107 - Atmosphere at work 84 404 - Factors disturbing time management

43

2-WORK ORGANIZATION 703 5-INTEGRATED TRAINING 254

201 - Distribution of tasks, missions

and functions 246

501 - Adequacy of training-job 52

202 - Regulation of absenteeism 27 502 - Training needs 48

203 - Interest of the work 15 503 - Available competency 45

204 - Autonomy on the job 80 504 - Training frameworks 99

205 - Workload 75 505 - Training and technical change

10

206 - Rules and regulations 187 6-STRATEGIC

IMPLEMENTATION 968

207 - Organization chat 73 601 Strategic orientation 105

3-COMMUNICATION-

COORDINATION-

COOPERATION

647

602 Authors of the strategy 38

301 - 3C internal to the service

306

307 308 Transmission of information

309 Vertical3C

310 Horizontal 3C

34

603 Breaking down and organizing

strategic implementation

205

302 - Relationship to neighboring services

93 604 Tools for strategic implementation

87

303 - 3C between the network and the

home office 41

605 Information systems 83

305 - 3C between the home office and branch offices 13

606 Means for strategic implementation 52

306 - 3C at the board of directors level 24 607 Personnel management

312

307 - 3C between elected authorities

and public servants 11

608 Mode of management 86

308 - 3C frameworks 98 TOTAL 3534

18


November 2014

Socio-economic diagnosis

of organizations

BEHAVIORS

- individual- trade groups

- personnel categories- pressure groups

- collective

STRUCTURES

- physical- technological- organizational- demographic

- mental

- absenteeism

- occupational injuries-personnel turnover- quality of products-direct productivity

HIDDEN COSTS

DYSFUNCTIONS

- working conditions- work organization

- communication-coordination-cooperation- time management- integrated training

- strategic implementation

ECONOMIC

PERFORMANCE

19


November 2014

Reduction of

DYSFUNCTIONS

Reduction of

HIDDEN COSTS

Imp

rove

me

nt o

f

ST

RU

CT

UR

ES Im

pro

ve

me

nt o

f

BE

HA

VIO

RS

-

(Strategic energy +

human potential)

development

higher ECONOMIC

PERFORMANCE

atrophied

ECONOMIC PERFORMANCE

Strategic strengths

and weaknesses

HIDDEN COSTS

hypertrophic

DYSFUNCTIONS

hypertrophic

BE

HA

VIO

RS

atro

ph

ied

ST

RU

CT

UR

ES

atr

op

hie

d

20


November 2014

Management

Tools

The trihedron

Cyclical process of problem solving

PE

RIO

DIC

AL

LY

N

EG

OT

IAB

LE

AC

TIV

ITY

C

ON

TR

AC

T

CO

MP

ET

EN

CY

GR

ID

IES

AP

(1)

PR

IOR

ITY

AC

TIO

N P

LA

N

PIL

OT

ING

LO

GB

OO

K

TIM

E M

AN

AG

EM

EN

T

TECHNOLOGICAL

CHANGES

ORGANIZATIONAL & PROCEDURAL CHANGES

STRATEGIC CHOICES:

PRODUCT-MARKET

CHOICE OF MANAGEMENT

SYSTEM

EVALUATION

IMPLEMENTATION

PROJECT

DIAGNOSIS

Policy-decision making (1) IESAP : Internal external strategic action plan

Steps مراحل مشروع التحسين

1. DIAGNOSIS التشخيص

2. PROJECT الخطة والمشروع

3. IMPLEMENTATION التنفيذ

4. EVALUATION تقييم النتائج



22


November 2014

Priority Action Plan(PAP)

خطة العمل

Time

Management

إدارة الوقت

Competency

Grid

جدول الكفايات

Piloting Logbook

مؤشرات التوجيه

Internal-External

Strategic Action Plan

(IESAP)

الخطة االستراتيجية

Periodically Negotiable

Activity Contract

أهداف األفراد

Tools األدوات

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Research 201523

1- Time Management Self Assessment Sheet

24

Discrepancies between time

Management and strategy

First type Second type Third type

Overly ambitious

strategyTimid strategy

poor quality of

strategic

implementation

BAB AA B

A: Time required to carry out all activities الوقت المطلوب

B: Time available الوقت المتوفر

Time appropriately applied

التوزيع الجيد للوقت

Poorly executed

strategic actions

Poorly utilized

time resources

Time resources are generally

appropriate HOWEVER they are

poorly adjusted, poorly

scheduled, poorly utilized


Research 201525


Research 201526

2- Competency

Grid

27

Find Training to match the Job

JT

TrainingJob Requirements

M

Table of skills in the accounting department of a metal casting company

© ISEOR 198528

29

Final purpose of the Competency

Grid

Single out

training need

Improve work

organization

Improve

personnel

management

Draw up the

training planRestructure a

unit

Define new

personnel

management

methods

- Reduce the

vulnerability

- Improve

versatility

- Control absenteeism

- Spread the workload

- Share out rewarding

tasks

- Assign jobs (Transfer,

promotion,

recrutement)

