INCREASING SUSTAINABLE HOSPITAL PROFITABILITY -CASE STUDY ستدامشفيات بشكل م ربحية المست زيادة- ح اة عملية لAdel Olleik Medhealth Cairo 2017 March 1, 1:pm www.gates-group.com +961 1 450270
INCREASING SUSTAINABLE HOSPITAL
PROFITABILITY -CASE STUDY
لة عمليةاح-زيادة ربحية المستشفيات بشكل مستدام
Adel Olleik
Medhealth Cairo 2017
March 1, 1:pm
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Outline
A. Problem Identification
B. Choosing an effective methodology
C. SEAM Positioning
D. Research Hypothesis
E. Field Work Results & Impact
F. Conclusion
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Problem Identification
1. Evolving Healthcare Systems with growing competition and challenges to meet more patient expectations and sustain profits.
2. Focus on cost control rather on smart Revenue Cycles (RC)
3. Poor management practices are masking inefficiencies and not sufficiently utilizing actors potential.
4. Sustainability! The day after accreditation! Quality Improvement Initiatives and Outcomes fade.
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HCO Standards Compliance Virus: SCV
Visible Performance
Sustainable performance
Organizational Development
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1st SEAM Conference in Lebanon-University of Balamand
November 2014
CompaniesUS Dollars, per person and
per year% of the
payroll
-supermarket 19, 000 $ 84 %
-Notaries / lawyers 25, 500 $ 40 %
-Hospital 24, 000 $ 51 %
- Social security
organism
-Bank
22,500 $
24, 500 $
45 %
45 %
-metal working industry
- Glass industry
28, 000 $
54,500 $
80 %
150 %
-Electronics industry 70, 000 $ 220 %
The very high level of hidden costs
Some cases from the database of 1 350 organizations
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Visible
costs
2010 2011 2012 2013
Integral
costs
Hidden
costs
Classical policy to cut
down visible costs
Preferable policy : to convert
hidden costs into value added
Hidden
costs
Hidden
costsHidden
costs
Hidden
costs
Hidden
costs
Hidden
costs Hidden
costs
Visible
costsVisible
costs
Visible
costs
Visible
costs Visible
costs
Visible
costs Visible
costs
2010 2011 2012 2013
Traditional consulting firms Focus on financial performance
Work with top management
Focus on audit
Don’t take into consideration the learning process of actors
Don’t take into consideration post implementation evaluation process
Don’t give a global solution
Don’t take into consideration social factors
Potential solutions: cutting costs and downsizing
9Patrick TABCHOURY-2014
1. All resources are Dead
except People, Bio
organizations Vs TWF
Virus
2. People have untapped
Potentials and could be
motivated
3. Change People from
Actors into Believers
and beneficiaries from
OD ,buy them in…
1. الناس هم المورد الحي
2. الناس لديها قدرات كامنة وقابلين
للتحفيز
3. تحويل الناس من ممثلين الى
مؤمنين بالرسالة ومستفيدين
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4. Facilitate people’s
ownership diagnosis,
planning ,
implementation and
improvement processes
5. No recipes for
customization
6. Financial Sustainability
is via Organizations’
Metamorphosis
4. للتغييروتيملكهم مشاركة الناس
5. االفكار الجيدة -ال وصفات حلول
اوالهي بذهن العاملين
6. هي عبر التحول ةاالستدامة المالي
الداخلي في المنظمات
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C. SOCIO ECONOMIC APPROACH TO
MANAGEMENT- SEAM
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SOCIO-ECONOMIC PERFORMANCE
ECONOMIC PERFORMANCE
SOCIAL PERFORMANCE
- Working conditions
- Work organization
- Communication-
Coordination-Cooperation
- Time-management
- In-house training
- Strategic implementation
IMMEDIATE
RESULTSCREATION OF
POTENTIAL
© ISEOR 1997
13
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1st SEAM Conference in Lebanon-University of Balamand
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Socio-economic approach
= innovative management
Social performance*Economic
performanceand
deeply embedded
*SOCIAL = HUMAN AND SOCIAL
Integrating
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Individual
Organizational
Macroeconomic
