Suggested Readings

"Overspent, Overdrawn, Overwhelmed: Reducing Health Care Costs"

"Going Lean in Health Care"
Primary Author: James Womack
White Paper, Institute for Health Care Improvement, (2005)
"Lean thinking begins with driving out waste so that all work adds value and serves the customer's needs. Identifying value-added and non-value-added steps in every process is the beginning of the journey toward lean operations. . . . Examples in this paper of lean thinking in health care demonstrate that, when applied rigorously and throughout an entire organization, lean principles can have a positive impact on productivity, cost, quality, and timely delivery of services."

"Achieving and sustaining improved quality: lessons from New York State and cardiac surgery"
Primary Author: Mark Chassin
Health Affairs, 2002
"Since 1989 the New York State Department of Health has published annual data on risk-adjusted mortality following coronary artery bypass graft surgery by hospital and surgeon. It was the first such program in the nation and is now the most long-lived. Many hospitals were prompted by the data to improve their cardiac surgery programs, and statewide mortality fell substantially as a result. This paper examines what physicians and hospitals did in response to the data, how the market reacted, and whether this approach to quality measurement and improvement could be used more widely."

"The implications of regional variations in Medicare spending I and II"
Primary Author: Elliot Fisher, M.D.
Annals of Internal Medicine, February 2003
"Using end-of-life care spending as an indicator of Medicare spending, the researchers categorized geographic regions into five quintiles of spending and examined costs and outcomes of care for hip fracture, colorectal cancer, and acute myocardial infarction. Residents of high-spending regions received 60 percent more care but did not have lower mortality rates, better functional status, or higher satisfaction."

"The Effects of Medical Group Practice and Physician Payment Methods on Costs of Care"
Primary Author: John Kralewski
Health Services Research, August 2000
"This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected."

"Managing Unnecessary Variability in Patient Demand to Reduce Nursing Stress and Improve Patient Safety"
Primary Author: Eugene Litvak, Ph.D.
Joint Commission Journal on Quality and Patient Safety, June 2005
"Increases in adverse clinical outcomes have been documented when hospital nurse staffing is inadequate. Since most hospitals limit nurse staffing to levels for average rather than peak patient census, substantial census increases create serious potential stresses for both patients and nurses. By reducing unnecessary variability, hospitals can reduce many of these stresses and thereby improve patient safety and quality of care."