Observations on Operations » aramark healthcare

Approaches to Healthcare from Around the Globe

astanowski — Wed, 16 Jun 2010 16:07:03 +0000

At the June 1-2 International Hospital Federation Meeting in Chicago, presentations from worldwide experts helped shed light on some of the world’s problems (and approaches) to healthcare. A presentation from the head of the Health Industry Investment Policy of the World Bank Group, Alexander Preker, focused on how much is being spent on healthcare worldwide. The stunning number was that the United States annual expenditure on health care of $2.7 trillion is approximately one-half of all worldwide expenditures ($5.5 trillion) in healthcare. A conversation with the Canadian Healthcare President, Pamela Fralick, discussed the irony to the U.S. approach of adding an additional 32 million onto its insured roles, because that number is roughly equivalent to the entire population of our northern neighbor. Fralick and Pan American Health Organization’s Ciro Ugarte both expressed a concern that the United States’ demand for additional practitioners may consume some of our neighbor’s trained healthcare human resources as they are lured over the borders to more lucrative positions.

George Porignon, Health Policy Expert at the World Health Organization, presented a healthcare model that focused around primary care practitioners, and not around the acute care hospital. What was fascinating was the discussion that followed by Indonesia’s Muki Reksoprodjo, who stated that although his country was as large as the U.S., it consists of two-thirds water, making logistical access to primary care resources difficult. Pan American Health Organization’s Ciro Ugarte talked about the difficulty in treating patients with limited primary care resources, who then come to the acute care facility for access.

AHA’s President Rich Umbdenstock discussed U.S .approaches and the difficulty of turning the massive system around to primary care, but provided examples of how primary-care centric organizations work in the U.S. Richard deFilipppi, a trustee at Cambridge (MA) Health Alliance and the Board Chair of the AHA discussed the Massachusetts system. Erick DeRoodenbeke, the Executive Director of the International Hospital Federation, nicely summed up the discussion….that more and more, the movement to Primary Care-centric practice is being led by state, regional, and local organizations, as legislating policy from a national body is hard to implement due to local variation. Lastly, a side conversation with the German Hospital Federation Chief Executive Georg Baum focused on how Germany controlled costs, especially drug costs, by having pharmaceutical organizations come in front of a panel and justify prices based on efficacy and value.

The perspective gleaned from discussions with international healthcare leaders served to broaden my view of things….removing some of my American myopia. Almost all nations are struggling with issues; most are not as fortunate as the United States to have our deep resources. More than once, representatives commented to me that it is hard to believe that the richest, most powerful country has so many uninsured. I tried to explain why, and the history that led up to where we are now, and that the answer was not easy. I was not sure if it was the language barrier or the shortcomings of our system that left my explanation somewhat lacking.

The Romanian Hospital Association’s First Vice President, Dr. Mircea Oltenu, stated to me that along with the recession, healthcare costs are crippling his country. Healthcare’s significant consumption of resources on each nation’s productivity, no matter what system is in place, is a common characteristic. As I left the meeting, my thoughts drifted to a hope that a cure for cancer, Alzheimer’s, and diabetes may be the only solution to solving the world’s healthcare issues. The eradication of these diseases could result in the same “dividend” that the eradication of polio in the 1950s and 1960s had for society, with its concurrent impact on lowering the need for iron lungs, long term care, human caregivers, and family’s resources. From a world-wide perspective, only miracles of cures for major diseases seem like the best hope.

Comparing Financial and Operational Data to Evaluate Clinical Engineering Performance

astanowski — Fri, 22 Jan 2010 17:02:21 +0000

In his January/March 2008 Journal of Clinical Engineering article, Clinical Engineering Benchmarking: An Analysis of American Acute Care Hospitals, Binseng Wang, ScD, CCE, Vice President, Performance Management and Regulatory Compliance for ARAMARK Healthcare’s Clinical Technology Services group, reported detailed analysis of data collected by Thomson Reuters from 253 acute care hospitals exploring a variety of different metrics, such as:

Total number of scheduled maintenance work orders completed in a year as a function of the total number of capital equipment owned by the hospital
Percentage of CE departments that have administrative support as a function of the number of FTEs
Total number of FTEs in the CE department as a function of adjusted discharges
The total number of pieces of capital equipment and unscheduled repairs completed in a year as a function of the hospital’s total patient occupancy percentage
CE labor expense versus total CE expense
Parts and supplies expense versus total CE expense
Service contract expense versus total CE expense
Total cost of management and maintenance of medical equipment (total CE expense) versus the total capital acquisition costs
Total CE expense versus the total number of beds that are staffed and operated by each hospital
Total CE expense versus adjusted patient discharges
Total CE expense versus the total number of capital equipment it maintains
Total CE expense versus the hospital’s total operating expense.

