Want to Make Tremendous Gains at Your Healthcare Site? Use Process Mapping! | healthcare

I want to tell you some ways to eliminate waste at your medical site. Am I talking
about physical waste, like soiled bandages or used needles? No, I mean any action
that results in a poor or unintended outcome. I mean taking too long to accomplish
some outcome, like taking too long to get an operating room ready for the next
surgery. The National Institute of Health in “Crossing the Quality Chasm” stated
that any waiting time for a patient is a waste. A patient waiting past the time of his/
her scheduled appointment is an example. A patient having to wait too long to be
admitted to a hospital after being seen in the emergency room is an example of
poor processes–a waste. A patient who develops an infection after being treated or
going through surgery is a good example of waste from unintended outcomes.
These are just a few examples. I am sure that you are aware of many more.Japanese manufacturers are leaders in eliminating waste. One trick they use is to
send a new employee to the manufacturing floor and have him/her watch someone
performing a task; the new employee is told to watch until he/she sees a better way
to do the job. These manufacturers know that the time spent doing this will save
more time and money in due time. Hospitals and healthcare sites are not
manufacturing plants, though. Yet many of the same principals can be applied. The
effort will more than pay for itself. In fact, savings of 3 to 100 times the investment
is not unusual. The movement going on in the healthcare field adapted from the
Japanese manufacturers is commonly called “lean healthcare.” Perhaps you have
heard of some of the terms associated with it, like Kaisen events or poka-yoke. You
don’t have to be a master of these tools and terms to make good use of them,
though. Many are just applying logic with common sense.The tools are best applied in efficient working teams or groups where some
problems with processes or outcomes are already agreed upon. If the working
group is larger than 3 or 4 people I suggest that one tool you use are string and 3
by 5 cards. You are going to use these to map out a process from beginning to end
and see if the group can find waste and suggest ways to eliminate it. Use the cards
to describe what physically happens during a process and use the string to connect
the activities that flow from one to another. For example, you might want to track a
patient in a doctor’s office coming in for a physical. The first card would represent
the patient’s encounter with the first staff person who records the patient’s
presence. From there, strings would indicate communicating with other pertinent
personnel of the patient’s presence and the ensuing events as well a string and card
that would indicate the patient waiting in the waiting room. In all of these mappings
you should be thinking of what you would like to use as variables to measure. You
certainly should be measuring time by all involved parties. You might also want to
count the number of successes/failures in communications. Many unintended
consequences occur at transition points and handoff points due to poor
communication. You might count if a supply was missing and someone had to
scurry to find another one. You will want to later find the mean and standard
deviations of these measures. The goal is achieve a target mean with as small as
possible standard deviation. For example, you should have 0 as a target for the
number of times a supply was missing.After reaching a mapping that all agree represents as best as possible the present
flow of events, the group should brain storm ways to improve the flow. The goal is
to find a significantly better path. If a consensus is reached, fine; implement it. If
not, then perhaps you will want to try the various ways and then decide which is
best, based upon agreed upon measures of outcomes.Once an optimized process is developed by the staff, you should write it down.
Make it a standard operating procedure and try to have all involved parties adopt it.
You might want to allow a little bit of wiggle room for individual differences in
performing a task; the goal of a common target with small standard deviation
should the goal of all, though.Another tool to use is open communication. Too often a staff person or nurse will
see some event unfolding that will lead to poor outcomes. If the work environment
is not conducive to positive communication–communication which does not result
in negative outcomes for the reporting individual–mistakes and waste will always
occur that could easily have been prevented. To reach a high level of positive
communication, the leaders at a site must work long and patiently to build trust. It
is not easy to do, but the payoffs are tremendous. Everyone wins!Most healthcare leaders think of quality improvement as applying to activities that
directly involve the patient. However, the best healthcare providers use these tools
and others to evaluate all the processes at a healthcare site. The admissions and
billings departments are ripe targets, for instance. The result will be happier, more
motivated employees who are working more efficiently. In fact, sites which were
experiencing a shortage of staff often finding themselves well staffed because of
quality improvement processes. I do suggest that you promise all employees
involved in these processes that you guarantee there will be no layoffs. Doing so
will produce better outcomes.If you want more examples of system wide applications of quality improvement in
healthcare facilities, I suggest that you go to the Baldrige Award site on the internet
and read the success stories of winners. Their results will amaze you, I promise.I hope that you seriously consider adopting these tools and research other methods.
Many are described at various healthcare sites. Two of my favorites are Institute for
Healthcare Improvement and the American Academy of Family Physicians.

