A Brooklyn Dentist You Can Trust

 

Whether you are new to the area or just looking for a Brooklyn dentist for the first time, you don’t need to look any further. Park Slope Dentistry has been serving the residents of Brooklyn for over 30 years. The conveniently located office will meet all of your needs with their professional and courteous staff. Office hours are event available on Saturday to help you meet the demands of your busy schedule. And you will love all of the great services that are offered in one location.

You and your entire family will enjoy premier services offered in a single location. General dentistry is available for both children and adults. If your child has any issues such as crooked teeth or a misaligned bite, Invisalign service can be used to correct those issue all at the same office. In addition, they offer a full service of cosmetic dentistry including laminates and veneers, crowns, implants and bonding. And of course you can schedule teeth whitening or even a smile makeover.

When you visit the office, you will be in the more than capable hands of a doctor who has been practicing in New York for over thirty years and has several hundred hours of continuing education to keep current on the latest techniques and procedures. He graduated from the New York University College of Dentistry and has undertaken extensive training in aesthetic, implant and reconstructive dentistry.

All you need to do is call the office to schedule an appointment with this team. They offer more than just basic service, here you can establish a relationship with the staff and the doctor knowing that they will meet your every need for a Brooklyn dentist. They work to accommodate your schedule, offer several types of sedation and relaxation methods and complete the highest quality work to give you the best smile possible.

The Asian Rhinoplasty as Today’s Face Correction

It is not an unusual thing these days when you do not feel great about your looks, especially face; you can go under the surgery knife and get the face correction as you please. Numerous people have been doing that especially in South Korea which is known with their high beauty standard for Asian girl. It is not so easy and also not something you can wish for, to have the double eyelid, small but pointing nose, pretty pink lips and light skin. And for that reason many girls are taking face correction such as nose job or rhinoplasty surgery. This surgery is meant to restructure your nose to be more pointed and more of the L shape from the bridge of the nose to the tip of the nose.

The surgery for Asian nose is known to be a little more challenging by some plastic surgeons. The challenging part of this nose job is the high required skill of the surgeon and the fact that surgeons are expected to maintain the identity of the patient and their ethnicity background. Comparing the L shape strut silicone that is being planted to the actual nose or through the mouth to the Asian Rhinoplasty is pretty much about the result and how the Asian rhinoplasty is more in favor for many Asian patient that ha L shape strut silicone. The reason of this preference is related to the result of the nose job. Many patients found out the sharp pointing nose is looking unreal underlying the actual nose bellow it. Besides that, this L pointing nose doesn’t have soft projection as many patients look for.

Therefore many nose job clinics, such as http://www.bjcohen.com/ by Dr. Barry J. Cohen are applying the Asian Rhinoplasty method to refine the nose and show the natural beauty expected by many Asian patients.

When to Apply for Medicaid Coverage

Although opinions vary on how to fix things, most Americans agree that the U.S. healthcare system can be difficult to navigate. Since the country is home to a for-profit healthcare industry, major operations, mid-range medical procedures and even routine checkups can be rather costly. Although the Affordable Care Act has made major inroads into fixing the problem and helped millions of uninsured Americans receive coverage, it wasn’t an end-all solution to the country’s healthcare woes. Fortunately, many people who don’t make enough money to qualify for ACA coverage are able to receive Medicaid through their respective states. If any of the following items describe your situation, there’s a good chance you qualify for Medicaid coverage.

1. You Make too Little to Qualify for ACA

Even though the Affordable Care Act has helped millions of Americans without insurance receive the coverage they need, not everyone qualifies for ACA subsidies. For example, if you make under $12,000 a year, there’s a good chance you won’t be able to receive coverage through the ACA. In this scenario, applying for Medicaid is essentially your only option. Sure, you’ll technically have the option of purchasing insurance without the help of subsidies, but if you don’t make enough money to qualify for ACA assistance, there’s no way you’ll be able to afford these plans out-of-pocket. Fortunately, many first-rate treatment centers and imagining facilities like http://middletownimaging.com/ happily cater to Medicaid recipients.

2. You’re Drowning in Medical Bills

Depending on the state you reside in, Medicaid coverage can be applied to medical expenses that were incurred before your approval for the program. This is particularly helpful for uninsured individuals who are drowning in medical bills they simply can’t afford. If you lack health coverage and are tired of receiving medical bills you can’t pay, don’t hesitate to apply for Medicaid.

3. You Require Medical Treatment but Lack Insurance

Few things are more aggravating than needing healthcare but lacking any sort of coverage. Instead of allowing your ailments to go untreated, it’s in your best interest to apply for Medicaid coverage. Even if you’re afraid of the unfair stigma a certain portion of society attaches to Medicaid recipients or simply think you may not qualify, you have absolutely nothing to lose by applying.

Being without health coverage in the U.S. can be downright devastating. People without coverage are often afraid of seeking medical treatment, as doing so stands to put a strain on already dwindling finances. Anyone who makes too little to qualify for ACA subsidies, is buried in medical bills or needs treatment but lacks insurance is urged to apply for Medicaid posthaste.

