Volume 5 (2020-21)

Each volume of Management in Healthcare consists of four quarterly 100-page issues. Articles scheduled for Volume 5 are available to view on the 'Forthcoming content' page.

The Articles published in Volume 5 include:

Volume 5 Number 1

  • Editorial
    Simon Beckett
  • Case Studies
    Collapsing organisational silos in health system operations
    Rhonda Stewart, Transformation Sensei, Virginia Mason Institute

    ‘Coordinated care’ is a growing concept in healthcare, with practices like electronic health records (EHR) helping disparate providers and specialists break out of silos to complement each other’s care for a given patient. But de-siloing is also beneficial — and sorely needed — in the way health systems organise their management teams, both in clinical and business operations. Virginia Mason Institute has helped medical centres minimise errors, reduce workloads and improve morale at all levels, from front-line staff to directors, through a series of reforms focused on cross-functional collaboration. These reforms may serve as a template for other systems to follow as they seek to conserve costs, engage staff and instil a culture of teamwork and shared goals. This paper describes how Virginia Mason applied VMPS in two scenarios. These scenarios showcase how combining two broad strategies and five specific tactics can diminish silos and improve efficiency, morale and financial performance.
    Keywords: lean management; efficiency; revenue cycle; waste reduction; staff engagement

  • Blending diverse expertise to optimise and sustain project outcomes
    Janine R. Kamath, Chair of Management Engineering & Consulting, Jason E. Barclay, Senior Project Manager, Lydia A. Baude, Senior Project Manager, Jeffrey R. Ehman, Senior Health Systems Engineer, David M. O’Brien, Senior Health Systems Engineer, Bradley E. Williams, Senior Project Manager, Munawwar A. Khan, Senior Principal Health Systems Engineer and Nicole K. Hanf, Senior Health Systems Engineer, Mayo Clinic

    Strategic projects in large healthcare organisations are often highly complex and dynamic, and they require a team of skilled business professionals to execute them. Examples of difficult, costly and extended project executions have been shared in the literature. Successful project execution involves many critical facets. One facet that continues to be of marked interest is effective resourcing of strategic projects. This paper focuses on describing a staffing approach used at Mayo Clinic (Rochester, Minnesota) to facilitate successful, agile and sustainable execution, with desired outcomes. In 2016, Management Engineering & Consulting (ME&C) began exploring a collaborative staffing model that partnered management engineers with project managers (PMs) to drive strategic, multisite projects. This ongoing collaboration model was evaluated from multiple perspectives, including project outcomes, timeliness, client and staff satisfaction and opportunities for innovation. Data and feedback on the model were collected with historical reports, surveys and focus groups with stakeholders, leaders, PMs and management engineers. The feedback and data indicated that the collaborative staffing strategy and model have further optimised service delivery, enabled professional staff to work at the highest level of their competency and dynamically blended knowledge, expertise and skills to achieve better and more sustainable overall project outcomes.
    Keywords: best practice; collaboration; execution; optimisation; project management; systems engineering

  • Practice Papers
    How non-value added work affects the productivity of healthcare professionals
    Rene T. Domingo, Associate Professor, Asian Institute of Management, Philippines

    This paper analyses how non-value added work significantly reduces the productivity of healthcare staff and the service capacity of healthcare systems worldwide. It first describes how the ageing population, manpower shortage and wastefulness in hospitals continuously increase the demand-supply gap. The paper explores the application of lean thinking practised by manufacturing industries in improving healthcare staff productivity to complement the conventional supply, demand and technology solutions. It illustrates the principles and best practices in spotting and stopping the seven lean wastes or ‘muda’, particularly in hospitals. The paper identifies several industry and institutional hurdles in improving productivity. It concludes with recommendations for policymakers, regulators and payers to enjoin healthcare institutions to adopt lean practices in order to improve their capacity, cost performance and patient care quality.
    Keywords: productivity; lean; non-value added; wastes; efficiency; manpower shortage

  • First things first: Analysing predecessor programmes to glean insights about Medicare’s primary care first programme
    Jonathan Staloff, Fellow, Value & Systems Science Lab, Leah M. Marcotte, Associate Medical Director for Population Health and Joshua M. Liao, Medical Director of Payment Strategy, UW Medicine

    In 2021, the Centers for Medicare and Medicaid Services plans to launch Primary Care First (PCF), a fee-for-service population-based primary care payment model that will engage primary care practices to assume accountability for the cost and quality of care for aligned beneficiaries. In terms of programme design, PCF progresses from several proposed or implemented predecessor payment models. Organisations considering PCF participation should be aware of how PCF compares to its predecessors and the operational insights that can be drawn from important similarities and differences. This paper addresses these issues by reviewing PCF design, summarising the design and available data from PCF predecessors, and using comparisons to discuss potential implications for PCF performance, including those related to risk adjustment, care management across patient populations, acute care utilisation management, data analytics and accounting and revenue cycle management systems.
    Keywords: Medicare; value-based payment; health policy; primary care; primary care reform; alternative payment models

