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Chapter 14
Holding the Gains
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Holding the Gains
Types of projects to select
Backlogs
Revenue less than expense
Poor outcomes
Engage support departments
Tools
HR planning
Managerial accounting
Feedback and control
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Project
identified
Decrease
staffing?Plan for
maintaining staff
Pool or
redeploy
Eliminate vacant
position
FTEs
needed
in otherdepartment?
Vacant
position?
Lay off
No
Yes
Yes
Yes
No
No
Human Resources Planning
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Holding the GainsManagerial Accounting
Understand the source of revenue Per member per month (PMPM)
Diagnosis-related group (DRG) (case mix adjusted)
Unit of servicerelative value unit (RVU)
Retail
Determine costs Fixed
Variable
Overheadallocation methodology
Conduct cost-volume-profit analysis (CVP)
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Holding the GainsControl
Facilities
Clinical Quality
High Touch
Run Chart for Birthing Center Patient Satisfaction
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Process Management Plan
Answerrequest for
appointment
Log on to info
system Current
New
Caller
status
Enroll caller
Make
appointment
Monitoring
Response plan
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Levels of Operational Excellence
Level 1
There are no organized operations monitoring orimprovement efforts at this level.
Quality efforts are aimed at compliance and the
submission of data to regulatory agencies. Level 2
Organization has begun to use operations data fordecision making.
There are pockets of process improvement activities
in which process mapping and PDCA or rapidprototyping are used.
Evidence-based medicine (EBM) guidelines are usedin some clinical activities.
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Levels of Operational Excellence
Level 3 Senior management has identified operations improvement
efforts as a priority.
Organization conducts operations improvement experiments,uses a disciplined project management methodology, andmaintains a comprehensive Balanced Scorecard.
Some P4P bonuses are received, and the organization obtainsabove-average scores on publicly reported quality measures.
Level 4
Organization engages in multiple process improvement efforts,using a combination of project management, Six Sigma, Lean,and simulation tools.
A significant number of employees have been trained in theadvanced use of these tools, and these individuals leadprocess improvement projects.
EBM guidelines are used comprehensively, and all P4Pbonuses are achieved.
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Levels of Operational Excellence
Level 5 Operational excellence is the primary strategic objective of the
organization.
Operations improvement efforts are underway in alldepartments, led by departmental staff who have been trained
in advanced tools. The organization uses real-time simulation to control patient
flow and operations.
The organization develops and publishes new EBM guidelinesand best practices for administrative operations.
The organization scores in the top 5 percent of any national
ranking of quality and operational excellence.
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The Future
Ambulatory
care
model
EBM based
Emergency and
inpatient care
modelEBM
based
Predicted
resource needs:
Facilities
Staff
Supplies
Clinical operations
Real-time data
Real-time control
Supply chain
system
Demand
prediction
system:
Volumeclinical
conditions
Staff scheduling
system
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End of Chapter 14