Myths in the Health Care Debate

Myth #5: Most Americans like their private health insurance and want to keep it.

First off, let’s start with the fact that in 2007 46 million Americans in this country have NO health care whatsoever. Not Medicare, not Medicaid, nothing. So that’s 18% of the population who either cannot afford health care or will not qualify because of preexisting conditions. Then there are the people who’ve been in the hospital for costly procedures who had to battle the insurance companies in order to get treatment. A retired nurse from Texas testified before Congress that when she was diagnosed with aggressive breast cancer, Blue Cross Blue Shield sent her an email informing her that because of an issue with her with her application(the company had mistaken her dermatologist’s notes on acne as a precancerous condition) her policy was being dropped. This was days before she was supposed to undergo a lifesaving hysterectomy. This practice, known as rescission, is often done by health insurance companies after one of their customers with an individual policy submits a claim for an expensive medical treatment. They dig through a patients records hoping to find anything that will disqualify the patient from receiving often much needed medical care. It saves the insurance company millions in medical claims; approximately 300 million was saved WellPoint Inc., UnitedHealth Group and Assurant Inc over a 5 year period. The insurance companies claim they are shielding themselves from fraud, however, during testimony before the House Energy and Commerce Committee committee over the practice of rescission, the CEOs from the nations top insurance companies refused to stop using rescission to cancel the policies of patients who did not intentionally deceive insurance companies on their applications. The key word being intentionally. They all responded by saying that the law allowed them terminating policies for even the most minor mistake. A poll conducted by the Harris Poll found that 75% of all Americans (independent, liberal, conservative) are actually for universal health care.

Myth #4: America has the best health care in the world and part of that is because our health care is not run by the government.

Based on the WHO’s World Health Report 2000, the US is ranked 37th in the world for health care . The report is based on five factors: life expectancies, inequalities in health, the responsiveness of the system in providing diagnosis and treatment, inequalities in responsiveness, and how fairly systems are financed. As we all know statistics can made to say almost anything, however, the findings in this report cannot be discounted completely. Maybe we’re not as low as 37 but we’re definitely not #1. France, a country with Universal Health Care, is actually #1. Since it’s inception the United States has been a trend setter of sorts. Other countries copy everything from our pop culture to our policies. If our for profit private health care system is so great, why are we the only industrialized nation on the planet doing it? America has never been perfect but one of our strengths has always been our ability to right social ills from slavery to women’s suffrage. We’re constantly evolving.

Myth#3: Our current system is fine, why change it?

We should question those who say this because they are from three camps: they are severely misinformed, they’re in the pockets of the health insurance industry, or they don’t want President Obama to accomplish anything significant. Currently Americans spend more money on health care than any other nation PERIOD . Switzerland, a country that requires ALL of it’s citizens to have health care, comes in 2nd and we spend 53% more than them. Ask the politicians who are for the status quo but appalled by the current deficit how these contradictory viewpoints. The only people who you will see saying that our current system is fine are those are blessed enough to have and it have never had any fear of losing it. Consider that America is touted as one of the greatest countries in the world and yet 18,000 of our citizens die unnecessarily each year because they have no health care. How can we say that our health care system is not broken?

Insurance companies lining the pockets of those who have the most influence in this debate may sound like conspiracy theory, but consider this: insurance companies spent approximately 100 million lobbying and producing commercials such as the infamous Congress in 1993 fighting the Clinton Health Care Plan; this time around they are spending millions more to fight it. What are they so afraid of? If the insured are so content with their current coverage, why are they so against a public option?

The people who represent us in Congress, both Democrat and Republican, have always tried to make everything political. If President Obama were to be successful where Clinton failed in 1993, it would represent a major accomplishment and some conservatives can’t have that. Republican Jim DeMint, Republican from South Carolina, famously said “If we’re able to stop Obama on this (health care), it will be his Waterloo. It will break him.” Why should an issue as important to million of Americans be looked at as an opportunity to “break” the President? As someone who represents the people of South Carolina shouldn’t his primary concern be what is best for them, not strategically outmaneuvering the new Democratic President? Bill Kristol, who played a pivotal role in defeating the Clinton push to reform health care, urged conservatives to “kill” Obama’s plan for health care reform; however, later he was on the Daily Show even though the public health care the troops receive is “the best” average Americans do not deserve this level of care. These objections to health care reform do not seem rooted in principal and reason but in a game of tic and tac played by both parties.

Myth#2: Tort Reform would significantly the cost of health care.

Often times this is the argument made as an alternative to drastically changing our current system. Doctors who fear being sued for malpractice begin practicing defensive medicine, which leads them to order expensive and sometimes unnecessary tests in order to avoid expensive malpractice suits. This inevitably increases the cost of health care. However, in a study done by the Johns Hopkins Bloomberg School of Public Health, defensive medicine accounted for at most 9% of the total cost of health care, and most experts doubt it’s that high. Some estimate it’s as little as 1%. When our country spends 53% more than anyone on health care, Tort Reform would not represent a significant improvement..

