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Stabilize Revenue Max. Force-out Costs

Refine Processes Add Volume

Increase Quality

Conditions for Value Innovation SEQUENCE OF ACTIONS

Nation Building

Social Programming Micro-Insurance

Competitive Advantage Home-Grown Training & Education

Value Innovated Cost, Quality & Experience Health Travel

Center of Excellence Quality CAPABILITIES


chose to do so. Management guru, Dr. Michael Porter’s research with Dr. Elizabeth Teisberg in Redefining Health Care recommends setting a national healthcare strategy of Value = Medical Outcomes ÷ Dollars Spent. HVFM aligns perfectly with this strategy.

The confounding TruTh of high qualiTy wiTh low cosTs The Law of Technology The law of technology says that a specialized tool will always be superior to a general purpose tool. Yet, the culture of hospital medicine values the flexibility of trained doctors practicing intuitive, artisan and customized medicine. Put plainly, general hospitals are designed to do everything for everybody. This sounds good but it raises costs and lowers medical outcomes for the largest categories of medicine. In The Innovator’s Prescription, Clay Christensen divides medicine into three types, where only Precision Medicine is appropriate for High-Volume Focus Medicine. Intuitive Medicine: Emergencies, trauma and diseases that are statistical outliers, consultative and expensive to diagnose. Empirical Medicine: Chronic diseases that

require a high level of coordination, trial and error to stabilize. Correct diagnosis is vital. Precision Medicine: Popular surgeries where the diagnosis and treatment are known.

‘if surface

assumptions about savings are wrong, (and they usually are), how do hvfhs get to super-low costs?

geTTing To value- innovaTed cosTs About half-way up the Action Map, the actor’s focus can move from quality to costs. Simplistic descriptions of how value-innovated costs, outcomes and customer experiences are achieved don’t do justice to the genius of Shouldice and NH.

If surface assumptions about savings are

wrong, (and they usually are), how do HVFHs get to super-low costs? The real explanation is based on Toyota Production System (TPS),

 REFERENCES References available on request (

the granddaddy of comprehensive lean management philosophy and operational practice. And, TPS expresses another paradox by driving quality up, while driving waste out and costs down.

opTimizing cosTs and qualiTy in Tandem TPS management shows why adding volume, optimizes costs and quality in tandem. Put simply ― waste and mistakes hide until a process runs at capacity. In hospital medicine, most mistakes and costs

happen at hand-offs. Consequently, consistent, repeatable processes increase quality by driving out variability and mistakes. Volume exposes other forms of waste: motion, waiting and inventory. Together, these are opposite to the truism that quality naturally costs more.

This spring Look again at the Action Map. Once an organization is about halfway up the skills and activities ladder or moving to the right and getting results…high revenue and increased reputation create wide latitude to create whatever the ownership wants. A last thought: US $25 billion could

build over 80 High-Volume Focus Hospitals a year. The Arab Awakening is a once-in- a-generation opportunity to chart new healthcare directions. There is room for lots of different visions and ownership goals while supporting the reality that value-innovated health care could help the region leapfrog over the skills of others. Healthcare’s signaling power supports

stability, predictability, participation and future- orientation. High-Volume Focus Medicine is the right tool for jobs that need doing. HB


Governance Stability

Costs Value Innovation Quality

Maximum Control Virtuous Circle

Wide Programming

Institutions & Governance

Fast Learning Build Skills

Create Confidence RESULTS

SKILLS, LOW TO HIGH activities, internal to external

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