From this study, Dr. Wang concluded that using multiple comparisons (both financial and operational) one can gain valuable insights into the current performance of a CE department and find areas that deserve further scrutiny to reveal unique characteristics and/or opportunities for improvement.

For a briefer commentary on clinical technology benchmarking, Dr. Wang authored an article in the October 2009 issue of 24×7 magazine that focuses on technology and service solutions for biomed. Here is a link: http://www.24x7mag.com/issues/articles/2009-10_10.asp.

Mentoring and Fellowships

astanowski — Mon, 14 Sep 2009 14:03:59 +0000

When I began my healthcare career at the Graduate Hospital in Philadelphia, I was fortunate to have access to a great preceptor, Beverly Slavic, who guided my fellowship. Bev taught me a lot of lessons about hospital management, but probably the lesson that stuck the longest was the value of hard work and perseverance in getting things accomplished.

I’m fortunate to be in a position to help others now through a fellowship program that my employer is offering in conjunction with the Institute for Diversity in Health Management. It’s been my job to shepherd this program and it is great to have our inaugural class of fellows on board.

Our first class at ARAMARK Healthcare, includes four Fellows, from some of the country’s leading healthcare administration graduate programs who are being mentored by executive preceptors at some of the top hospitals in the U.S., including NorthShore University HealthSystem Children’s Hospital of Philadelphia; The Methodist Hospital in Houston and Henry Ford Hospital in Detroit.

Fellowship work kicked off this past July and each of the four Fellows is working on projects within their host hospitals. The group also is combining on a project to study asymmetrical paternalism as it relates to how behavioral economics can motivate healthy food choices in a hospital dining setting.

When we were structuring the program, I was fortunate to get to spend some time with executives who were very committed to the fellowship process. As an example, Tony Armada, FACHE, President and CEO of Henry Ford Hospital and Health Network was very supportive and made many suggestions which we incorporated into the program.

The Fellowship agenda also includes educational programs on diversity. Fred Hobby, the president of the Institute for Diversity, who helped shape the structure of this program, told me that ” When you have someone of a diverse profile in a C-Suite level position, their representation of the community at large helps to minimize the disparity of healthcare delivery because they understand the specific needs of the people who are visiting their hospital.”

The application enrollment period for the second year of the Fellowship is concluding this month and the program and four new fellows will be named shortly for the 2010-2011 project work. If you know anyone that is interested in applying for the fellowship, they can visit www.aramarkhealthcare.com to download the application.

The Physician / Administration Dynamic

astanowski — Fri, 17 Jul 2009 17:57:35 +0000

I recently had my annual physical. Inevitably, the discussion with my internist yielded to the health care environment. We’ve had a long relationship, probably extending to about 20 years. She was telling me that her practice was unable to hold onto two young PCPs in the group, simply because the practice was not able to pay them enough.

The relationship of physicians and executives represent two legs of the famous “three legged-stool,” a metaphor that has been a long-standing staple in graduate school education. The relationship between physicians and administration has intensified. Some physicians are now “owned” by hospitals. Independent physician practices look at hospital-owned practices as hospitals competing for their business, and inevitably favoring them. Hospitals see independent physicians forming freestanding facilities as competing for bread and butter hospital business. New competition is arising such as from retail-based health clinics, that are adding services like wart removal. These clinics have the further potential to disrupt referrals.

On Friday, July 25, 2009, I’m going to be participating in an exclusive panel discussion at the AHA Health Forum Leadership Summit in San Francisco. Sponsored by ARAMARK Healthcare and led by Patrick Cawley, MD, MBA, chief medical officer of Medical University of South Carolina (MUSC) Medical Center in Charleston, South Carolina and President, Society of Hospital Medicine, the session will explore some of the ways in which successful hospitals are working with physicians in a collaborative role in the operations of a hospital.

Health reform needs to come from us in the industry. What are the approaches we need to make to provide for better health outcomes? How can we improve the processes of care? How can the legs of the stool – board, physicians, and administration become sturdier and improve the care that society depends on us to provide?

Look for comments from the meeting later on this blog.