Myth#1: If we having allow a public option our country will become a bankrupt and socialist.

Anytime a policy benefits the public by giving them something, it is seen as a hand out that will inevitably destroy this country. The same was said of Social Security when it was introduced by FDR in 1935. Medicare and Medicaid were also called “socialized medicine” when Truman introduced them in 1945. But we enacted all these programs and somehow the United States did not immediately become a socialist country. Today many of the politicians that would’ve probably been against these programs when they were introduced fight to keep them alive.

Why American Health Care

Obesity is America’s number one health problem. It commonly leads to diabetes, Type 2, heart disease, kidney disease, and sometimes cancer.

According to a recent report quoted by the New York Times, obese citizens spend about 42% more per year on health care than normal-weight Americans.

“Obesity, and with it diabetes, are the only major health problems that are getting worse in this country, and they’re getting worse rapidly,” Dr. Thomas R. Frieden, director of the Center for Disease Control, said.

If obesity is driving up health care costs, what can we do about it? Ask doctors to charge less? Make the drug
companies provide free diabetes medicines and diet pills to obese people? Ask the insurance companies to provide their services for free?

Maybe we could nationalize the whole health care system and force all American taxpayers share the cost equally of caring for these unfortunate Americans who are the victims of…what? The restaurant industry! That’s it! Fast food and Doritos did it to them! Lays potato chips: “Bet you can’t have just one!” They dared these poor souls to become addicted to their deadly products–and it worked!.

I’m sorry. I’m being ridiculous to make a point. My point is, our health care system is buckling under the weight of
the expensive round-about procedures we do and drugs we provide to counteract the effects of what people are doing to themselves.

Digging Our Graves With A Fork & Knife
We are a nation of food-aholics. Most of us don’t eat real foods prepared at home from fruit, vegetables, whole grains and beans. Most of what we eat has to center around either some animal meat and fat and lots of highly refined carbohydrates. Very few vitamins and minerals are left in our food–and almost no fiber. And we wonder why we get fat , have diabetes, heart attacks, and require expensive medical care.

My medical care costs me nothing but the time it takes to do some daily exercises and eat right. Chalk
it up partially to vanity–I never wanted to let myself get overweight or suffer the diseases that plagued my family tree.

A big part of my medical care is to eat what science and my conscience tells me I should, rather than stuff that merely tastes good.

But it’s all worth it to me. I’m not pleading with the government to get me health care. Nobody had to inform me that eating too much of the wrong foods would make me sick: I figured it out on my own after reading a few good books and research reports. It wasn’t hard–and it was a benefit for me to stay well.

What would I do about the health of the American people?
The best thing the health care professionals could do is to stop coddling us. Stop treating us like imbeciles.
Tell us the truth. I suspect that if doctors and public health officials leveled with citizens and told them the
golden truth that “We all are about 97% responsible for our own health, based on what we choose to eat,” it might make an impression after a while.

It probably won’t happen, I know, because the fast-food industry and other makers of fat-food(meat packers and the dairy and sugar industries) are in control of our FDA and the US Department of Agriculture. They would scream bloody murder if the public were told the truth about how their food products are the reason our arteries are plugged up with cholesterol and why we’re growing obese.

But, the bottom line is, we don’t have to eat those foods. Nobody is forcing us to eat foods that lead to heart
attacks, breast cancer, strokes, Alzheimer’s Disease, colon cancer, etc., etc. If you don’t believe me, then read the medical research that clearly establishes the connection between what we eat and these diseases.

Did you know that there are still pockets of people who still eat traditional diets that are primarily vegetarian–and
they rarely have heart attacks. Their women very rarely get breast cancer. People of these nations live to 90 and 100 years frequently, with sharp minds, good eyesight and they continue to work in their gardens and orchards. They are respected and contributing members of their society. If we chose to eat like these people, we could reduce our need for expensive and dangerous health care.

Here’s a simple truth of economics: If there was no demand for health care because everyone was healthy, then health care would be cheap. It’s a matter of supply and demand. A lot of cardiologists standing around with no triple-bypasses to do would quickly lower their prices. That’s my answer to the high cost of health care: Get healthy!

How do you get healthy? A good starting place to help you understand what’s wrong with our typical American diet is a book by T. Colin Campbell, Jr., PhD, entitled “The China Study.”

Paul H. Kemp is a lifelong entrepreneur, writer, and amateur athlete. Hanging out with many amateur, pro, and the occasional Olympic athletes, together with extensive reading of medical research literature, have given him an insight into what high-performance athletes eat when they want optimum performance.

Senator Ted Kennedy on the Importance of Health Care

Senator Ted Kennedy has shown true leadership in his quest for health care reform over the last four decades. I’ve been a small business owner for the last several years, after having been with two global technology companies. Health care reform and insurance, in particular, is critical to our country. Without it, we will certainly be driven into far more financial turmoil than we are in today.

