HCM II – Flashcard
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Definition of contract
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an agreement between two or more parties creating obligations that are enforceable in court or otherwise recognizable by law
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Tax form for a consultant
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1099
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Tax form for a worker
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W2
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Essential elements of a contract
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Offer Acceptrance Consideration (each person gives something -> payment for service) Meeting of the Minds
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3 types of contracts
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Written Oral Implied/quasi (equitable estoppel)
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Unenforceable contract issues
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Lack of mutual assent Illegality Capcity Coercion Fraud Statute of frauds Parol-evidence rule Breach
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Types of restrictive covenants
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covenant against competition covenant against solicitation confidentiality covenant anti-piracy covenant -> can't bring employees with them
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Definition of fiduciary
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authority to act on behalf of others with the responsibility to act with a high degree of conduct
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Definition of risk management
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Recognizing and managing the amount of risk you are willing to take
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Four principles of risk management
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Avoidance Reduction of effects Transfer Acceptance
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Specialties most likely to be a practice owner
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Specialty surgeons, anesthesiologists, radiologists
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Major trend in physician employment
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Physicians going from self-employed to being employed
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Description of Accountable Care Organizations (ACAs)
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Groups of providers who care for a wide variety of health needs of a defined patient population
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Define ambulatory care
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a wide range of medical services and procedures that are conducted on an outpatient basis
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Trend in ambulatory care
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Up to 70% of surgical procedures are performed on an outpatient basis
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Define concierge medicine
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Primary care practice with a limited number of patients who typically self-pay fees for unlimited access to physicians
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How concierge medicine works
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smaller practices; fee/month
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Founder of LEAN
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Taiichi Ohno
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Key LEAN principles for healthcare
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Patient is the primary focus Care must be of the highest quality Promote efficiency Identify and remove practice/treatment defects Maximize business safety Organize all elements of practice Eliminate all waste
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LEAN Prerequisites
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Passionate vision that the patient comes first A public declaration of commitment by leadership to all constituencies of LEAN Commitment to eliminate waste Aggresive pursuit of error-free medicine Thorough knowledge of the "LEAN HOUSE" program
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Definition of heijunka
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Leveled production, no bottlenecks or waste. (i.e. - scheduling patients to meet demand)
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Definition of jidoka
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the safety element/be watchful for defects. Keep patients safe. Leads to predictable cycle time
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Definition of standard work
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leads to a predictable cycle time
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Definition of Kanban
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A way of signalling when new supplies are needed
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Definition of andon
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A light. A signal for a need or problem with equipment or process
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Definition of takt time
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Paced treatment. Prociding service at and to meet the rate of demand from patients. (420 minutes/40 patients = 10.5 minutes/patient)
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Definition of one piece flow
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All equipment, supplies, and information are available for one person to do everything
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Definition of pull treatment
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patients determine the services
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Definition of muda
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Waste. Consumes resources, but adds nothing of value. Worst is patient death.
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Examples of wastes
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processing, stock on hand, movement, defective products, overproduction, time on hand (waiting), transportation
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Goal of 5S
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maintain a clean, well-organized workplace
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5 principles of 5S
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Sort - only essential items kept in work area Simplify - put things in order of use Sweep - identify and remove unsafe conditions. Put everything back at the end of workday Standardize - Train and enforce standard work. Audit and make changes Self-discipline - consistently train, enforce, and reciew standards and policies
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2 bin Kanban example
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When first bin is empty, that is the signal for it to be refilled
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Definition of par
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"safe" number of supply items that must be readily available
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Definition of buffer
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extra stock to meet variation in heijunka
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Definition of sleeping inventory
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that which is not needed
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Definition of kit
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container for all supplies needed for one operation
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Key kanban formula
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daily use X lead time = minimal required inventory
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Definition of kaizen
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continuous incremental improvement. Need kaizen officer or office that develops action plans and is totally flexible in thinking
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Basics of six sigma
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A business strategy developed by Motorola Focus on customers and processes that customers want improved Goal - elimination of all/virtually all defects Look for variation/defects in a process Variations/defects are removed through repeated curative effects
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Five steps of 6 sigma
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1. Define the defect 2. Measure - time/result/cost of defect 3. Analyze - get to the "why" 4. Improve 5. Control - maintain/sustain the solutions
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Seven critical flows of LEAN healthcare
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1. Patients 2. Clinicians 3. Medication 4. Supplies 5. Information 6. Equipment 7. Process Engineering
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Definition of a traditional X manager
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Bleak view of people -> w/ contempt. Assumes that people dislike work, responsibility or change. The way to manage people is to coerce them, threaten them, and tightly control them.
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Definition of a traditional Y manager
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Esteem and self-actualization are continuing needs for most people. People are/can be committed to quality, creativity, and productivity. Management should be: decentralized, delegated, broad.
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Characteristics of a LEAN manager
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Engaged daily with the details of the practice No delegation of details Create effective and clear value stream maps Primary guide to management is policy Constant collection and analysis of data to match goals Always visible/accessible In larger organization, implement cross functional management
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Licensure flow
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Graduate medical school -> temporary license -> graduate medical education -> full license -> practice
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Two key principles of hiring
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fairness and consistency
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Three key hiring mandates
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Hire the best; make them better; be an advocate for your employees
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Diqualifications of licensure
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Lying or withholding information Not having all required records Drug/alcohol abuse or dependency Child/spouse/elder abuse Failure to complete academic obligations Failure to maintain proper immigration status Violation of federal drug law Other felonies Medicare/Medicaid disqualification or fraud
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Summary of National Quality Forum
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Decrease medical errors by employing 30 healthcare practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients
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Five broad categories for improving patient safety
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1. Creating a culture of safety 2. Matching healthcare needs with service delivery capability 3. Facilitating information transfer and clear communication 4. Adopting safe practices in special clinical care settings or for specific processes of care 5. Increasing safe medication use
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Lease issues
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Total costs = rent + insurance/taxes/utilities Allowable uses Build out clause and allowance ADA accessibility Signage Indemnification/damages Term/Termination
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Medical record retention requirement for PA
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7 years
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Types of Insurances needed
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Malpractice Excess coverage (catastophic) Regulatory liability (audits) Business owner (business, property, general) Personal Umbrella Directors and Officers Fiduciary Employment Practices Liability Insurance Unemployment compensation Worker's comp
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4 types of risk
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High impact, low probability High impact, high probability Low impact, low probability Low impact, high probabity
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Main take-away from Benefits of kanban for Park Nicollet Health Services
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The waste was sleeping inventory. Kanban would keep better control of inventory.
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Main take-away from Flow of Clinicians at Virginia Mason
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benefit of one-piece flow
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Main point of Flow of clinicians at Park Nicollet Family Medicine Department
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Kaizen --> dictate at the end of patient appointments instead of waiting until the end of the day (standard work)
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Main point of Virginia Mason Medical Center, Cancer Institute
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Change type of schedule to cascade scheduling
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Main point of Virginia Mason OR
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Paradigm shifts from cost center to profit center, and to an expanding center without spending more money, getting a bigger facility, or adding more people
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Main points of Virginia Mason Hyperbaric Medicine
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1. Biggest tactical problem was bringing it in the building 2. How to get patients moved through the chamber --> Kanban cards 3. Biggest cost savings was using the 5 W's to avoid construction costs, and constructing the chamber in the current building
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Main point of Park Nicollet Primary Care Standing Room
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Problem with patient rooming. Inconsistent rooming caused issues
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Park Nicollet Type II diabetes
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What was the focal point in improving diabetes care? Blood testing
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Park Nicollet health service, case cart standardizations
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what was initial improvement? standardization of kits