- Improve rewards

30

3- Internal External Priority Action Plan IESAP

External خارجيا

• Product المنتج

• Market السوق

Internal داخليا

(Managing Resources:

Dysfunctions Minimization)

• Technologies لتكنولوجياا

• Human Potentials Management

إدارة القدرات البشرية

31

32

4- Priority Action Plan PAP

PAP: electrical goodsmanufacturer

Divisions or deptsor services involved(active participants)

X

X

X

O

X

ZY

Provisional planningchart

Translation of strategic objectivesinto priority actions

STIMULATION PRINCIPLE

JJMAM NOA DFJ S

O

O

O

X

O :activeparticipant

X : contributor

- Regular cleaningof work stations- Installation ofsigns

- Creation of astaff trainingprogramme(demonstration)

- Implementationof monthlyinformationmeetings(in teams)and discussionsabout safety(implementationand results)

Priorityaction

Observations

Safetyimprovements

Developing stafftraining and communication -coordination -conciliation onsafety

Priorityobjective

Improvementsin safetyand workingconditions

Strategicaxis

Distributionof area

DECENTRAL-IZATION

PRINCIPLE

Distribution of time

SYNCHRONIZATIONPRINCIPLE

Sensitivepoints

VIGILANCEPRINCIPLE

© ISEOR 1994

33

34

5- Strategic Piloting Indicators Log

IMMEDIATE RESULTS

(SAFETY MANAGEMENT)

CREATION OF POTENTIAL

(DEVELOPMENT MANAGEMENT)

Internal

activity

Description

of activity

Absenteeism

Turnover

Industrial

injuries

Quality

defects

Productivity

differences

External

activity

Strategic

Vigilance

External

reasons for

dysfunctions

Immediate

results

Costs Income

Extra wages

Over-

consumption

Overtime

Non-

production

Loss of

productivity

Creation of

potential

Economic

balance

PAP

Selected

actions

Project

Indicators

of evolution

Actions

required to

implement

strategy

List of

dysfunctions

detected in

interviews

Socio-Economic log-book

35

36

6- Periodically Negotiable Activity Contract PNAC

Definition of the PNAC

PERIODIC NEGOTIABLE

SECTIONS OF

STRATEGIC PLAN

LIMITED

DURATION

(6 months)

DIALOGUE WITH A

SUPERIOR IN THE

DIRECT HIERARCHY

OBJECT: COHERENCE

AND FEASIBILITY OF

OBJECTIVES AND

MEANS

WAGE INCREASES: FIXED

FOR THE ENTIRE

ENTERPRISE (non negotiable)

© ISEOR 1998

37

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38

PNAC Form

N° Objective IndicatorResources to be used

% Weight

3/3 2/3 1/3

1

2

3

4

5

6

7

8

9

10

TOTAL 100%

39

7- Economic Balance

40

Economic Balance

Costs Performance

Initial amount

Depreciation Yearly amount

Yearly amount

Total Total

Yearly added value creation

Why SEAM !

- Holistic

- Scientific: principles, steps, tools, & impact

- Staff Centered

- Sustainable Impact

- Measurable Incremental Profits

- Could be applied in Organizations

working by other methodologies like TQM

or BSC



SEAM Positioning-Thematic Periphery of the Subjectموضعة سيم

SEAM

HRM / Talent Mngt

Intervention Research &

Scientific Consultation

Leadership

Downsizing

OD

Mngt & Strat.

Control Methods

Change Mangt

Governance

BSC ABM

TQM6 Sigma

LEAN

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42

Fac

tors

Affect

ing

Reve

nue C

ycle

Mngt

(Obje

ct)

ت

دارا

إلي اى

علة

رؤث

لم ارص

نالع

ا

RCM

P4P

Managed Care

Utilization Manageme

nt

Standards &

reqirmrnts

Health Tourism

Government & HCS Regulation

s

Congested Economy

Competitors &

Mergers

Payment System

Codification

Costing & Pricing

Practices

HTM

Clinical Integration

43

Profile of Organization Hosting Intervention

120=> 250 beds private hospital in Kuwait

1,250 staff

Quickly growing in scale with dynamic

expansion plan

Internationally accredited

Applying TQM

Aims at maximizing profits especially by

improving RCM

Department:

Reception, Admission, & Billingwww.gates-group.com +961 1450270


SEAM and the Specifics of

Intervention Site Context

Site , SEAM

& RCM

Tribal Values & Believes

Governance Structure & Leadership

Style

Multi-nationalities

& Multicultural interaction

Strategy & Performance

Standards



D. HYPOTHESIS



Hypothesis

Core:

Applying a staff centered methodology

(SEAM) improves RC profitability sustainably

Descriptive:

Revenue Cycle dysfunctions prevail especially

those related to weak strategic

implementation, ineffective organization,

and ineffective integrated training.