I recently read Senator Ted Kennedy’s health care reform article printed in Newsweek called “The Cause of My Life”. In this article Mr. Kennedy talks about why he has tirelessly lobbied for universal health care throughout his career.

Mr. Kennedy has had plenty of tragedy and medical issues throughout his family’s life. Health care reform became a rallying cry for him when his 12 year old son, Teddy, had his right leg amputated because of cancer. During his son’s cancer treatments, he met and spoke with many families, who unlike the Kennedy’s did not have the ability to afford quality medical care.

As a small business owner with two children, we are all too acutely aware of how important it is to have health care coverage. This is especially true if you are the only bread winner and there is no other coverage.

My elderly father was recently hospitalized after fainting at home. After 5 days of hospitalization, they finally deduced that he had anemia due to a bleeding ulcer. The cost of the hospital stay … sixty four thousand dollars ($64,000). This didn’t even include the 911 ambulance ride, or the doctor’s visits. Fortunately, for my father he had insurance, which covered most of the cost. Can you imagine someone who could not afford this cost?

Senator Ted Kennedy had additional experiences within his own immediate family. His son Patrick was hospitalized several times for serious asthma attacks and his daughter, Kara, was diagnosed with lung cancer in 2002. Fortunately for both children, their father was able to pay for medical treatment and they are both alive and well today. Without Mr. Kennedy’s health care reform, countless families would not be so lucky.

Mr. Kennedy and actually all of the Kennedy brothers have always been a champion of the common people. He could have chosen easier policies on which to fight and win, but he chose this cause because he knew this is a cause that affects all of us at some point in our lives. We are one of the few industrialized countries without some form of universal health care.

I also just returned from visiting one of my college friends who is terminally ill, also with cancer. For weeks, his insurance company denied him coverage to go to the hospital. Only after pleading with them and telling them how ill he was, did they “grant” him coverage. Then, when it was determined that he only had a few weeks to live, they initially denied him hospice care to live out his short life at home. Why would any sane health care insurance company deny someone a better quality of life, even though it’s been determined that it also saves them money?

Senator Ted Kennedy may well succeed in death as he tried to do in life … to create real health care reform. With the support of Barack Obama’s administration, we could be on our way to creating a country that lives up to its creed of taking care of the poor and the rich, the old and the young, and the uninsured, as well as the insured.

Affordable Health Care

Do you really have an idea how essential affordable health care is for every American citizen? Affordable health care ensures appropriate medical care facilities so as to keep the future of progeny secured beforehand. Nothing comes easy as it seems to be and affordable health care is too distant a dream. Most of the medical treatments are just not in consonance with the size of an average American’s pocket. In such dire conditions what one needs is an affordable health care which entitles you to have secured back up whenever your family requires proper medical attention.

Even if you seek a simple body diagnosis, then do not expect best health care because the cost would drain half of your month’s salary. What would be the case if you have to undergo some major medical treatment, you will end up taking medical loans which will be a liability on your children in future. Spare yourself from such atrocities of medical expenses and resort to an effective affordable health plan which takes cares you health.

In such conditions it becomes essential to find out ways for best health services. Instead of waiting for expenses slashing down to ground you can opt for following steps

* Prescription drugs are indeed effective ones but you can ask chemist to provide you a cheaper alternative for the same prescribed medicine. Do not fret; cheap prices have nothing to do with the quality of drug. It’s just that few brands have high cost and some others offer the same stuff in lesser prices offering you an efficient health care service.

* If you are really looking for an alternative, you can buy over-the-counter drugs as well. These are cheaper and the difference lies just in their packaging and pricing.

* Almost every town has a medical school. Go to medical schools as they offer affordable health care that would not step up your budget.

* If you seek routine check up, then instead of trundling to a hospital you could simply wait for next community health fair. Doctors, nurses, and technicians are experts and can provide required health care service in an efficient manner.

* If you really looking for alternative, try avoiding weekend stay in hospitals as much as possible. Since on weekends most of the medical institutions are closed and ones that are open demands hefty fees. So, Monday would be a far better option for an affordable health care.

* One of the best way to ensure best health services is to check for affordable health insurance plan which would cover your all medical expenses. Make sure you apply in-person to have clear idea of what is at stake.

* Lastly, affordable health services can be acquired if you will scrutinize your medical bill for hidden charges rather paying it immediately. Medical bills are mostly in the form of codes, figures, and accounting which none except medical practitioners can decipher. It should be your motive so better tally the invoice with what all services you have received, negotiate on charges incurred, and bargain enough. This is up to you to turn your expensive treatment into an affordable health care

Health Care Plan is Important

The Obama health care plan, whether you believe in all of it’s tenets or not, is one that at least gets us pointed in a direction. Putting it another way, the cost of inaction will drive us even further into a country that cares more about political lobbying than the real needs of our people. It’s important to really understand what Mr. Obama’s health care plan is about in order to make a fair judgment one way or the other.

