Where is money wasted in healthcare? - page 6

Some time ago, I took a week-long class in a process called "Six Sigma", which began in industry and has now migrated over to health care. Officially, it is known as a "process improvement" effort,... Read More

  1. by   reiver71
    I think spending resource $$ to try to adapt the latest industrial trend to a healthcare model is wasteful. Hospitals I've worked in have tried to incorporate these types of programs since it became popular to do so and have usually failed....Why? Because we deal with people and not commodities on an assembly line. We're anxious to get people trained at the various belt color levels so they can engage in busy work projects to save the parent company money. But what's the effect on patient outcomes/satisfaction? What's the effect on the staff that has to work short? Or without tangible resources? Our supply room was "leaned", and the result was that we are often out of the basic necessities required for patient care. That's efficient. Our break room is going to be "leaned" soon.....a project that I'm pretty certain that the patients I care for could care less about.
    I don't believe patients care how many "black belts" are on the staff; they just want to know that they will receive appropriate, competent and empathetic care. We can become so focused on the process that we forget about the person.
  2. by   rph3664
    Quote from Katnip
    I agree with the time it takes to do redundant paperwork.

    Enormous numbers of dollars are spent on futile care because a family member doesn't want to let go. Hospital admins need to grow a pair and say we've done all we can, try to sue us. I recently saw a case in New England somewhere where a family sued because the hospital refused to override a patient's advance directive. Judge wouldn't even look at the case saying the advance directive was a legitimate, legal document and they had no right to override it. We need to see more of that.

    And speaking of lawsuits...they need to stop or drastically cut back. Greedy lawyers go after scared, grieving or greedy families. Yes, there are some cases of malpractice or negligence where compensation should be awarded. But things go too far. Even if a hospital or other defendent wins, it can cost a huge amoount of money and time to defend the case.

    Also the quick readiness to sue leads to more and more unecessary tests so doctors can cover themselves.

    Spending money on cosmetic items rather than patient care. Will that grand piano in the lobby actually help a patient get well? How about the marble tiles, the original paintings, etc? Put money where it can help.
    My hospital has two grand pianos in it. Both were donated by people in the community, and volunteers come in to play them. One of them at my hospital is the father of a co-worker who did it several times a week until he recently had a stroke at age 92. The artwork in the lobby and both pediatric wards (regular and psychiatric) was donated as well.

    Our hospital has spent millions of dollars over the past few years on a computer system that has probably caused way more problems than it has solved. :angryfire

    One of my co-workers refers to the aforementioned program as "Six Sigmoid."
  3. by   rph3664
    Quote from country mom
    Not to mention that better packaging could potentially mean less solid waste ending up in landfills. Some other posters mentioned pre-packaged kits. I know they can be handy in some cases, but take a suture removal kit for instance- those metal scissors going into the sharps waste, when they could be sterilized and used again. I've always wondered about those expiration dates too- maybe a scam so facilities have to buy more supplies?
    I think it's more about rotating stock. Did you know that paper products in grocery stores now have expiration dates?
  4. by   rph3664
    Quote from Pierrette

    I wouldn't make the decision based on age -- but on the person's history, current condition, and prognosis. Just 2 years ago, my step-father's kidneys failed and he needed dialysis for a few weeks. He was in his early 80's ... and prior to that bout of pneumonia and sepsis, he was fully alert and physically active. Even during the height of his infection, he was fully alert, oriented, etc. Within 24 hours of being on anit-biotics, his condition began to significantly improve. He was discharged to home in approximately 10 days and off dialysis in 1 month. Within 3 months, he was playing a little golf again.

    So ... yes ... in his case, dialysis was worth it. He had an acute illness that interrupted an active life. Anyone with any common sense can see the difference between such a scenario and one in which the patient has had severe dementia for a couple of years, unable to care for themselves, not enjoying life, etc. -- patients for whom their current organ failure is NOT the result of an acute and curable illness, but rather the current stage of their of the death process.

    ...And no one in this thread has suggested that there be some mandatory age at which further health care would be denied with no regards for the specific circumstances. To suggest such is to put words in our mouths. What we are suggesting is that a whole lot of money is spent on people (usually elderly) who have no chance of returning to a meaningful, happy life. We should develop a culture and systems whereby such cases are guided to services more appropriate to their situations and not waste scarce, valuable resources on false hopes and unrealistic expectations. If God is going to intervene and make a miricle, he/she doesn't need us to waste our resources to get it done.
    Our hospital's cardiac surgeon has done CABGs on people in their 80s. Some people might find that unethical, but if the person was active and otherwise healthy before, I don't have a problem with it.

