Dialysis and more Dreams

This is a follow up to the previous post, “Dialysis and Dreaming” wherein I wrote about my dreams for an ideal center and pointed to Dialyspa as an example of a step in the right direction.

When I went for my dialysis treatment the next day, I just barely mentioned Dialyspa and one RN in particular lit up! She had seen and met with the Dialyspa people at the ESRD Network Convention in June and was extremely impressed with their business model, staffing levels, employees, and their approach to dialysis in general.  She said, “That night I spoke to my family and told them I wanted to move to Houston to work for Dialyspa.  Everything about their operation appealed to me. I felt like I was appreciated as an employee.”  That’s pretty high praise.  But I can’t blame her.  I felt pretty much the same from a patient point of view.  I want to move to Houston, too!

So, what does that say about the Dialyspa business model and their approach to dialysis?  It says there’s plenty of room for improvement in the dialysis industry,  not only for the patients but for the employees.  The same nurse mentioned that she started as a tech over 25 years ago and at the time, they simply attended to patients.  They had few other duties because there was a machine tech who took care of the machines.  When the Patient Techs arrived for their shift, the machines ready to go and that evening, were cleaned by the Machine Techs.  Between patients, the machine techs did all the hardware work.  Patient Techs were for patients. They were not allowed to leave their stations for tasks they do now.  All the stocking and re-stocking of supplies were done by others.  Over the years, the Patient Techs assumed more and more responsibilities as the company pared down the number of employees.  Now, she said, even as an RN she has to do menial chores that she didn’t have to do as a Tech.  The company focuses too much on cutting costs and not enough on patient care.

I have to agree with that.   As a patient my observations have been very much the same.  At the “Center from Hell“,  I noticed all too often how there would be no patient techs in sight.  Alarms would go on and on for several minutes without attention.  (And the alarms there were really loud and obnoxious!)  This was a center that operated way too much on the “For Profit” Business Model to the point that patient services suffered due to under staffing and poor equipment.  During the three years I was there, they “upgraded” their dialysis machines.  But it was with older, used machines.  They went from antique machines to old machines!  This is the center with old tube televisions hanging from the ceiling where three or four patients shared the same one and no one could ever find the remote controls to change the channel.  They claimed there was a move scheduled in the future and they would “upgrade” to new TV’s then.  This was the center where they still carried large, heavy containers of solutions to the machines because they didn’t have a central water system.  Some of the techs were only a 100 pounds themselves.  As they lugged the containers it looked like something out of a small Asian village with the women carrying water from the local source.  The chairs were an older generation and had been repaired and recovered many times.  Frankly, the management should be embarrassed but I’m sure they got a pat on the back for their annual “profits”.

The “For-Profit” model is, very simply, revenue mius the cost of doing business.  Whatever is left at the end of the year is profit.  Success, in this model, is measured by the increase of profit from one year to the next over the years.  If you don’t increase profits every year, you fail.

“For Profit” Model:  Profit = Revenue/Income – Costs

Here’s the rub:  If costs increase, more cuts are necessary to increase profits.  Now, add in the efforts by Medicare and insurance companies to decrease their payments to providers. Revenue goes down, costs go up, profits suffer. What happens? How does the “For Profit” model accommodate this? You simply cut costs.  You can see the downward spiral that results.

The patient and staff are caught in the middle because they represent major factors in the “cost of doing business”.  A quick, easy solution to the downward spiral is to cut staff since salaries are a large part of the cost of doing business.  It’s an easy target.  If you cut staff, someone has to assume responsibility for the tasks and that falls to those left after the cuts.  The staff becomes over burdened, and morale suffers.  Gradually, you lose the better staff and are left with second tier staff.  At the end of that chain is the patient, left dangling. That was one major reason I left the “Center from Hell”.

In the course of my research on this topic, I discovered Dialyspa and I wrote about them in the previous posting, “Dialysis and Dreaming“. I can, without hesitation,  say I’m really impressed.  But, some comments in the discussion at my center the next day, made me think about the Dialyspa concept and the “For Profit” Model.  How do they do it?  How does Dialyspa balance their need for profit with their commitment to patient-centered care?  So, I called them and I think I found the answer.

