pnqiad
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Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 1:49 pm

'Production line' heart surgery

Quote:

This is cardiac surgery on the production line, in an extraordinary hospital in India.

The Narayana Hrudayalaya in Bangalore is the largest heart surgery hospital in the world. It has 1,000 beds, and last year it carried out a staggering 6,000 operations, half of them on children.

By contrast Great Ormond Street in London did less than 600.

It is a pretty interesting concept. I had read about this a couple / three years ago. This concept may actually even work in countries like the US where costs of such heart surgeries are astronomical. It could even work for other types of surgery / health care and help reduce costs.
 
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DocLightning
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 4:52 pm

I guess I want to know more about the logistics.

Certainly for routine cases, I don't see why an "assembly line" model wouldn't work. The problem is what happens when you wind up with a patient who has unusual anatomy. It happens. And sometimes you don't figure it out until you're actually in there.

But I'd actually like to visit a hospital like this and see exactly what they do differently. You can't have the patients on a moving line in the OR. The life support systems are too bulky to move with them (or are they?). It's fascinating, but the article is too vague.
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pnqiad
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 5:01 pm

Doc,

Here's another article about the same doctor and his hospital - it offers a few more clues about the ways to achieve cost cutting - reminds me of the Wal Mart model of cost cutting (not in a derogatory sense at all) - using volumes to reduce per unit cost:

http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4493
 
andz
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 5:06 pm

Interesting stuff. How old is the hospital? The monitor on the anaesthetic machine went off the market in 2000.
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DocLightning
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 6:27 pm

I guess I have some doubts. First of all, medicines and supplies are less expensive in India than they are in the U.S.

Also, demand in India is necessarily higher due to greater population, leaving socioeconomic factors aside.

I simply think that a 5,000 bed hospital in the U.S. would wind up with a lot of empty beds.

But I do wonder if some of the changes that he's making could be applied here. Again, I'd just need to know more detail. The fact that enjoys similar complication rates to ours is definitely encouraging and impressive.
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airportugal310
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 6:29 pm

Quoting DocLightning (Reply 1):
The life support systems are too bulky to move with them (or are they?).

Maybe you could suspend them from the ceiling on a rolling track system? Just a thought...practical, Doc?
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Ken777
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 7:06 pm

Back in the 60's there were two top heart surgeons in Houston (DeBakey and Cooley) who would be close to production line surgery in terms of time management. Surgeons in training (after working as a surgeon for 2 years) would open and close, then watch and work with the "masters". The approach allowed for more surgeries and maximized the use of the teachers.

We're seeing a lot of changes in medicine here, with Nurse Practitioners and Physician Assistants growing in their participation. For many situations this change can add efficiencies and lower costs. The key is to ensure they know when to bring in the Doctor that is (or should be) supervising them.

Another important change is the delegation of minor surgeries. When my wife had her port inserted (and later removed) the work was done by a Physicians Assistant who did almost all of that procedure in the hospital. He did far more than the Doctors who would do the procedure when requested by the patient. Nor many patients asked for a doctor though as the referring doctor (oncologist) warned their patients that the PA did a better job of it.

The cost issues for the US will unfortunately reduce our potential for cost reductions. Look at the rice of drugs in the US and compare them to Canada, Mexico or India. Same overcharging for medical equipment? Probably. And that's part of our problem.
 
pnqiad
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 7:35 pm

Quoting Ken777 (Reply 6):
The cost issues for the US will unfortunately reduce our potential for cost reductions. Look at the rice of drugs in the US and compare them to Canada, Mexico or India. Same overcharging for medical equipment? Probably. And that's part of our problem.

Another part of the problem - at least in some areas (not sure if this is true in all US states) is that it really isn't a free market for establishing hospitals. For example - here in Virginia - you need from the state what is called "certificate of need" and by all accounts doling such certs. is influenced / controlled by existing players in the market. For example - here in Northern VA - INOVA group fought tooth and nail to avoid a new hospital to come up by influencing the state government and delaying this "certificate of need". Why not have true free market and let every qualified player establish a hospital? More supply = lower prices - no?

Quoting DocLightning (Reply 4):
I simply think that a 5,000 bed hospital in the U.S. would wind up with a lot of empty beds.

But at 1/3rd the population of India - I doubt if US has a single hospital even a third that size. Apparently the biggest hospital in the US has only 600+ beds. There is no reason to not let a hospital come up as long as it abides by all quality standards?
 
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DocLightning
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 8:02 pm

Quoting pnqiad (Reply 7):

But at 1/3rd the population of India - I doubt if US has a single hospital even a third that size. Apparently the biggest hospital in the US has only 600+ beds. There is no reason to not let a hospital come up as long as it abides by all quality standards?

Here's the problem:

Consider our largest cities: New York and Los Angeles. The hospitals in those cities are on the order of 400-500 beds at the largest. So if you open a 5,000 bed hospital, ten of those hospitals have to close. The megahospital needs to be located somewhere, which will be convenient for people close to it and really inconvenient for people who used to use the smaller hospitals.

One thing that I can see happening is the Memorial Sloan-Kettering model of having specialized hospitals in which the hospital only deals with certain sorts of treatment. MSK does only cancer. So imagine if you had a massive referral center for heart surgery. You need heart surgery, you go to "Mega-Heart Central." And that hospital does only hearts. So your local hospital would do routine stuff like treat pneumonias, deliver babies, take care of trauma cases, etc. The megahospitals would do anything specialized.

In India, these megahospitals filled an empty void. In the U.S. such a center would have to displace the existing hospital networks, which would raise uproar not only from the administrations of those hospitals, but also from the communities.
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Ken777
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Mon Aug 02, 2010 10:40 pm

Quoting DocLightning (Reply 8):
The megahospital needs to be located somewhere, which will be convenient for people close to it and really inconvenient for people who used to use the smaller hospitals.

It's logical that part of the need for a hospital is location - generating ease of access and treatment. The time required for an ambulance to get to a hospital is always going to be a critical factor. The time it takes parents-to-be to the hospital will always be an important factor.

It all gets down to the nature of the US, where cars and expressways establish the viability of a general hospital. Even the ease of parking at a hospital can be a factor these days.

As for specialized hospitals, our general hospitals work hard to establish reputations in various specialties. There is, however, only one major burn unit in the town. One major Children's Hospital although the other hospitals have Pediatric wards.

The problem I personally encountered when going to a "nationally recognized cancer center" was a refusal to work with my insurance company and a requirement to bring $14,300.00 with me to the "first appointment" - when I was going for a second opinion, with path reports, PET/CT Scan images and slides pre-delivered. Concentrated speciality centers can easily result in financial centers. At least more so than your normal local hospital.
 
SmithAir747
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RE: Prod. Line Surgery - Can It Be Used Elsewhere?

Wed Aug 04, 2010 1:12 am

I distinctly remember years ago (late 1980s-early 1990s) about "production line" ophthalmic surgery at a polyclinic/hospital somewhere in the USSR (Moscow?).

The operating theatre was a large one, with 8 tables forming a carousel that spun from one "station" to the next. 8 patients could be operated on simultaneously; once one surgeon finished his task at his station, the "carousel" would rotate to the next surgeon's station.

Remember that one?

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