Organizational behavior,
industrial psychology
Strategists
and
economists
Purpose : To link three performance levels
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ISEOR
SOCIO-ECONOMIC INSTITUTE
OF ENTERPRISES AND
ORGANIZATIONS
Non-profit organization
CREATED IN 1975
sponsor
UNIVERSITY
JEAN MOULIN LYON 3
1 POLE for 125 researchers
have carried out
1 700 000 hours of research
151 DOCTORAL theses in
MANAGEMENT SCIENCES of
which 126 have been defended
1/2 of the time inside
enterprises
90 000 pages de
publications
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Working conditions 578
Work organization 703
Communication-Coordination-
Cooperation 647
Time management 384
Integrated training 254
Strategic implementation 968
3534
Qualitative modelization of
dysfunction treatment
(expert system softwareSEAMES 1987-2014)
Knowledgebase
1 350 enterprises
37 countries
Number of generic dysfunctions 1-WORKING CONDITIONS 578 309 – Information transmission 132
101 - Layout and arrangement of the
premises 120 310 – Vertical 3C 108
102 - Equipment and supplies 235 311 – Horizontal 3C 93
103 - Nuisance 58 4-TIME MANAGEMENT 384
104 - Physical conditions of work 23 401 - Respecting deadlines 64
105 - Physical workload 6 402 - Planning, scheduling of activities 97
106 - Work hours 52 403 - Poorly-assumed tasks 180
107 - Atmosphere at work 84 404 - Factors disturbing time management
43
2-WORK ORGANIZATION 703 5-INTEGRATED TRAINING 254
201 - Distribution of tasks, missions
and functions 246
501 - Adequacy of training-job 52
202 - Regulation of absenteeism 27 502 - Training needs 48
203 - Interest of the work 15 503 - Available competency 45
204 - Autonomy on the job 80 504 - Training frameworks 99
205 - Workload 75 505 - Training and technical change
10
206 - Rules and regulations 187 6-STRATEGIC
IMPLEMENTATION 968
207 - Organization chat 73 601 Strategic orientation 105
3-COMMUNICATION-
COORDINATION-
COOPERATION
647
602 Authors of the strategy 38
301 - 3C internal to the service
306
307 308 Transmission of information
309 Vertical3C
310 Horizontal 3C
34
603 Breaking down and organizing
strategic implementation
205
302 - Relationship to neighboring services
93 604 Tools for strategic implementation
87
303 - 3C between the network and the
home office 41
605 Information systems 83
305 - 3C between the home office and branch offices 13
606 Means for strategic implementation 52
306 - 3C at the board of directors level 24 607 Personnel management
312
307 - 3C between elected authorities
and public servants 11
608 Mode of management 86
308 - 3C frameworks 98 TOTAL 3534
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Socio-economic diagnosis
of organizations
BEHAVIORS
- individual- trade groups
- personnel categories- pressure groups
- collective
STRUCTURES
- physical- technological- organizational- demographic
- mental
- absenteeism
- occupational injuries-personnel turnover- quality of products-direct productivity
HIDDEN COSTS
DYSFUNCTIONS
- working conditions- work organization
- communication-coordination-cooperation- time management- integrated training
- strategic implementation
ECONOMIC
PERFORMANCE
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Reduction of
DYSFUNCTIONS
Reduction of
HIDDEN COSTS
Imp
rove
me
nt o
f
ST
RU
CT
UR
ES Im
pro
ve
me
nt o
f
BE
HA
VIO
RS
-
(Strategic energy +
human potential)
development
higher ECONOMIC
PERFORMANCE
atrophied
ECONOMIC PERFORMANCE
Strategic strengths
and weaknesses
HIDDEN COSTS
hypertrophic
DYSFUNCTIONS
hypertrophic
BE
HA
VIO
RS
atro
ph
ied
ST
RU
CT
UR
ES
atr
op
hie
d
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Management
Tools
The trihedron
Cyclical process of problem solving
PE
RIO
DIC
AL
LY
N
EG
OT
IAB
LE
AC
TIV
ITY
C
ON
TR
AC
T
CO
MP
ET
EN
CY
GR
ID
IES
AP
(1)
PR
IOR
ITY
AC
TIO
N P
LA
N
PIL
OT
ING
LO
GB
OO
K
TIM
E M
AN
AG
EM
EN
T
TECHNOLOGICAL
CHANGES
ORGANIZATIONAL & PROCEDURAL CHANGES
STRATEGIC CHOICES:
PRODUCT-MARKET
CHOICE OF MANAGEMENT
SYSTEM
EVALUATION
IMPLEMENTATION
PROJECT
DIAGNOSIS
Policy-decision making (1) IESAP : Internal external strategic action plan