    Some people who are not in health care think we should do away with life support. Good heavens, if you have had general anesthesia, you have been on life support! The overwhelming majority of people who go on it, come off it within a matter of hours or maybe a few days, and recover completely or nearly so. That's why it exists in the first place.
  5. by   irisorchid
    Poorly organized units and supplies, filing systems, etc. The places I worked recently seemed to stock and file things for the convenience of the stocker, not the nurses who are using the supplies. In one place, the Pharmacy dumped a pile of IVs in a box and the nurses had to sort them out and put them on shelves (over some nurse's heads) and you had to handle several IVs to find the one that you needed. I think a new person on the floor should be able to find what they need in less than a minute. When a nurse makes $45-$55/hr on the the floor, they are paid $0.75-$0.95/min. If each nurse is spending excess time trying to locate the supplies that they need every shift that really adds up over a year, not to mention the daily stress and frustration and overtime at the end of the shift trying to get charting done. This is time better spent doing pt care or charting.
  6. by   muffylpn
    its labs oh my God its the labs-I work on a Geri-Med-Pysch Unit (GMPU) so u need 2 have 2 conditions
    to get on my unit; which also means 2 different doctors. 1 of which is a hospitalist who changes every
    12 hrs. Constant repeat of labs and even when u see that the same labe was done yesterday and it
    was normal u would have to call a different doctor to get it d/c and they never d/c them.
  7. by   irisorchid
    Hospitals need to solicit input from nurses and ancillary help before they design a floor or new wing. I think we have all worked in places that were designed poorly. Example: A floor was redesigned in a local hospital recently. My friend who worked there asked me--"What would you do with the rooms nearest to the nsg desk?" "I'd put the sickest or confused pts there so I could watch they better." Of course, but the architect/hospital admin decided to put a visitor waiting room across from the nurse's station! No place to put those confused pts, not to mention trying to communicate at the nurse's station without violating HIPPA. Millions of dollars spent on a remodel that is going to cause all kinds of problems for the staff who has to work there 24/7 for years and years.
  8. by   DeepFriedRN
    Quote from ShayRN
    Sorry- the real crux of my argument with you is your arbitrary decision of basing someones LIFE on whether they are "existing" vs "living". There are many ways to justify this "saving of money", and each one is as zany as the last. Should we select people who don't contribute to society? Should we pick people who are going to die anyway? Should we pick people who have serious diseases? Should we only pick the poor people?

    Please don't fall into the thinking that money is more important than life itself. What benefits a person if they gain the world, but lose their soul? The money you save anyway will not go toward anything good; it will simply make rich people richer. Which doesn't include you or me.
    The problem with your argument is that you assume these people are LIVING. The people I think Shay is referring to, their bodies are doing the best they can to die, which is the natural course for each and every one of us. If their bodies had their way, these people would have already passed. Going to these extreme measures to keep their bodies alive is the "arbitrary decision" being made, WE have decided that they are GOING to live, no matter what it takes. It's not always about the monetary cost, either. The process of drawing out someone's death in this manner is draining in others ways, as well. Mostly for the body that we're doing it to.
  9. by   RN Randy
    Quote from ShayRN

    What would be the cutoff age for aggressively trying to save a life rather than letting nature take its course? Have we not seen miracle patients come back from what we thought were impossible odds?
    In Europe I believe they start adult cut-off ages around 65 and go from there, depending on Dx.
    Not so much cut off of care, but of funding for said care, which usually results in cut off of care....?

    As for Corporate America,
    The only hope for the US health system is a prayer that we can revamp it correctly after the collapse.
  10. by   DeepFriedRN
    Quote from thinkertdm
    Concentration camp survivors existed. Would you have preferred them all to have died?
    I would just like to ask who will be deciding who lives and who dies. The insurance company?

    Also, I see SCI patients with a high cervical injury, all with a vent and no chance for recovery. These people are little more than heads, with no ability to move, and will ultimately cost far more than a 95 year old on a vent. Should they be "allowed to die"? Many other people are included in your "existing vs living" analogy.

    Be offended all you want. Deciding who should live and who should die all to save money, comparatively meaningless bits of paper, is inhuman.
    And to address this, I'd just like to add--if these cervical injury patients who are vented are alert and oriented, then they DO still have a chance for a meaningful life. They can still laugh at a joke, read or tell a story, think, share. It's not the same life you or I will live, but it can still have meaning. I, for one, find it "inhuman" to keep a body that is trying to die, alive. If someone is dying, they are dying. It's not abitrary, it's a fact.

