Actually, let’s use an example of caring for the elderly and disabled, since I ran one of the largest home care companies in the country. There are many ways productivity could be improved in caring for the elderly and disabled. I employed 42,000 caregivers. So, let’s look at a few ways productivity could be improved.
About 20% or more of our staff was involved in “visits”. We were in the midst of increasing the number of visits a caregiver could complete in a week by 25%. We were already much higher than hospital home care agencies whose staff average 15 visits (3 per day) a week compared to our 20 (4 per day).
Better logistical planning alone could have increased visits to 5 per day (according to Medicare these visits should average 20–40 minutes, my own personal experience with home physical therapy says that is about right). So “visiting” staff spend 7.5 hours per week with patients, our goal was to increase that to 12.5 hours per week. And I think there was room to improve on that.
The inefficient scheduling used by most health care entities do not use sophisticated algorithms like those used by FedEx and Amazon to route their staff, so visiting nurses are spending way too much time getting from A to B instead of delivering care. Often more time in their cars than with patients.
Interestingly, since we paid our staff by the visit instead of per hour, our nurses, PTs, OTs, etc. were pretty excited about seeing their productivity increase along with their pay.
At the time, we were working on improving the logistics of scheduling and commuting between assignments, we were also working on inventory systems and data capture. Nothing is less efficient than a nurse showing up and not having the right inventory in her trunk for the visit. Or spending a great deal of time doing paperwork or using a medical protocol that has since been proven obsolete (especially under the new Medicare episodic reimbursement system).
Bottom line, the initiatives would produce better outcomes, better data capture, higher pay, higher revenue, and more care per worker delivered. A neat feature was the dial in feature that confirmed the location of the caregiver proving they had visited the patient and feeding directly into the payroll system so no “time or visit” sheets were required.
The back office of most home care agencies is so bad that it is hard to describe. Interestingly, most companies have seen almost no gain of productivity after investing heavily in productivity equipment, since the work standards are rarely updated.
To address this issue, we began to explore how to make the “computer” the worker and the individual its support staff. The essence is the computer began to do as much of the work as possible and make most of the decisions, while the individual provided the human interface and emotional component needed for successful human interactions.
So, if you were a nurse, the computer selected you as the person to call based upon your work history and your skills, where you lived, where you would be going. The computer then initiated the call, the scheduler would then be put into contact with you to explain the assignment, if you said yes, you were scheduled. Alternatively, you could have the computer run your schedule and you would get emails to let you know what was what.
For continuous care, there are several options to increase productivity. One has been the development of “not quite” assisted living locations where say 60 residents live in a senior apartment with a floating home health aide to assist with daily living needs. This model makes home health aides almost three times more efficient yet preserves many of the joys that go along with independent living and a personal relationship with a home health aide.
The worst pay largely goes to companions and entry level home health aides who do not bring many skills to the job. We found some of the best “companions” are empty nester “young” elderly people that want to spend time with other older seniors and earn some needed supplemental income. It is easy to make this group more productive, they go from working zero hours to working 24–30 hours a week. But they are constrained from working to much since the government begins to claw back their social security if they earn too much… something that should change.
But it’s not just home care… I ran two physician groups that had over 400 physicians in them. Whether you are using better scheduling systems or physician extenders you can improve productivity dramatically. Through better scheduling we improve physician visits from 15 per day to 28 per day and according to the health plans we contracted with our outcomes were better… this part was not related to our productivity but through the effort we put into creating a great referral network and not one based on personal relationships.
Another area we improved productivity was eliminating our referral clerks and not contracting with health plans that required referrals (that was only possible since we were about 30% of the primary care access for a large geographic area… so it was us or no one). We were happy to meet with insurance companies and address referral issues they had with our physicians, but prior to this change we had 32 referral clerks probably talking or on hold waiting to talk to 32 people on the other end of the phone and no value was being created in the health care system.
Now let’s move to the fact, that CMS (I was an executive for one of CMS’s largest contractors of Medicare). CMS estimates almost 30 percent of care delivered by people do little or nothing to improve patient quality of life or extend their life. 30%! Eliminating this wasteful care would not only make these people more productive producing useful services but lower the cost of health care in this country to within reach of what Europe spends on health care.
Productivity is not just people worker “faster”, but more often more efficiently or the elimination of non-valued added paperwork. I remember taking over an accounting department early in my career that had 28 people in it producing reports for the company key management. Within a year we shrunk the staff to 16 people and got the work done in less time simply by reviewing everything to determine how to best get the information to the top executives with the least amount of duplicate and redundant effort.
There are some jobs, that most likely won’t lend themselves to significantly more output per worker. But as overall productivity improves, the benefits accrue to everyone if through no other way than lower prices for goods and services.
