The Use of ABC Tool by NHC to Reduce Cost - Case Study Example

The use of ABC tool to reduce cost By student’s name Course code+ name Professor’s name University name City, state Date of submission The use of ABC tool by NHC to reduce cost Introduction The National Health Service faces an uphill task in changing itself into a patient-centred institution, while equally saving more that £ 20 billion within a period of 3 years (Taylor 2011, p 68). One crucial step in solving the challenge is by managing healthcare more effectively and efficiently. Two reports by (Guillebaud Great Britain 2009, p 176) have warned that the NHS in a year loses a lot of money through overpriced supplies, under usage of staff, patients occupying hospital beds too long, and depending on agency workers. An investigation ordered by the secretary of health into the productivity of NHS and how its resources utilized have revealed that health institutions could save £5billion of their £55billion budget. The report further announces that the NHS is required to deliver 2-3% efficiencies per year, which will set it to its goal of achieving 10-15% real term cost reduction by April 20121. This can be accomplished through actions such as reducing operation expenses and managing improper variations in the quality of healthcare experienced by patients (Feldstein 2007, p 76). Because processes in health systems are variable and complex, it necessitates the use of more sophisticated tools of management. The Department of Health(DH) currently suggests the use of Patient-Level information and System (PLICS). However, the primary concern of effective management is not about the level to report or analyze certain costs, instead of how to approach cost behavior analysis. The ABC tool has been designed to guide patients and clinics towards creating a custom self-management plan (Baker 2008, p 98). This report contends that more attention to the fundamental principles of Activity Based Costing (ABC) presents the possibility for trust presently investing in PLICS to achieve more benefits from their systems. Analysis Conventionally, the initial step when studying a process is creating a flowchart representing what a patient will go through. The process begins when a patient come to the reception area. The arrival of the patient could be random, planned or sent from the emergency room. Once here, the receptionist asks the patient about the type of treatment or examination they want, evidence of payment or medical insurance cover, and all documents needed. Once the receptionist captures all these details, patient waits for a technician or doctor to call them to conduct a preliminary test in preparation for the examination. The testing a client goes through can be classified as either X-ray, digestive radiology, magnetic resonance, ultrasound scan, angiography among others. Once a patient is through with the exams, they evacuate the examination area and proceeds back to the reception area to meet their companions. Later, back office processes are conducted to input the information into computers, print images and scans before the results are given to the patient or submitted to the physician. Creating and understanding the workflow in a healthcare facility is normally conducted in a brute-force style; that is physically taking a stopwatch and timing each step of the medical examination process (Taylor 2011, p 128. This can be seen as taking a picture from the technician's/doctor's daily processes majoring on examination of a patient including the preparation of room before a review, the examination itself, generation of report and discharge of the patient from the chamber. The upper flow diagram is resourceful for representing the activities and processes involved, and the order of such events. Furthermore, they act as a device for communicating with the person working at the imaging centre. Nevertheless, the flow-chart does not give any procedures to identify areas for improvement. Due to this, a three-step approach is suggested to determine areas for improvement. i. ABC costing tool to determine significant activities from a cost point of view. ii. Shifting to know one of the patients’ worries, the waiting and process times and iii. Imitation to test the effect of suggested solutions before implementing them. These processes, a joint venture between providers of health care and patients, are likely to be aided by the development of ABC tool recently. The ABC as a tool is presently designed as a stand-alone online software that medics can access using login credentials received from researchers (Baker 2008, p 98). The tool begins with a patient reporting their burdens using its scale. The tool uses a behaviour algorithm with advice for treatment based on the given guidelines. The scale used by the tool was determined to be a reliable and valid questionnaire. Furthermore, the results indicated that when the tool is used, patients provide feedback of perceived better healthcare. Patients also valued the questions asking about their emotions as these affected their view of the disease burden. The tool makes use of an algorithm with advice for treatment based on the current OCPD healthcare rules. The final report could be used in simple decision making between medical service providers and patients by assimilating the unity of the domains such as smoking status and symptoms and aiding individualized treatment plan with a change in behaviour. Findings The following were the major issues identified with the use of the tool; i. The NHS required major reductions in costs. ii. Conventional programs don’t support making of decisions by healthcare experts to monitor costs. iii. During the period of ABC design stage, trusts issues made it difficult to understand a problem and implement it. iv. The tariff was unable to connect cost incurred for an activity that has happened. v. Legacy conventional costing programs do not give clinicians with the knowledge of the cause and effect relationships between their actions, clinical results and resources. vi. It was identified that complicated allocation methods for