Steps مراحل مشروع التحسين
1. DIAGNOSIS التشخيص
2. PROJECT الخطة والمشروع
3. IMPLEMENTATION التنفيذ
4. EVALUATION تقييم النتائج
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Gates Research 2015 21
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Priority Action Plan(PAP)
خطة العمل
Time
Management
إدارة الوقت
Competency
Grid
جدول الكفايات
Piloting Logbook
مؤشرات التوجيه
Internal-External
Strategic Action Plan
(IESAP)
الخطة االستراتيجية
Periodically Negotiable
Activity Contract
أهداف األفراد
Tools األدوات
24
Discrepancies between time
Management and strategy
First type Second type Third type
Overly ambitious
strategyTimid strategy
poor quality of
strategic
implementation
BAB AA B
A: Time required to carry out all activities الوقت المطلوب
B: Time available الوقت المتوفر
Time appropriately applied
التوزيع الجيد للوقت
Poorly executed
strategic actions
Poorly utilized
time resources
Time resources are generally
appropriate HOWEVER they are
poorly adjusted, poorly
scheduled, poorly utilized
29
Final purpose of the Competency
Grid
Single out
training need
Improve work
organization
Improve
personnel
management
Draw up the
training planRestructure a
unit
Define new
personnel
management
methods
- Reduce the
vulnerability
- Improve
versatility
- Control absenteeism
- Spread the workload
- Share out rewarding
tasks
- Assign jobs (Transfer,
promotion,
recrutement)
- Improve rewards
External خارجيا
• Product المنتج
• Market السوق
Internal داخليا
(Managing Resources:
Dysfunctions Minimization)
• Technologies لتكنولوجياا
• Human Potentials Management
إدارة القدرات البشرية
31
PAP: electrical goodsmanufacturer
Divisions or deptsor services involved(active participants)
X
X
X
O
X
ZY
Provisional planningchart
Translation of strategic objectivesinto priority actions
STIMULATION PRINCIPLE
JJMAM NOA DFJ S
O
O
O
X
O :activeparticipant
X : contributor
- Regular cleaningof work stations- Installation ofsigns
- Creation of astaff trainingprogramme(demonstration)
- Implementationof monthlyinformationmeetings(in teams)and discussionsabout safety(implementationand results)
Priorityaction
Observations
Safetyimprovements
Developing stafftraining and communication -coordination -conciliation onsafety
Priorityobjective
Improvementsin safetyand workingconditions
Strategicaxis
Distributionof area
DECENTRAL-IZATION
PRINCIPLE
Distribution of time
SYNCHRONIZATIONPRINCIPLE
Sensitivepoints
VIGILANCEPRINCIPLE
© ISEOR 1994
33
IMMEDIATE RESULTS
(SAFETY MANAGEMENT)
CREATION OF POTENTIAL
(DEVELOPMENT MANAGEMENT)
Internal
activity
Description
of activity
Absenteeism
Turnover
Industrial
injuries
Quality
defects
Productivity
differences
External
activity
Strategic
Vigilance
External
reasons for
dysfunctions
Immediate
results
Costs Income
Extra wages
Over-
consumption
Overtime
Non-
production
Loss of
productivity
Creation of
potential
Economic
balance
PAP
Selected
actions
Project
Indicators
of evolution
Actions
required to
implement
strategy
List of
dysfunctions
detected in
interviews
Socio-Economic log-book
35
Definition of the PNAC
PERIODIC NEGOTIABLE
SECTIONS OF
STRATEGIC PLAN
LIMITED
DURATION
(6 months)
DIALOGUE WITH A
SUPERIOR IN THE
DIRECT HIERARCHY
OBJECT: COHERENCE
AND FEASIBILITY OF
OBJECTIVES AND
MEANS
WAGE INCREASES: FIXED
FOR THE ENTIRE
ENTERPRISE (non negotiable)
© ISEOR 1998
37
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PNAC Form
N° Objective IndicatorResources to be used
% Weight
3/3 2/3 1/3
1
2
3
4
5
6
7
8
9
10
TOTAL 100%
40
Economic Balance
Costs Performance
Initial amount
Depreciation Yearly amount
Yearly amount
Total Total
Yearly added value creation
Why SEAM !
- Holistic
- Scientific: principles, steps, tools, & impact
- Staff Centered
- Sustainable Impact
- Measurable Incremental Profits
- Could be applied in Organizations
working by other methodologies like TQM
or BSC
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SEAM Positioning-Thematic Periphery of the Subjectموضعة سيم
SEAM
HRM / Talent Mngt
Intervention Research &
Scientific Consultation
Leadership
Downsizing
OD
Mngt & Strat.