I’m a small business owner without the comforts of a big company medical plan. Fortunately for me, my wife IS employed by a large company and we DO have decent, not great health care. But, what if neither of us had this luxury? I was with two of the largest technology companies in the world, Oracle and HP, but was eventually laid off some years back, like so many other unfortunate individuals.

The Obama health care plan is trying to fix some serious flaws in it’s system. I recently visited a terminally ill college friend of mine. He was initially denied even a visit to the hospital. He finally got approval and was diagnosed as having only a few weeks left to live. His family then lobbied to have insurance over his cost of home care to live out his short life in dignity and quality. Now, it has been proven over and over again that home care for the terminally ill saves money and provides for a much better quality of life than a hospital stay. Why deny someone this option?

We all recognize that employers are struggling during these tough economic times. And, costs of hospitalizations and the like have increased over 100%, but consider the options for no health care reform. It will continue to be pushed out to the next generation and then the next. The answer then would be to burden our children and our children’s children. Is this the legacy we want to leave behind?

The Obama health care plan really is about a few key tenets. Probably the most important component to me is that of preventative health care. This hot button is debated amongst so many people. On the one hand, the bloated medical systems want to care for you only after you come down with an illness. Wouldn’t it make more sense to prevent the illness in the first place? Things such as quality screening to make sure you are exercising regularly, eating properly, etc. Wouldn’t you rather stay well, rather than go to the hospital when you’re sick?

Another key component of the health care plan is around the use of technology. The US is one of the few developed countries that really are a leader in this area. How is it possible that we cannot figure out how to fix our antiquated medical reporting system? Transportable medical records would reduce errors, increase efficiency and save all of us money! Why can’t the doctor that I saw for my dislocated shoulder 10 years ago be able to easily share that information to my new doctor who’s treating me for arthritis? An efficient sharing and collaborating of medical records would allow for a better health experience for the patient.

Finally, competition in insurance coverage is a serious flaw in our system today. The Obama health care plan is target to correct this problem. Why should a few insurance companies make the bulk of the money? If there is little to no competition, there’s no way to know whether you are getting insurance at competitive rates and whether the quality of care is at its highest.

The real answer to the debate on the Obama health care plan, though, is the cost of INACTION. We all know that the health care system is severely broken. Let’s make a step forward, instead of lobbying to take two steps backward.

Lean Methodology in Health Care Quality

Lean production (Lean) is a type of quality improvement methodology which has been implemented in many industries. Its principles and practices also have been applied to health care organizations with success. This has been accomplished with refinement for the nuances of health care. Lean is a process management philosophy which has its roots in manufacturing and technology. It was developed as part of the Toyota Production System for the process assembly of automobiles (Toyota Motor Corporation, 2009). The Toyota System is comprehensive and spans a large number of methods and practices. It was initially influenced by the work of W. Edwards Deming and Henry Ford and was also inspired by innovation in the American grocery store industry of the 1950s (Keller, 2006). This is reflected in the Just-in-Time philosophy of productivity improvement, which emphasizes producing quality products efficiently through the complete elimination of waste, inconsistencies, and unreasonable requirements (Toyota Motor Corporation, 2009). Though the Lean methodology was initially developed as part of an overall system focusing on the production of automobiles, its principles also have been adapted for health care. As certain case studies indicate, Lean thinking and tools have been successfully applied to specific health care settings. The scope and value of Lean production within this field will be explored in this paper.

Significance:Value

A significant component of Lean is the concept of value: the theoretical concept of value, the measurement of value, and the tangible processes behind delivering value. Lean is unique in that it accounts for the reduction of waste in order to achieve both real and potential value. Recovering this value can present itself in the form of saved costs or other tangibles. Lean thinking dictates that the expenditure of resources for any purpose other than delivering value to the customer is considered to be wasteful. The reduced expenditure of time, money, and resources is thought to bring additional bottom-line benefit to the customer. The customer-centric focus of Lean thinking is especially relevant to health care. Broader levels of patient/customer satisfaction are constantly being sought. This mode of thinking has been brought on by increased competition among organizations and the need to differentiate services. It is recognized that providing complete customer satisfaction can be vastly beneficial to health care organizations. Customer satisfaction can be an equally important measure of an organization’s performance as the delivery of quality health outcomes. This is a factor which is exemplified in Noriaki Kano’s model. Lean thinking dictates that processes and methods must be efficiently optimized with the needs of customers in mind in order for organizations to be fully effective.