Why Use a Licensed Freight Broker of Transportation? | transportation

The Right Kind of Freight Broker SavesSomeone who controls the freight in any buy/sell transaction can benefit two ways by either earning money or saving money on the selecting of and payment for the transportation.By engaging the services of the right kind of Licensed Property Broker of Transportation, a Shipper or Buyer is outsourcing essential transportation management: Rate Survey, price negotiation, carrier selection, contract writing (by the load), and contract enforcement over the carrier. He is at the same time freeing up valuable time that can be used productively in other ways. Transportation management fees are contained in the freight cost per shipment, which are at or below the actual Average Market Rates.1) A SELLER can EARN MONEY on transportation by selecting and paying the transportation provider (Broker or carrier) himself and invoicing his customer for the freight by the “prepay and add” method. That is, to sell his wares with a delivery price as a line item in the sales contract labeled “Ship Best Way…$Amount”.Some sellers do this cost effectively for their customers (preferred) and many do not. It is legal and ethical to modestly mark up the transportation cost to arrive at your invoicing figure. Your earned Mark Up is for providing a legitimate service to your client by hiring a transportation provider to his benefit (he simply orders your product and waits for its arrival. Prepaid-Ship Best Way, F.O.B Destination).Supplying an accurate Bill Of Lading (BOL) to the consignor’s shipment loading location (Origin) is essential. Freight Brokers can draft a proper Bill of Lading for you for each shipment and fax or email it to the point of origin for use by the consignor (Shipper). The Bill of Lading is a very important document. This document spells out legal obligations to the carrier and all parties concerned: what is being transferred (Description), who the property is being transferred between (the Consignor and the Consignee), who is paying the freight charges to the carrier (“prepaid”, “collect”, or “third party”.) The Freight Broker is “third party” for all carriers supplied. The Bill of Lading documents that temporarily the shipment is in legal responsible custody of the Carrier while in transit. In addition, this documentation specifies at what point responsibility for freight damage claims against the carrier, if any, transfer from the consignor to the consignee. The notation will usually be either “F.O.B. Origin” or “F.O.B. Destination”. F.O.B. means “Free On Board” indicating that the consignor is free of responsibility for damage claims against the carrier at the point designated. The F.O.B. point is a negotiable item in the sale.2) A BUYER can SAVE MONEY (“a penny saved is a penny earned”) on transportation by selecting and paying the transportation provider (Broker or carrier) himself, electing not to have the seller do it for him. He buys a product, selects the transportation provider, who is also interested in the shipment from beginning to end. Not as simple, but he is earning money by saving money, he is providing this service on behalf of himself.This frees him to get the best deal on freight on his own, with his own negotiating power and the expertise of his Freight Broker. The company that provides the Transportation service can also be a valuable partner in gathering all the tedious load information that is prerequisite to finding the right carrier, with the right trailer, at the lowest possible price for the buyer.CARRIER PERFORMANCE ENHANCEMENT occurs when using the right kind of broker. A good broker is recognized by the carrier industry as an important credit approved large volume customer; as well as an industry partner who is able to affect his carrier reputation among his wholesale, freight broker, customer base, for reliability in the fulfillment of spot market hauling contracts. Every load is contracted in writing by the Broker to the Carrier. Through a main Internet Load board Carrier and Broker Performance Report postings and reviews, Brokers and Carriers have the ability to effect one another’s reputation publicly.This exertion of positive and negative pressure has a very good influence on both parties towards honoring each contract (load). That is why a good broker writes a detailed contract for every load tendered to a carrier. When you order Transportation service for a load either by phone or email, your broker gets busy with price negotiations, contract writing, and enforcement.The right kind of good and reliable transportation brokerage benefits shippers and carriers, enabling them to save precious time and money in today’s economy. Outsourcing to a Freight Broker who will professionally supervise your shipment and enforce your targeted transportation budget, will give you greater control of the best outcome.

Internet Marketing Consultants – Prepare Your Clients For the Video Revolution | graphic multimedia

With the video revolution under way many small businesses are wondering how they can start to use this medium to promote themselves. Internet marketing consultants can also show you how to leverage your video content across video hosting sites such as You Tube to increase traffic and authority and search engine ranking.So, this week i will take you through the process and show you exactly what tools are used and how to make your own promotional videos. Lets start with the basics…1) Computer – I recommend using an Apple Macbook to do graphics, multimedia and music on but there are numerous programs for the PC.2) Software – Screen Flow, Final Cut, PowerPoint3) Video Footage – Go to istock.com, sign up and gain access  to a multitude of graphics and video footage. Its not cheap, but it allows you to quickly produce great material using really high quality footage.4) Enbedding the video – We use ‘Screencast.com’ to host our videos.  The service allows you to upload videos and provides you with the ‘html code’ to embed the video on your site. It’s as easy as copy and pasting the code into the page.  We have tried many other video hosts such as Viddler but find the quality is reduced through compression. ‘Screencast’ retains the original quality of the video which is essential when using a combination of slide shows and video.  The service costs around $10 per month. Screenflow is available  for the mac and costs around £80.Got the tools? Time for the process…Obviously your own footage is best but for those starting out using videos you may wish to collate material form other sources.  A simple way to start off is to using PowerPoint, create a presentation and download video and graphics as you need them. PowerPoint allows you to easily embed multimedia footage into the individual slides and add descriptive text.- You can also add ‘actions’ to text boxes allowing you to control when and how it appears on the slide. (This is usually controlled by clicking the mouse)- Build your presentation, taking note of – how long each slide appears for and  does the presentation convey the message you want?- Once you are happy with the slide show,  it is time to record the presentation using ‘Screen Flow’.- Configure the recording/ set up the slide show and Record.A good guide for each slide length is if you read it through slowly each time before clikcing the mouse to move to the next slide.Screen Flow will allow you to add extra footage such as live screen grabs and music. When you are happy, save the presentation and export it as a Mov file selecting the highest quality conversion and desired dimensions.Now, simply upload the mov. file to Screen Cast and  it will provide you with the code to embed to your web page.Yes,  it takes  time to get right but after a  fair amount of trial and error you will be there! The creative opportunities are endless and it allows you to create fresh marketing material that really stands out from the crowd.