Home Health Care: Convenient and Less Expensive

Despite popular belief, you don’t have to be in a hospital or nursing facility to have a staff of professionals take care of you – the is an alternative called home health care. Essentially, many of the same type of services offered at hospitals can be offered to you at your home through specialized agencies, and often it’s more convenient and less expensive for you in the end.You know that health care, ultimately, is to take care of you after you’ve been injured or sick. Now, if you can do this at your home, and gain your strength and self-sufficiency back in an environment where you’re more comfortable, that would be a great option to exercise.Some home health care services include: wound care, patient education, nutrition therapy, injections, intravenous therapy, and speech-language therapy. Staff can also monitor serious illness and unstable health status, as well as helping with getting you into and out of bed, helping you bathe and use the bathroom, and doing things like light housekeeping, cooking, shopping, and laundry.To find agencies available for this type of work, do an internet search and find out if there is anything local, and find out if they provide the exact service to the specifications that you require. Be aware that there are arrangements made between insurers and the agencies, so always ask questions before deciding who to hire.So when they’re there, what should you expect from a home health care team? They should be aware of your diet, your amount of exercise, your blood pressure and heart rate, your breathing, your temperature, and all of your vitals. They should know your medication routines and have them all up to date. They should check on your pain levels and your mental and physical condition every day, if not more often. They will make sure that your home is safe, and they will teach you how to take care of yourself as the process moves forward.They’ll also explain to you what your plan of care is. It’s essentially a list of everything you need – what services, by what type of care professional, what equipment they need, how often they need to take care of what parts of your health, and what you should expect when the treatments are complete.And be sure to ask yourself questions while you are under care. Are they treating you respectfully? Are they explaining why they are doing what they’re doing? Are they continually suggesting ways to improve your treatment? Are they putting your mental and physical health first with regard to the service?Ultimately it’s up to you to pick the best service provider for your home health care, so do your research and decide if it’s for you.

Lean Methodology in Health Care Quality Improvement

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:ValueA 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: WasteLean 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 AnalysisA 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 wasteSources 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 RecoveryThe 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 HealthcareThe 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.ConclusionLean 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.

Brainstorming The Ideas for Influencing Your Mobile App Audience

Once the app is downloaded, you have little time to take a sigh of relief, and then again start focusing on making things easier for the them till their goal is achieved.

According to the AppsFlyer, an app marketing company, the global uninstall rate for apps after 30 days is 28%. Entertainment apps are most frequently deleted, whereas apps based on Finance is least frequently deleted. No matter which app category you belong to, your strategy should be to remain in the mobile phones of users for a long time, and not just sit around but to fulfill your purpose as well.

If we analyze the encounters of users with an app step by step, it can help us unveil the critical factors that influence mobile app audiences, so that we can work upon those and achieve our purpose. Here are the details:

Step1. Finding Your App in Appstore

For this, we have to first find out what exactly users type to search an app. Based on a research, it has been found that 47% app users on iOS confirmed that they found the app through the App Store’s search engine and 53% app users on Android confirmed the same.

What have been their search queries? Interestingly, as the per the data provided by the TUNE research, 86% of the top 100 keywords were brands.With little scope for non-branded categories, most of the keywords were either of games of utility apps. Common keywords in the non branded category are: games, free games, VPN, calculator, music, photo editor, and weather.

Leaving brands aside, if we analyze the user-type of a Non-branded category, we will get two types of users:

1. Users are informed, and they know what they are search

2. Users are exploring possibilities, have no precise information in mind.

If you are a mobile app development company, targeting non-branded users, then your efforts must be directed to creating apps that compel these two types of users. To do so, we have to analyze once they are on an app store, what keywords they use to search. Regina Leuwer, with expertise in marketing & communications, bring some light to the subject. She reached out Sebastian Knopp, creator of app store search intelligence tool appkeywords, who shared with her the data of unique trending search phrases. And according to that data, in 2017, there were around 2,455 unique search phrases trending in the US.

Now, if we study these data to get information, we will find that name of the app is critical to attract the attention of the users.

If your app belongs to non-branded category, then make sure your app name is similar to the common search queries but also unique in comparison with your competitors. So that when your app name is flashed, they click it on to it, finding it purposeful and compelling both.

Step 2. Installation

Remember your users are on mobile devices has limited resources, from battery to storage and RAM to Internet. Everything is limited. So better create an application that is easy to download or say get downloaded with 5 minutes. One critical advice here:

1. Keep the application file size small.

If you are a developer, use APK Analyser to find out which part of the application is consuming maximum space. You can also reduce classes.dex file and res folder that contains images, raw files, and XML.

Step 3. Onboarding

After the user has successfully downloaded your mobile application, don’t leave anything on assumptions. Guide them properly. This you can do through an onboarding process, where users can learn the key functionality and where to begin with the mobile app. Below are the 3 things you need to keep in your mind when creating an onboarding process for your users.

Short and Crisp: The entire guidance of features and functions should be completed within few seconds, with easy options loud and clear option to skip.

Precise Information: Don’t introduce them to the app. They already know what they have downloaded. The objective to inform about the key functions and features.

Allow Users to Skip: Let the tech-savvy users skip the intro. Your app is to meet their requirement and not to have a friendly session.

Step 4. Purpose and UI
Here, the stage is set for your app and it is the golden chance for you to impress your users. What is needed here is the collaboration between purpose and UI of the app. It totally depends on the problem-solving capability and ease of use of the mobile app. Interface design plays the critical role, allowing the users to access features of the apps easily and quickly to perform the task for what they have downloaded the app. When it comes to interface design, make sure that the design is interactive and task-oriented. Here are some factors that you must take care off while creating mobile app interface:

1. Usability: The Mobile phone is an epitome of convenience and if your users find it difficult to use your app, then there is no way there are going to make the space for it in their mobile phones. From screen size to the color of the app, there are many factors that are equally critical and need attention.

2. Intuitive: To create an intuitive User Interface, you have to read the mind of the users, and develop a model based on that. The next should be precise, clear and ‘obvious’ in an interface.

3. Availability: Key features should be hidden in the drop down menu or even if so, it should be obvious for the user to look into the drop-down. An intricate work of design and research is required to make essential features available for the customers and they don’t need to navigate here and there.

If you need more help with the user-interface and innovative ideas for a mobile app, write to me [email protected] and I promise to get back to you with interesting mobile app designs.