Foreign lessons in hospital efficiency

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MARCO WERMAN: The high cost of healthcare in America was addressed at length by the president last night. Mr. Obama argued there's so much waste and abuse in the current healthcare system that making more efficient would provide a way to expand coverage to the nation's uninsured. That's a message Boston University professor, Eugene Litvak, has been promoting for years. Litvak is a Soviet-trained management consultant who now advises US hospitals on better ways to manage the flow of patients. The World's Katy Clark has more.

KATY CLARK: Eugene Litvak is an unlikely profit. He learned the art of efficient business operations in the notoriously inefficient Soviet Union. But Litvak says his outsider status helps him when it comes to addressing the inherent waste in America's healthcare system.

EUGENE LITVAK: Many people who were born in this country believe the healthcare delivery system should not be even touched because it just was this way forever. I don't have this baggage and many people just forgive me because believe that this guy is Russian, crazy; he just doesn't know what he is doing.

CLARK: But Litvak does know what he's doing. It's called operations management or the art of meeting customer's needs as efficiently as possible. Operations management is common in other industries � making cars for instance or making donuts � but it's relatively new in hospitals. Litvak says running a hospital is a lot like running a restaurant.

LITVAK: If you want to increase customer throughput through the restaurant we have only three means to do that. The first one you would ask your diners to eat quickly and you would ask your waiter to serve them quickly. That's the first option. Second option you build more restaurant tables so you make sure you accommodate more people. That's how you improve access to your restaurant. And finally the third option that you make sure that your tables are not staying idle.

CLARK: The healthcare system has already implemented the first two options, reducing the length of a typical hospital stay for instance and adding more beds. Litvak says the third option, managing the flow of patients more efficiently, is the least tried. But he maintains it holds the most promise. Take what happened at Cincinnati Children's Hospital. CEO Jim Anderson brought Litvak on as a consultant four years ago. Anderson was concerned about chronic delays and patient overcrowding.

JIM ANDERSON: He helped us understand the importance of surgical scheduling so that in our elective surgeries we schedule those in a much more even way throughout the week rather than have them peak at any particular time of the week in a very unregulated way.

CLARK: Litvak also suggested that Cincinnati Children set aside two operating rooms strictly for emergencies in order to minimize disruptions to scheduled surgeries. These days Cincinnati Children's Hospital is doing more surgeries with the same resources and pulling in an additional $137 million in revenue. Jim Anderson is thrilled with the results but he says it wasn't a simple process.

ANDERSON: Well it is hard work and it does go against the cultural norms of healthcare.

CLARK: Translation: Doctors don't like to change their schedules around and administrators are loathed to antagonize doctors. That's meant an uphill battle for Eugene Litvak. In 12 years of preaching efficiency Litvak and his colleagues have managed to get only a half dozen in the US to implement their ideas. Fighting an entrenched system though is nothing new to him. America's healthcare bureaucracy reminds him of his life back in the Soviet Union.
LITVAK: Frequently having some conversations with decision makers I feel that if I can only replace English with Russian I would feel like I'm back home.

CLARK: But Litvak remains hopeful that hospitals will come around to his way of thinking especially if President Obama's healthcare reform efforts succeed. Litvak believes if America is ever going to provide high quality healthcare to all its citizens, hospital administrators have to start thinking more like modern factory bosses and less like Soviet-era bureaucrats. For The World this is Katy Clark.