direct costs have been carried forward from conventional systems to the new ABC program. Clinicians makers find it hard to determine how these costs have a cause and effect connection. vii. There was lack of education and training workshops when the ABC program was started. viii. Increased awareness of ABC’s principles requires to be integrated in the culture of NHS. ix. More focus to the fundamental values of ABC is required to acquire event greater assistances from their programs. x. There’s need to find out the most effective usage of the introduction of the ABC program and the information communicated. xi. An issue emerged that in certain scenarios it is presumed that an activity session is available only in a single form, although other types take longer than the other sessions and take up more resources. Recommendations i. Content and layout. Certain suggestions were made concerning the improvement of the programs' layout, like including a ‘home-button.' Other suggestions were made regarding the content of the tool. It's recommended that individual goals from past consultations would be visible. This will assist the technicians/doctors to reflect on the, with the patient. Additionally, it can facilitate a discussion about the progress of the patient towards reaching the set goals. The disease burden could also be classified as severe, moderate or mild as this information is needed by the healthcare insurance agencies. ii. Algorithm for treatment. Certain providers of healthcare unexploited a few things in the treatment algorithm such as important signs (blood pressure and pulse rate), inhalation prescriptions for patients and how to cope or adapt. Moreover, many patients believed that many of the treatment options were too overall less concrete, more so the ones advising referral of patients to other medical facilities. A healthcare service provider pointed out that there's a danger that the ABC tool at a certain point will give inadequate chance to deviate from procedures if they believed such an action is for the benefit of the patient. Other healthcare providers believed the advice for treatment should be designed in such a way that it's simpler for patients to know and incomprehensible initials such as ‘ICS' avoided (Lee, Estes & Close, 2007, 72). iii. Implementation of tool in Chronic Obstructive Pulmonary Disease (COPD) care. Nearly all healthcare providers approved that the tool must be employed in the electronic medical record systems of the hospital or general practitioner. Because the tool had not yet been incorporated into the EMR systems during the time of the research, using it was time-consuming. This is due to the additional preparation needed and the fact that all data had to be migrated from the tool into the existing systems. Stakeholders suggest that the data should automatically be transferred across systems. No certain priority was shown as to whether the tool should be completely integrated or connected to the EMR systems. Even if it could not be incorporated, many healthcare providers would still embrace it, but only for a chosen group of patients suffering from Chronic Obstructive Pulmonary Disease (COPD). However, some would not because it would be laborious due to the added preparations and input the data in two systems. Their suggestion was that a precise manual be designed that provides practical steps on how to efficiently use the software during consultations, giving details for instance what preparations to be made before seeing a patient and how to begin a conversation with them. Also, it would be of importance to create a patients' prototype or a video of instructions to learn about the software before using it when consulting with a real patient. A further suggestion was the development of workshop and seminars to train healthcare providers how to use the program. All these will require concentration on how to begin a conversation with a patient having COPD, as well as steps to optimally use the program for common decision-making and personalized care planning (Bramley-Harker and Lewis 2005, p 65). Conclusion An efficient healthcare system provides a focus on the time and resources wasted from the point a patient enter and leaves a medical facility. Because of the wastage of resources, the NHC incurs extra expenditures which could otherwise be avoided. The use of the ABC tool has shown an improvement in the time patients wait at healthcare points and utilization rates for equipments at hospitals. The tool seems to be a very useful program for consultations with patients. Both healthcare providers and patients agree that the tool offers extra value and, therefore, suggest that it should be in integrated into the ordinary care and finally into the EMR software of healthcare service providers. References Taylor, C., 2011. Fundamentals of nursing: the art and science of nursing care, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Baker, J. J. 2008. Activity-based costing and activity-based management for health care. Gaithersburg, Md: Aspen. Feldstein, M. S. 2007. Economic analysis for health service efficiency: Econometric studies of the British National Health Service. Amsterdam: North-Holland Pub. Co. Campbell, D., 2016. NHS could save £5bn a year on running costs and 'bedblocking', finds report. The Guardian. Available at: https://www.theguardian.com/society/2016/feb/05/nhs-could-save-5bn-a-year-by-cutting-running-costs-say-reports [Accessed March 28, 2017]. Slok, A.H.M. et al., 2016. 'To use or not to use': a qualitative study to evaluate experiences of healthcare providers and patients with the assessment of burden of COPD (ABC) tool. Nature News. Available at: http://www.nature.com/articles/npjpcrm201674 [Accessed March 28, 2017]. Guillebaud, C. L. W., & Great Britain. 2009. Report of the Committee of inquiry into the cost of the national health service. London, Eng: H.M.S.O Lee, P. R., Estes, C. L., & Close, L. 2007. The nation's health. Boston: Jones and Bartlett. Bramley-Harker, E. & Lewis, D., 2005. Commissioning in the NHS: challenges and opportunities, London: Nera Economic Consulting. Read More