    You know, my mom used to say something to me when I was a teenager. (Usually in reference to my too-short skirt, LOL). She said, "Darlin', just because you can, doesn't mean you should." I think that is true in so many situations in life, this included.
  11. by   dotherightthing
    Quote from country mom
    some time ago, i took a week-long class in a process called "six sigma", which began in industry and has now migrated over to health care. officially, it is known as a "process improvement" effort, but long story short it's about cutting costs and saving money. the six sigma process was designed by engineers, so it takes months and months of measuring, graphing and data collection to get the end result. i'm a "cut to the chase" kinda girl, so would love to hear where other nurses are seeing wastefullneess in health care. big things, small things, whatever.
    may as well start with the smaller stuff. i don't remember the cost of the last band aids i bought but i can assure you that one band aid didn't cost 5 bucks or $1.00. $5.00 for a box of 30, maybe, which breaks down to about 17 cents per band aid-so charge $.25 then or $.50 then. charge near the real price for an item or service, build in some reasonable amount for the uninsured, but don't budget for a hospital president's $12 million per year salary. or $2 million for that matter. if an mri machine costs $150,000 to build, don't charge $1 million for it. these are the kinds of things that drive up the cost and each consumer, whether it's the hospital buying an mri to the person who needs the test.....each is being held hostage by the need. and don't even mention the insurance companies who are working based strictly on numbers,not the individuals who need a service. give every person health care and see how easily prices come down.
  12. by   RN Randy
    Quote from thinkertdm
    Concentration camp survivors existed. Would you have preferred them all to have died?
    I would just like to ask who will be deciding who lives and who dies. The insurance company?

    Also, I see SCI patients with a high cervical injury, all with a vent and no chance for recovery. These people are little more than heads, with no ability to move, and will ultimately cost far more than a 95 year old on a vent. Should they be "allowed to die"? Many other people are included in your "existing vs living" analogy.

    Be offended all you want. Deciding who should live and who should die all to save money, comparatively meaningless bits of paper, is inhuman.
    Wow thinker, what part of "hopeless case" are you not getting?
    No one is saying there should be a decision of who lives and who dies, sheesh.
    If your prognosis is zero then it's zero. The discussion is about keeping bodies stewing in the ICU.

    Just because we can keep a zero-prognosis carcass alive long after it dies and even starts to rot, doesn't mean we should.

    If I'm told I have 6 months to live r/t whatever disease, then I plan to have a really cool 6 months.

    However; they say if they spend a simple 2 million on me, they can guarantee that I live another 3-4 months, so is it fair for me to suck up that 2 million that could have been spent on research for a cure to BILLIONS of people? Could have been spent on 200 other folks under age 18, that only needed 10 thousand each to get through the ER or ICU after the drunk hit them, to live on another 75yrs and become scientists that use someone else's 2 million to find the cure? Could have been spent on 2000 other people that only needed a doctor visit and run of antibiotics to live? Could have been spent on....... ?????

    Who are you to decide who has to die because you think your way is the only way?

    If you ever get the chance to come out of your expensive, sterilized world and visit people who are truly in need, people who are truly sick, people who's hope of life rests on a $4 injection they can't afford or even find... please do. You'll be so amazed at how blind you didn't know you were. You really *can* live without 75% of the stuff you *think* you need.

    Wanna save money? Stop letting the water run non-stop when you don't have to. Stop leaving lights on. Stop letting equipment run in the corner if it isn't being used. Stop using disposables when you don't need them. Stop breaking open those kits to get a single item out because you're too lazy to go find what you need. Stop taking equipment/supplies home to operate on your cat. Stop running flyers for your little league team at work. Stop allowing others to 'live and let live' as *YOU* watch them waste the very money you're crying about here, while doing nothing about it. (etc, et al, ad nauseum)

    Still though, if you find this magic money-tree that seems to be the root of your ideals, please tell us where it is.
  13. by   howardrgreenberg
    I haven't read many of the messages in this thread which has received a massive response, but I will say that waste and inefficiency in health care, re Paul Krugman (NYT columnist, Nobel laureate, MIT economist professor, etc) is in the insurance. As it is said, we have an insurance crisis, not a health care crisis. The 3d party system, e.g., the Blues, render the system massively redundant and inefficient. According to Paul, there is no need to ration and take other extreme measures. We need single-payer, to wit Medicare for all. That will not happen until the system kills the country's economy, because we don't act sans a massive crisis. And even then we might not act.

    The reason little change will occur without a meltdown crisis is the baby boomers, Big Pharma and the AMA.

    That is my two cents.