Problem Addressed: Waste

Lean focuses on the maximization of process velocity through the reduction of waste. It provides tools for analyzing process flow and delay times at each activity in a process. The focal point is the separation of “value-added” from “non-value-added” work. This is complemented by tools which aide in the identification and elimination of root causes of non-valued activities. The primary problem addressed by Lean is waste, which can affect value in a number of ways. It may result in lower quality products, higher costs, less favorable customer experiences, excessive time or effort expended to complete goals, or fewer resources available for innovation which could provide potential value at a future date. Waste can be found in people, processes, tangibles, and other areas. Eliminating waste through the lens of Lean production can help to achieve the goals of health care organizations. There are eight generally identifiable centers of waste: overproduction, waiting (time on hand), unnecessary transport or conveyance, over-processing or incorrect processing, excess inventory, unnecessary human movement, defects, and unused employee creativity (United States Army, 2009). There are variations on these categories of waste depending on the setting or industry. For the purpose of health care Caldwell (2005) slightly refines these measures into seven categories of waste. These consist of “in-quality/out-of-quality staffing or overcapacity, overcorrection, over processing, excess inventory, waiting, motion of patients or staff, and material and information movement (Caldwell, 2005, p. 46).” Regardless of the differences in terminologies used, there are common centers of waste in health care which can be targeted for elimination. These can be identified through Lean processes which focus on root cause analysis.

Process: Root Cause Analysis

A crucial process in Lean is the identification of waste through root cause analysis. Root cause analysis in Lean involves a method called 5-Whys (Toyota Manufacturing Kentucky, 2003). This method rapidly identifies root causes and aides in determining the relationship between multiple root causes. It can be learned quickly and does not require statistical analysis. This method is especially effective for an implementation team in the initial stages of problem exploration. The application of this strategy involves asking a series of why-related questions to drill down into a problem area. Asking progressive questions about a perceived difficulty forces team members to think critically about the actual sources of waste and inefficiency. It is suggested that at least five questions (5-Whys) are posed to arrive at the root cause, though a root cause may be discovered in more or less inquires.

The following is an example of a 5-Whys exercise used in a hypothetical hospital setting:

(Q1) Why are patients being diverted to neighboring hospitals?

(A1) Because wait times for our hospital are exceeding industry norms.

(Q2) Why are our wait times exceeding industry norms?

(A2) Because patient volume is exceeding capacity.

(Q3) Why is patient volume exceeding capacity?

(A3) Because not enough hospital beds are available.

(Q4) Why are not enough hospital beds available?

(A4) Because hospital patients are not being discharged efficiently.

(Q5) Why are hospital patients not being discharged efficiently?

(A5) Because ER staff is not following best practices for proper discharge.

In this example, waste in the throughput process comes from incorrect processing. Once hospital management determines the root cause they can implement further training, ensure compliance with existing standards, or eliminate other barriers. In this case the hospital might consider implementing a training program to ensure that ER staff is following best practices for patient discharge. The hospital might also conduct additional 5-Whys analyses to uncover other problem areas. Once root causes of waste are uncovered, the elimination of waste or other related action plans can be executed.

Sources of waste

Sources of waste vary greatly by industry. The majority of waste encountered by health care organizations occurs in flow and throughput. As a result, Lean implementations in this field are primarily focused on the elimination of waste in staffing and staff/patient processes. Unlike manufacturing industries most health care organizations have very little inventory. Thus, some of the Lean concepts related to inventory control are less applicable to health care. Health care organizations typically spend a larger percentage of operating expenses on overhead and labor costs. This can account for 50 percent of the operating costs while inventory is in the range of 2 percent (Caldwell, 2005). Understanding waste in throughput entails a comprehension of the relationships between process variables and costs. Costs are not causes of waste but are indicators of interrelationships between processes. While the ultimate goal of most Lean implementations is to recover costs as tangible benefits, eliminating costs without fully understanding processes is problematic. Looking at the types of cost recovery is essential to determining an action plan.

Solution: Cost Recovery

The ultimate goal of most Lean implementations is to attain a tangible benefit, often in the form of a cost recovery. However, not all process improvement opportunities will result in immediate returns. The actual realization of a benefit depends on the nature of the improvement as well as the additional steps that management takes to achieve it. Caldwell (2005) cites three types of cost recovery through the elimination of waste: Type 1, Type 2, and Type 3. In a Type 1 situation the process throughput improvement will yield a direct cost recovery. For example, a process improvement that reduces length of patient stay would recover costs in the form of reduced resources expended. In a Type 2 situation, the process improvement saves time but does not result in cost recovery without additional hours worked per unit of service. A provider may spend less time per patient because of reduced length of stay but scheduling will need to be adjusted in order to capitalize on the benefit to workflow. Lastly, Type 3 yields savings in the form of immediate optimization of capacity. In this situation a process improvement in an emergency room, for example, may allow a provider to see more patients in the same staffed time without additional action taken by management. This is similar to a Type 2 recovery but with no changes to scheduling. This can occur if the provider is willing to see more patients per unit of time and sufficient patient volume exists to achieve capacity. Maximum velocity is achieved without additional action needed to be carried out by management. These examples show that throughput improvement may not achieve an immediate benefit without other factors. It also brings to light the fact that throughput improvement may yield different benefits such as recovered costs, time saved, or increased revenues. Regardless of the actual benefit achieved and the way that it is realized, the ultimate outcome must increase bottom-line value and satisfaction to customers in some way.