Control Methods
Change Mangt
Governance
BSC ABM
TQM6 Sigma
LEAN
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42
Fac
tors
Affect
ing
Reve
nue C
ycle
Mngt
(Obje
ct)
ت
دارا
إلي اى
علة
رؤث
لم ارص
نالع
ا
RCM
P4P
Managed Care
Utilization Manageme
nt
Standards &
reqirmrnts
Health Tourism
Government & HCS Regulation
s
Congested Economy
Competitors &
Mergers
Payment System
Codification
Costing & Pricing
Practices
HTM
Clinical Integration
43
Profile of Organization Hosting Intervention
120=> 250 beds private hospital in Kuwait
1,250 staff
Quickly growing in scale with dynamic
expansion plan
Internationally accredited
Applying TQM
Aims at maximizing profits especially by
improving RCM
Department:
Reception, Admission, & Billingwww.gates-group.com +961 1450270
Gates Research 2015 44
SEAM and the Specifics of
Intervention Site Context
Site , SEAM
& RCM
Tribal Values & Believes
Governance Structure & Leadership
Style
Multi-nationalities
& Multicultural interaction
Strategy & Performance
Standards
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Hypothesis
Core:
Applying a staff centered methodology
(SEAM) improves RC profitability sustainably
Descriptive:
Revenue Cycle dysfunctions prevail especially
those related to weak strategic
implementation, ineffective organization,
and ineffective integrated training.
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Hypothesis
Explicative:
Causes of dysfunctions are structural and
behavioral rooting mainly to: department
leadership style, weak policies and
procedures, staff competency
deficiencies, and incomplete integrated
training programs.
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• Diagnosis :التشخيص• Horivert Qualitative Interviews
• Time Management Self Assessment
• Competency Grids
• Calculation of Hidden Cost
• Mirror Effect
• Expert advice
• Plans: إعداد الخطة • Focus Groups
• IESAP
• PAP
• Strategic Piloting Indicators Log
• PNAC
• Implementation التنفيذ
• Evaluation تقييم النتائج
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Diagnosis Results
1. Themes of dysfunctions
2. Subthemes
3. Pivotal Ideas (Baskets)
4. Selected Focus Groups & Projects
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0
20
40
60
80
100
120
140
160
180
6 Strategic
Implementation
2 Work
Organization
4 Time
Management
3 CCC 5 Integrated
training
1 Work Conditions
1-Themes of Dysfunctions
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0
10
20
30
40
50
60
2-
Su
b T
hem
es
of
Dysf
un
cti
on
s at
all L
evels
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Gates Research 2015 53
re-organization
occupancy and
utilization management
improving usability
of HIS
relation with
physicians
competency based
trainingbillingImprove customer
servicepricing &packaging
Retention &
Motivationcodification
Effective
recruitment
Improvement of
Governance & Leadership style in
RAB deparment
managing Insured
patientsStaffingplace redesign
Facilitate
Teamwork
quality
improvement cycle implementation
1st level 4 18 4 7 3 4 1 3 1 5 1 1
2nd level 16 15 12 18 11 15 3 4 5 5 7 11 2
3rd level 23 10 21 8 15 9 17 13 13 7 9 4 11 9 8 5 1
Grand Total 43 43 37 33 29 28 21 20 19 17 16 15 12 11 9 5 1
0
5
10
15
20
25
30
35
40
45
50
3- Pivotal Ideas at All Levels
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Dysfunctions
Projects
1st
level
2nd
level
3rd
level Total
1- Occupancy and utilization
management 18 15 10 43
2- Competency-based training 3 11 15 29
3- Retention & Motivation 1 5 13 19
4- Effective recruitment 7 9 16
5- Improvement of
Governance & Leadership
style in RAB department 11 4 15
6- Case Management
Expert Opinion -Originated
7- Cost accounting for Pricing8- Effective Insurance Denials Management
% of dysfunctions covered
by projects
359
34%
4-
Sele
cted P
roje
cts
(8 c
hose
n o
ut
of 20 p
roje
ct Idea)
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Solution Planning Tools
ESAP
PAPs
Economic Balance
PNAC
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Impact
- Management Believes more in
Staff growing & their initiatives
- Growing Supervisors Moral and
productivity
- Incremental Profits:
> 1,000,000 $ per year.
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Hypothesis Confirmed
Profitability of RC can be improved by:
o Improve recruitment practices for the
department
o Designing & Implementing Competency-based
integrated training programs
o Improving leadership style and effectiveness in
the department
o Enhancing motivation and retention programs
for department staff
o Restructuring
o Improving utilization management practices
o Improving Usability of HISwww.gates-group.com +961 1450270
Gates Research 2015 59
Conclusions, 4Ps
Listen to Your Staff,
they are giving you Diagnosis & Solution
SEAM focuses on ownership.
Ownership is the key to sustainability results
People Process Product Profit
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Thank you…
Healthcare Management & Business Solutions…
+961 1 450270
+965 55468899
www.gates-group.com
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Think Locally, Learn Globally…
for adopting finest functional
designs and engineering
for implementing smart quality
solutions and information systems
Gates Copyright 2015 62
International Org. for accrediting Acare
Think Locally, Learn Globally…
for adopting finest functional
designs and engineering
for implementing smart quality
solutions and information systems
Gates Copyright 2015 63
International Org. for accrediting Acare