Posted by: knightbird | July 24, 2012

Improving Health Care

As I prepare for presentations to the White Earth Reservation’s Communities Collaborative Brain Development Conference, in Mahnomen, MN, I consider once again the huge reluctance of the health care system to pursue massive improvement on a grand scale through the use of Lean Healthcare. It has become very clear to me that the future path for healing will use fewer medical resources, and more culture change through behavioral health resources. I put together an Excel spreadsheet that demonstrates the reduction in medical resource use in primary care if the theory I am working off of is successful.

Part one of the theory is that we can gain a 20% improvement in provider productivity using Lean tools. For a provider seeing 20 patients a day, the improvement is 6 patients more seen per day. Part two of the theory is that the use of a biopsychosocial treatment model in an integrated primary care behavioral health treatment facility leads to a reduction of 35% in patient visits to their provider in the two year following their treatment.[i]

Let’s assume a patient population of 10,000 each visiting their primary care provider at the national average of about 3.2 visits annually, or 32,000 visits. If their medical providers see an average of 20 patients daily, and work a 240 day annual work year, 6.67 providers are required to meet the demand. A 30% productivity increase reduces medical provider requirements to 5.13.

Here’s the next assumption: patient visits are reduced by 35%. Instead of 32,000 visits, the number becomes 20,800. This reduces provider need in the non Lean Healthcare improvement scenario to 4.33, and with Lean Healthcare improvements to 3.33. The ratio of 3.37/6.67 medical providers equals 1 to 2, or a 50% reduction in provider need.

This leads to further cost reduction through the elimination of 50% of exam rooms, supporting provider team, supplies, tests and a host of other expenses involving space requirements.

The implications of this are profound. The first providers to attempt this improvement will find increased productivity, and an increase in revenue, until the decline in patient visits start. With increased productivity, this provider is in an idea spot to attract new patients because of reduced wait times and improvements in patient satisfaction, so we can postulate that this provider will attract and keep a significant base of new patients. And with improved patient outcomes, the provider may well attract more institutional support from insurance companies.

Eventually, chronic disease will decline and with it the expensive prescription pill industry. As with all industry, the hangers on will seek political and institutional advantages. They will complain of unfair competitive practices, which won’t stick. Eventually, certain provider groups will no longer be competitive and decline, or disappear. It’s inevitable.

In the meantime, we will have happier, healthier patients whose health issues no longer extract an extraordinary cost on society. What a day. So, where are the other pioneers?


[i] T C R Wilkes, MB, ChB, M Phil, DCH FRCP(Edin), MRCPsych, FRCPC, FAPA; Lindsay Guyn; Bing Li, MA;       Mingshan Lu, PhD; David Cawthorpe, PhD, “Association of Child and Adolescent Psychiatric Disorders with Somatic or Biomedical Diagnoses: Do Population-Based Utilization Study Results Support the Adverse Childhood Experiences Study?,” The Permanente Journal 2012 Spring;16(2):23-26

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