Examples of Lean implementation in Healthcare

The study of actual Lean implementations in health care is essential to understanding their application. One example of a successful implementation is outlined by Fairbanks (2007) at a medical center in Vermont. This implementation dramatically improved overall throughput processes within the organization. An implementation team was assembled and delved into all steps of the processes they were analyzing in order to determine the sources of waste. They utilized various Lean steps and methodologies to conduct root-cause analyses and prioritize process improvements. The team measured time involved, identified activities, and made rapid improvements through the elimination of non value-added activities. A large part of their improvements involved the elimination of redundancy. The topic of redundancy shows the importance of analyzing all processes, even those which are perceived to contribute to customer value. Even though a particular function may provide value in an organization it is possible that a redundant function may exist which can be eliminated. In another case example Lean methodology was used to streamline the physical space and inventory areas of a Denver-area hospital (Gabow, Albert, Kaufman, Wilson, & Eisert, 2008). The implementation team utilized the 5-S approach to organize physical work spaces within the hospital. 5-S is a Lean improvement which incorporates visualization management to organize objects and supplies. The five Ss stand for sort, set in order, shine, standardize, and sustain. These steps involve tasks ranging from simple clean-up and organization to the implementation of detailed visual controls. In a 5-S environment there is “a place for everything and everything in its place, when you need it (Lean Innovations, 2003).” The Denver hospital used this approach in a series of projects focusing on individual offices, nursing stations, entire laboratories, and financial services departments. These spaces were reorganized to achieve optimal work flow and good space management. The successful outcomes included reclaimed physical work space, improved lab turnaround time, reduced time in locating equipment, and better processes which could improve patient care (Gabow et al, 2008). The 5-s method is an excellent first step in implementing Lean programs in a health care organization. Improvement of physical work space can positively affect mindset and mental perception of work. Another case example of a successful 5-S implementation involves a rural health clinic in Georgia. Lean techniques were used in this organization to resolve problems with bottlenecks, turnaround times, customer satisfaction, and overworked nurses (Cross, 2009). 5-S is one of many Lean tools which can provide immediate benefit.

Conclusion

Lean is a multifaceted approach to quality improvement which has tangible benefits to health care organizations. There are aspects which focus on reducing non value-added work and waste to achieve value in various ways. Successfully implementing Lean in health care depends on the setting involved and the motivation of management and teams. Health care encompasses a wide range of organizations and each has unique characteristics which must be considered in light of Lean processes. Important considerations in implementing lean in any environment can be reduced to a few key points: Understanding the concept of value Understanding waste and its sources Learning how to determine and analyze root causes Prioritizing multiple root causes Devising methods to eliminate waste Determining ways to recover costs or achieve benefits Analyzing effectiveness and repeating steps if necessary In addition, it is important to note that eliminating waste through a Lean process may not immediately result in tangible benefit. Management must thoroughly analyze action plans and make adjustments based on actual outcomes. Additional steps may need to be taken following initial process improvements. This is especially relevant in health care where process throughput improvement and staffing are areas which are commonly targeted. These areas may involve more challenges when trying to extract benefit. Freeing time for providers cannot always be capitalized upon without other capacity and throughput improvements. Scheduling or work flow functions may need to be overhauled in order for providers to increase overall process velocity and maximize value per unit for time. It is also crucial to realize that humans are not machines. Theoretical methods of quality improvement in Lean may not always be feasible to achieve at maximum levels. The Lean methodology developed by Toyota is very cognizant of respect for people. It is reflective of a collective culture and a holistic concept rather than a series of parts or steps. This is a fact which cannot be overlooked by management and teams when planning an implementation. People perform processes with normal human variation and improvements must be sensitive, appropriate, and sustainable.

Health Care Reform

As a concerned American citizen, I feel compelled at this time to express some strong personal convictions about what is happening in the United States right now with health care reform. In recent months and especially in the last few weeks, this has swelled into a big issue, almost rivaling the economic crisis in media attention and in many Americans’ minds. Why?

“Health care plan?”

Well, for one thing, everyone recognizes that the U.S. health care system is in dire need of reform (and frankly, just about every other system in this country run by the federal government is in the same boat). The percentage of Americans who lack health insurance has grown substantially in recent years, medical costs have skyrocketed, and many people are not getting the health care they need. Health care is a complex multifaceted issue that involves both the public and private sectors and directly affects all Americans sooner or later. Thus, reform of this system is a big project likely to draw wide attention.

But more than that, health care reform is in the spotlight right now because the administration of President Barack Obama has made it a priority. “Health care reform can not wait, it must not wait, and it will not wait another year,” as President Obama famously declared near the middle of his first year in office. The president has been pushing Congress to quickly pass new legislation that would, with his signature, supposedly deliver better and more accessible health care to the American people.