  • Medication cost sharing in low-income elders with chronic disease co-morbidities: Policy implication of PPACA provisions for dual eligibles and parallel systems at national health services
    S. Mantravadi, Health economist

    The implementation of the Patient Protection and Affordable Care Act (PPACA) is aimed at addressing patient safety, quality and insurance coverage for patients with co-morbidities in the United States. Chronic disease patients with both Medicare and Medicaid coverage, however, are further impacted, especially for prescription drug coverage. Additionally, the healthcare reform act entails specific provisions that only affect coverage benefits for low-income elders with chronic disease eligible for both Medicare and Medicaid insurance (dual eligibles). This paper will review the impacts on dual eligible beneficiaries prescription drug cost sharing, Part D plan optimisation and Medicare Advantage premiums. It will focus on the impacts of reducing the Part D doughnut hole and prescription drug cost sharing on patients having additional chronic disease co-morbidities, with reference to healthcare management theory of insurance. This paper will also analyse impacts that affect beneficiary quality of care and access. Dual eligible care for chronic disease patients will be summarised in the context of health insurance and management/economic theory. The PPACA provisions concerning dual eligibles Part D cost sharing align with the theory of demand for health insurance and health care. For dual eligibles with chronic disease, reduced medication cost sharing will increase medication adherence and reduce inpatient expenditures with reference to insurance theory.
    Keywords: chronic disease; impact of cost sharing; dual eligible; national health systems

  • Utilisation improvement plans for avoidable hospital delays
    Jose R. Masip, Consultant, DOCDUO Consulting Group

    Providing optimal healthcare in the inpatient settings inevitably involves specific management strategies to keep costs at bay. While prices appear to drive the high-cost trends in the healthcare system with no feasible solution on the horizon, the overutilisation of services and goods worsens this scenario. Managing the length of stay and avoiding hospital delays are strategies essential to controlling clinical operating costs. Hospitals run software suites, specifically designed to capture and report on delays. Without departmental action plans, however, these strategies do not generate sustainable and continuous improvement. This paper complements the topic of avoidable hospital delays (AHDs) by describing the use of avoidable delay tracking systems and contributes to the body of knowledge with the development of utilisation improvement plans based on the type of trending AHDs. It also proposes splitting AHDs into clinical and non-clinical delays to better elucidate the type of action plans required to resolve these issues. The next step points to the development of clinical protocol and guidelines specific for AHDs as well as gathering indirect and direct data to quantify the weight of AHDs in hospital profits.
    Keywords: avoidable hospital delays; discharge planning; hospital costs; action plans; overutilisation; length of stay; protocols; case management; continuous improvement

  • Research paper
    Strategic leadership: A study of strategic health leadership (SHELDR) practices among former US military Surgeons General
    Douglas E. Anderson, Chair of Health Work Group, West Virginia Eastern Health and Human Services Collaborative, Talbot N. Vivian, Professor, Old Dominion University, Brian J. Masterson, Senior Behavioral Health Medical Director, United Health Group/Optum, James A. Johnson, Professor, Central Michigan University and C. Bruce Green, Managing Director, Deloitte Consulting LLP

    This study identifies leader development gaps and strategic health leadership (SHELDR) competencies, explores how a cohort of strategic leaders applies those competencies and makes recommendations to improve development of future leaders. The literature identifies leader development gaps and applicable strategic leadership theories leading to development of the SHELDR Model. A qualitative case study determines which competencies are most applied (or not applied) by a cohort of former Military Health System Surgeons General (SGs). An expert panel compared and contrasted the SHELDR Model, interview results and recommended how to develop future SHELDRs. Transformation, complexity and collaborative leadership theories provide the foundation for the SHELDR Model. SGs selected develops leaders, develops and promotes vision, builds trust, challenges the status quo and actively listens as competencies applied most often. Systems approach, listening, critical thinking, communication and emotional health are identified as competencies to develop. The SGs and the expert panel generally agree on the competencies. Immersive learning, assignment to strategic-level projects, critical thinking and role playing are common recommendations on development of future strategic leaders. To successfully transform complex health systems, SHELDRs need specific competencies — strategic-level leadership competencies. Aspiring and current health leaders will benefit from the insights on developing future leaders. Organisation leader development plans should use the SHELDR Model as a developmental and evaluation guide. Research on other cohorts and the SHELDR’s interrelationship with the competencies and development of more strategic-minded leaders earlier rather than later with the right methods to support health system transformation and better outcomes is required.
    Keywords: strategic leadership; transformational leadership; complexity leadership; collaborative leadership; leader development; leadership competencies