page 1
page 2
page 3
page 4
page 5
page 6
page 7
page 8
page 9
page 10
page 11
page 12
page 13
page 14
page 15
page 16
page 17
page 18
page 19
page 20
page 21
page 22
page 23
page 24
page 25
page 26
page 27
page 28
page 29
page 30
page 31
page 32
page 33
page 34
page 35
page 36
page 37
page 38
page 39
page 40
page 41
page 42
page 43
page 44
page 45
page 46
page 47
page 48
page 49
page 50
page 51
page 52
page 53
page 54
page 55
page 56
page 57
page 58
page 59
page 60
page 61
page 62
page 63
page 64
page 65
page 66
page 67
page 68
page 69
page 70
page 71
page 72
page 73
page 74
page 75
page 76
page 77
page 78
page 79
page 80
page 81
page 82
page 83
page 84
page 85
page 86
page 87
page 88
page 89
page 90
page 91
page 92
page 93
page 94
page 95
page 96
page 97
page 98
page 99
page 100

July 07 Businessexcellence 47 shifting sand, of course, but hospitals tend to take their census at midnight, for operational reasons. “But the fact that you have 20 beds open at midnight doesn’t help you,” says Fosdick, “because there are not 20 people waiting to be admitted. What’s important is how many beds you have open at 11 o’clock in the morning, or four o’clock in the afternoon. The metrics in healthcare are outdated, and as we get better measurements we can hold people accountable.” The Nebraska Medical Center has also started a program called Crew Resource Management Training, developed by the aviation industry in the United States in the 1980s in response to a rise in fatal accidents. “They determined that the most common problem was breakdown of communication in the cockpit,” says Fosdick. “The most common experience of an accident was a pilot with no previous safety problems, who was fl ying for the fi rst time with a co-pilot, and they weren’t listening and communicating. They developed a whole training program around that communication. We worked with LifeWings to instill CRM into our operating room culture. So far, we’ve trained over 1200 people.” A nurse with six months’ experience working for the fi rst time with the hospital’s chief surgeon, he points out, may be hesitant to identify a potential problem, but better communication can save time, and even lives. Another area ripe for improvement is the preparation of instrument packs for surgery. “The number of surgical instruments used today has increased dramatically,” says Fosdick. “There are so many sophisticated and unique things used by orthopedics, or neurology, but our approach to preparing these packs is the same as it was 50 years ago. We take our lowest paid people, our techs, and they have to fi gure out which instrument is which and put it in the right tray. Why can’t we put RFIDs on the equipment and verify by computer that we have all the right things in the kit? That’s the kind of thing I want our people to think about.” Nebraska Medical Center “None of our priorities has anything to do with fi nance, but if we do these four things, our fi nancial performance will improve” Dealing with the complexities of the healthcare industry requires an insurer that understands the business as well as its risks. At Zurich, our dedicated underwriters, risk managers and claims professionals have years of experience in the healthcare industry and work with customers to develop an insurance program that responds to their unique needs. Zurich organizations like FedEx, for instance, they know that what’s important is to get the package there on time. They fi gured out how to get people working in the same direction.” Effort has been rewarded with honors, as well as profi ts. “We applied for a JD Power award and were fortunate enough to receive the Hospital of Distinction Award two years in a row,” says Fosdick. “Nobody else in the state has done that. We’re also a Magnet hospital for nursing excellence. We’ve just completed an assessment by the State Quality Review, which incorporates healthcare and many other industries, and we are at the second highest level of that now. Our goal is to reapply again in December and strive to get the fi rst level, and then we will go after a Malcolm Baldrige Award.” [The Malcolm Baldrige is a national quality award given by the United States National Institute of Standards and Technology, (NIST)]. Quality initiatives continue with a six sigma quality improvement program, which sees fi ve people a year taken off their jobs for two to three years of full time training to become black belts, or lean manufacturing experts. “We monitor continuously how much it’s costing us and how much we’re saving and we always come out way ahead,” says Fosdick. “We’re always looking for what other industries have done and how we can adapt that to help us. “We have a balanced scorecard program that right now is at the department level,” he continues. “It’s nowhere near where I want it to be, and we’re working to reassess how we measure things.” Length of stay is a common measurement in hospitals, but by itself it doesn’t tell you anything, says Fosdick. If you deliver a lot of babies, instead of doing open-heart surgery, your length of stay goes down, but it doesn’t mean you’re doing any better. “I wanted to fi nd a better metric that would determine how we’re doing at keeping people here for the appropriate time and no longer. So we’re looking to change our metric system.” Another misleading measurement is often the number of beds available. It’s a constantly

Businessexcellence July 07 48 Choate Construction has never missed a deadline in its 18-year history, which may help explain its strong and steady growth. Company founder and CEO Millard Choate tells Keith Regan how strong internal process controls ensure projects are done right first time about reputation All