Where is money wasted in healthcare?

[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.

[amateur]

i dunno:uhoh3:

[vandermom]

Fill the "RED BAG" with non truly biohazard waste. It is not necessary to place every chux or dressing in those containers... they should soaked to qualify (known infectious excluded). If a red bag is he closest thing available then it is used for almost everything.

[Tina1968]

I believe that there is a lot of waste in medicare and medicaid due to inappropriate mental health care and care concerning the developmentally impaired. I am in home health care for the developmentally impaired with comorbid mental illness. It seems as if this is an "undiscovered" field in that government services together with healthcare services are not sure exactly how to provide for these individuals. The majority of care that I provide is daily home care assistance, however, many of my clients require professional mental health care and (usual) health care services as well. I find myself assisting my clients to emergency department care almost regularly and primary care weekly for incidentals. My clients are covered almost 100% for their care, provided I produce discharge paperwork and primary care paperwork. A lot of my clients are mentally ill and the majority of their ailments are considered frivolous and non-emergent, but my hands are tied, in that I must respond to any medical complaints, be it serious or unfounded due to the agency I work for and their responsibilities.

I am almost feel ashamed to admit that this is very frustrating to me because a great deal of the time, my clients refuse their medications (fully paid for by the state) and they end up flushing them down the toilet after they have been paid for through tax funded assistance.

I see much waste in my field, and it is very frustrating!

[A New Start]

I'm just a lowly 52 year old pre-nursing student, but your subject is one of the biggest reasons for me to enter nursing. I have been a quality control tech.

You are not looking for industry wide waste. You are looking for your personal and your team's errors. Study YOUR processes causing waste and errors at your facility. Work on the problems that belong to you. Six Sigma gives you the tools to find the "low hanging fruit" that's easy to get and it will help you become a stand out leader in whatever you are leading.

Sorry about the lack of easy quick answers, but if you spent a week studying Six Sigma, you know what I'm talking about. Get those groups together and do fish bone charts. Start there. No one knows the problems better than the people doing the work. No one has more knowledge for reducing pressure sores than your CNAs. But they have to be involved, inspired, and empowered to do it. They know what's getting in the way, but do they have a voice in changing the things that get in their way?

My concern for this industry is that it punishes the reporting of errors and it wants to do Quality improvement by inspections and surveys. All that is down stream of the causes and effects. Punishing error evidence pushes the evidence underground. Other industries do less of this. Remember, we are attacking systems, not people.

I was thrilled when I read my first account of Florence Nightingale. She was our example. Remember, she improved her death rate in her field hospital from 40% to low single digit loss during the Crimean War. She used statistical analysis to do it. She was not looking for people to blame. She was looking to improve methods, materials, environment, and protocols.

Please embrace the possibility of what you can do with the knowledge you now have. I wish I could work for you.

Remember, people resist change. We all do it. Homeostasis is not just physical. It's psychological as well. In fact, all systems seek homeostasis.

That's why you're reading all the nay saying on this topic. But if you pull the problems and the solutions from your own people, they will soon feel like they can truly make a difference. And they will. Step up leader! Believe!

Gary

[LadysSolo]

Excuse me but I DO have a Living Will and Durable Power of Attorney for Health Care, and despite the fact that I am only in my mid-50's and really would like to see my grandchildren, if I have a high (or low, for that matter) spinal cord injury or other condition requiring that I be put on a vent or am unable to do my own ADLs, NO THANK YOU!!! Let me go!!!!

[guislander]

How about the patients that are admitted multiple time in a single year for "chest pain", but have no postive cardiac markers, no postive stress test, no ct that shows PE, but the patient wants dilaudid q2 hours for chronic pain they have at home. Pt stays for 3+ days each time. Is discharged from one hospital and goes to another in less than 24 hours for same complaint to get more dilaudid.

[linda535]

My company also recently went "LEAN", a la Toyota, with all the Japanese catchwords, philosophies and especially hired profe$$ional facilitators. This led to multiple "events" which were week-long (and sometimes longer) committee meetings (catered lunches provided), where everyone brainstormed to try to figure out how to save money and time for the patient. In the background, the regular departments went without needed staff or got "float pool". The kicker is that many of these wonderful-changes-to-save-money have gone by the wayside because they didn't work in the real world, or actually annoyed the patients.

I believe my company is really trying to cut healthcare costs, but some common sense has gone by the wayside.

Linda

[NYCRN6]

I actually took that class. Very interesting and good thing to have on your resume.

My project was simply about the clean utility room and products left that were unused at discharge in precaution rooms. Some were over 40 dollars for 1 discharge.

Some people did the kitchen/dietary area. Others did huge projects taht I didn't have time for since I was a staff nurse working 32 -42 hours a week. You have to have a narrow scope for your project. VERY narrow. Or else you will be changing the world. Where do you work?

[texashyles]

Seems like a lot of families want EOL pts to remain in the hospital rather than move into Hospice because they don't/can't take turns taking care of their loved ones who took care of them for years. Throw away society? No use for the elderly? No respect, I think. There comes a time when we all must change our schedules and work together as family and friends of a pt to care for them in this special end time.

[ShayRN]

Seems like a lot of families want EOL pts to remain in the hospital rather than move into Hospice because they don't/can't take turns taking care of their loved ones who took care of them for years. Throw away society? No use for the elderly? No respect, I think. There comes a time when we all must change our schedules and work together as family and friends of a pt to care for them in this special end time.

I think it is more of a fear of taking care of loved ones. It use to be people were always taken care of in their homes, how many of us saw that growing up? If I wasn't a nurse, I wouldn't know what to do. How to change a bed with someone in it. Besides, I think we forget as nurses how difficult it is for those outside of health care to clean dirty butts of adults. To empty a cath for some may be a VERY big deal.

Besides, with this economy the way it is, even I would be hard pressed to take more than a week or two off (unpaid) to take care of a loved one, and I think my job is pretty secure. There are those who are trying to do everything possible to stay under the radar so they can keep working. I don't think my grandmother would be upset if I continued to work while she was sick if it meant I got to keep my home, she isn't that selfish.

[RN Randy]

I am almost feel ashamed to admit that this is very frustrating to me because a great deal of the time, my clients refuse their medications (fully paid for by the state) and they end up flushing them down the toilet after they have been paid for through tax funded assistance.

I see much waste in my field, and it is very frustrating!

There's another one. Not just the med cost, but the added long-term cost.

Please don't let people flush medications....

http://www.dec.ny.gov/chemical/45083.html

rb

[kbrn2002, ADN, RN]

Its also a matter of the doctors on the case just being honest. How many times have you had a patient's family member say "they never said he could die!"

Also, how many drugs get wasted because they are narcs? We have had entire bottles of Roxanol wasted because a patient dies before it is opened and you cannot reissue a narc. Other scripts can be sent back for credit, but not narcs, its stupid.

agree 100%! Where I work it's noc shift [my shift ] responsibility to destroy narcs. What a waste! We get an order for roxanol, ms etc for a dying pt, the pharmacy sends enough to last a month [we don't have an in house pharmacy] and the pt dies before even using one dose. A waste of money and of nursing time spent in the med room destroying drugs and documenting it instead of working on the floor doing something productive.

Unfortunately, since this is a federal law, I don't see it changing anytime soon