Hypothesis

Explicative:

Causes of dysfunctions are structural and

behavioral rooting mainly to: department

leadership style, weak policies and

procedures, staff competency

deficiencies, and incomplete integrated

training programs.



E. FIELD RESULTS



• Diagnosis :التشخيص• Horivert Qualitative Interviews

• Time Management Self Assessment

• Competency Grids

• Calculation of Hidden Cost

• Mirror Effect

• Expert advice

• Plans: إعداد الخطة • Focus Groups

• IESAP

• PAP

• Strategic Piloting Indicators Log

• PNAC

• Implementation التنفيذ

• Evaluation تقييم النتائج


Research 201550

Diagnosis Results

1. Themes of dysfunctions

2. Subthemes

3. Pivotal Ideas (Baskets)

4. Selected Focus Groups & Projects



0

20

40

60

80

100

120

140

160

180

6 Strategic

Implementation

2 Work

Organization

4 Time

Management

3 CCC 5 Integrated

training

1 Work Conditions

1-Themes of Dysfunctions



0

10

20

30

40

50

60

2-

Su

b T

hem

es

of

Dysf

un

cti

on

s at

all L

evels



re-organization

occupancy and

utilization management

improving usability

of HIS

relation with

physicians

competency based

trainingbillingImprove customer

servicepricing &packaging

Retention &

Motivationcodification

Effective

recruitment

Improvement of

Governance & Leadership style in

RAB deparment

managing Insured

patientsStaffingplace redesign

Facilitate

Teamwork

quality

improvement cycle implementation

1st level 4 18 4 7 3 4 1 3 1 5 1 1

2nd level 16 15 12 18 11 15 3 4 5 5 7 11 2

3rd level 23 10 21 8 15 9 17 13 13 7 9 4 11 9 8 5 1

Grand Total 43 43 37 33 29 28 21 20 19 17 16 15 12 11 9 5 1

0

5

10

15

20

25

30

35

40

45

50

3- Pivotal Ideas at All Levels



Dysfunctions

Projects

1st

level

2nd

level

3rd

level Total

1- Occupancy and utilization

management 18 15 10 43

2- Competency-based training 3 11 15 29

3- Retention & Motivation 1 5 13 19

4- Effective recruitment 7 9 16

5- Improvement of

Governance & Leadership

style in RAB department 11 4 15

6- Case Management

Expert Opinion -Originated

7- Cost accounting for Pricing8- Effective Insurance Denials Management

% of dysfunctions covered

by projects

359

34%

4-

Sele

cted P

roje

cts

(8 c

hose

n o

ut

of 20 p

roje

ct Idea)



Solution Planning Tools

ESAP

PAPs

Economic Balance

PNAC



Impact

- Management Believes more in

Staff growing & their initiatives

- Growing Supervisors Moral and

productivity

- Incremental Profits:

> 1,000,000 $ per year.



F. CONCLUSION



Hypothesis Confirmed

Profitability of RC can be improved by:

o Improve recruitment practices for the

department

o Designing & Implementing Competency-based

integrated training programs

o Improving leadership style and effectiveness in

the department

o Enhancing motivation and retention programs

for department staff

o Restructuring

o Improving utilization management practices

o Improving Usability of HISwww.gates-group.com +961 1450270


Conclusions, 4Ps

Listen to Your Staff,

they are giving you Diagnosis & Solution

SEAM focuses on ownership.

Ownership is the key to sustainability results

People Process Product Profit



Thank you…

Healthcare Management & Business Solutions…

+961 1 450270

+965 55468899

www.gates-group.com

61www.gates-group.com +961 1450270

Gates Research 2015

http://www.gates-group.com/



Think Locally, Learn Globally…

for adopting finest functional

designs and engineering

for implementing smart quality

solutions and information systems

Gates Copyright 2015 62

International Org. for accrediting Acare

http://isqua.org/home

https://www.univ-paris5.fr/eng

Think Locally, Learn Globally…

for adopting finest functional

designs and engineering

for implementing smart quality

solutions and information systems

Gates Copyright 2015 63

International Org. for accrediting Acare

http://isqua.org/home

https://www.univ-paris5.fr/eng

Documents

INCREASING SUSTAINABLE HOSPITAL PROFITABILITY -CASE …ahfonline.net/.../Increasing_Sustainable_Hospital_Profitability.pdf · INCREASING SUSTAINABLE HOSPITAL PROFITABILITY -CASE STUDY