I have to wonder, though: Why such a rush to health care reform? You can’t fix a broken system overnight, whether it’s the economy or health care. Reform is a major undertaking that requires careful research and accurate analysis of the situation, together with a generous period of honest public discussion and debate concerning short-term, medium-term and long-term measures that should be taken to correctly address the situation. Moreover, these elements of reform need the foundation of common moral and ethical guiding principles.

None of these requirements are being met in the current rush to draft and pass health care bills. As a result, U.S. health care reform is on the road to disaster.

So again, why this hurried effort by the Obama administration to enact health care reform? The administration has its reasons for hurrying. One is that they have a semi-secret agenda to accomplish, and this agenda collides head-on with the will of the American people. Whether the mainstream media will acknowledge it or not, there is in fact a fundamental issue even more important to Americans than the twin heavyweights of economic recovery and quality health care. That issue is the right to life of every human being, especially the most innocent and defenseless–the unborn child in the womb.

In Washington, health care reform is being touted merely as a ruse. It serves as a convenient vehicle to advance the Obama administration’s ever more urgent hidden agenda. That agenda is to increase federal funding of, and expand public access to, abortion. And this is the most important reason why health care reform has drawn the scrutiny of Americans right now.

The urgency of this semi-secret agenda from the viewpoint of its proponents becomes clear when we look at trends in recent years. Since 1993, the annual number of abortions and abortion providers in the United States has been in steady decline. U.S. voters across this country (a majority of whom are women) have built and continue to support a vast infrastructure of state restrictions on abortion, from parental notification laws to bans on state funding for abortions to sonogram viewing and waiting period requirements for pregnant girls prior to their scheduled abortion procedure. These laws, together with adoption, crisis pregnancy care centers and various outreach programs, have been wonderfully beneficial for women, for their unborn children and for society itself. Meanwhile, polls have confirmed that an increasing percentage of American citizens oppose the legalization of abortion through the Roe v. Wade Supreme Court decision of 1973. As of this writing, survey reports indicate that a majority of the American people are pro-life.

However, in Congress the overall trend with abortion has been moving in the opposite direction, especially since a Democratic majority came to power in 2006 in the House and Senate. In 2007 Representative Jerry Nadler and Senator Barbara Boxer introduced an infamous joint resolution deceptively named the Freedom of Choice Act (FOCA). The contents of this revolting abortion bill are so evil and frightening that it could only have come straight from Hell and been conceived by the Devil himself. It would have, at one stroke, demolished all state restrictions on abortion. Moreover, this draconian bill would have far surpassed Roe v. Wade in elevating abortion to the status of a “fundamental human right” subject to unlimited government funding and support. Apparently our Congressional representatives intended to remove every legal barrier and provide every possible incentive for Americans to murder their offspring.

So a rift has opened up between the American people and their federal government on the issue of abortion, and in the past few years this rift has been growing increasingly wider. The Obama administration may have given up on FOCA due to massive public opposition (thank God), but it is still bound and determined to enact at least some of FOCA’s provisions into law-for example, the sickening concept of “abortion coverage” as a “health benefit”-whether the American people support them or not.

And what is driving this wicked agenda to ram abortion down our throats? The answer is money. Abortion is still a big, $100 million-per-year business that makes a handful of doctors and companies in the U.S. quite wealthy. But with the gradual nationwide decline in demand for killing “services” and a fervent pro-life ethic among the younger generation of Americans, abortion providers face the real threat of going out of business altogether sometime within the next decade or two. Thus to salvage a sinking enterprise, the multimillion-dollar abortion industry has turned to the rich and powerful federal government for a hand–just as the financial institutions have turned to the same government for rescue from annihilation since late last year. In both cases, the government has generously responded with legislation and fiat money. This administration is not serving our interests but the interests of rich and powerful lobby groups on Capitol Hill. In my estimation, the Obama administration is the most corrupt administration in American history.

This is another reason for the race to health care reform: President Obama and his cronies don’t want Americans to find out the truth behind their new health care policies. In a democracy, corruption has to hurry or else it can’t achieve its ends. Too much research, analysis, discussion and debate-essential for proper reform and healthy for democracy-would expose this corrupt agenda and result in its doom. The “hurried” and “evil” aspects of health care reform both result from the driving force of corruption. Transparency and accountability are crucial for the correct functioning of democracy, yet little of either is evident with our government’s rapidly coalescing health care plan.

So given the divergence between American respect for life on the one hand and governmental obsession with death on the other, our leaders are forced to pretend that they are representing the wishes of the people while they pursue an agenda contrary to those wishes. How long they can keep up this charade remains to be seen in these uncertain and unpredictable times. However, a few things are certain. The American people want affordable health care reform that respects life. Their elected representatives want a health care plan that pads their own pockets and funds murder. Sooner or later, either the abortion industry or its puppet government or both will cave in. But the pro-life movement in this country is strong, it is steadily advancing, and it is destined to win.