But some background first.  What is the Dialyspa commitment? Their website contains their statement which they affectionately refer to as “Neill’s Deal”  I love the large, bold print, simple, straight-forward language,  and Neill’s signature to complete it.  But, the meat of it is extremely important.  It is a clear commitment to patient-centered care. (I have a passion for “Patient-Centered Care“.)  It is a well-rounded approach to the delivery of dialysis services involving the staff, management, and patients in the process.  Dialyspa has modified the “For Profit” model and the result of that is what I’ll refer to as the “Neill Simon” model.

The Neill Simon model approaches customer and staff satisfaction by providing a well-equipped center.  From their website description that includes the facility (what they describe as “amenities” and “best in class treatment”), emergency/disaster response with backup generators, up-scale treatment chairs, televisions that are also touch-screen Internet monitors, etc. .   Much of this design came from the now-departed co-founder Neill Simon who even specified the ice chips should be from Sonic Drive-in because he liked those in particular.  Dialyspa refers to Neill’s input into the center design as “…represents his vision of a serene, relaxing environment that infuses a traditional, compassionate approach to patient care with the latest technology and equipment.”  Only a patient could come up with that ideal!  But all that costs and takes a toll on the profit.

The big difference in the two models (Neill Simon and For-profit) is that profit takes on a subjective value.  It is no longer just a cold financial calculation (as displayed above) but “profit” is now measured against customer/patient satisfaction and staff morale.  I discussed this with the co-founder and Chairman of the Board, Dr. Jeffrey Kalina.  I pointedly asked, “How do you reconcile profits for Dialyspa in the For-profit model?” His answer was that they consider customer service a priority over profits.  Of course profits are important but not at the sacrifice of customer or staff satisfaction.  Clearly, Dialyspa is not operating on a simple “For-profit” model.

Dr. Kalina also remarked about the “Neill’s Deal” has a positive effect on the more difficult patient.  They have taken on some patients who were considered difficult at other centers and had histories of shortened or missed treatments.  He reported that out of over 6000 treatments, only 11 were missed. He credits the Neill’s Deal (if you haven’t viewed it, take a moment.) with that success and the resulting interactions of staff with those patients in a patient-centered model.  That ratio of missed treatments is truly an achievement!

In the “Neill Simon” model, profit is not a precise calculation.  But, (putting my modeler hat on) it could be, if these factors are applied in a “weighted manner”.  For example, if you had measures for customer and staff satisfaction such as a periodic survey, this could be factored into the calculation so that:

Profit = Revenue-Costs+/-(survey weighting factor).

This wouldn’t please a CFO or a strictly bottom-line oriented businessperson, but it’s the way Dialyspa does business and this approach to dialysis upsets some of the large-scale dialysis providers because it exposes a weak spot in the strictly “For-profit” model.  If Dialyspa continues to expand in the Houston area and outside, large dialysis providers will surely lose business to them.  Competitors will either have to improve their approach to patients/customers and staff or figure a way to survive with a business model that does not take patients and staff into consideration.  And, to my extreme pleasure, Dialysis has plans to expand in and out of the Houston area.  So, perhaps this more patient-centered approach to dialysis will come to a location near you.   We can dream and dream harder.

© 2012 DevonTexas

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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One Response to Dialysis and more Dreams

  1. Kathlynn Cramer says:

    I read both Dailyspas blogs and was very impressed with the “Dream Place”.
    Although I have a good dialysis center and they seem very caring and have been an
    advocate for all the problems I have experienced in the month and a half I have been going,
    there are issues I liked about Dailyspas. The chairs look great. I was more impressed with the
    dividers for privacy. Since I am a women and was placed with a catheter because the fistula
    failed at first, being exposed to the cleaning once a week and the care of changing the solution
    in the catheter tubes every dialysis treatment is a little embarrassing. Guess being modest over 65 is something I value. Our techs bring us cold water in small cups(not ice cubes). That is ok with me because I am always cold but I appreciate that as soon as we say, “I need something to drink”, they go and get it. Also, if someone needs a protein drink, or bar, they bring it to you. Some patience are prescribed by the doctor if blood work shows they need it. That is why I think my dialysis place is one of the better ones. Not a Dailyspas with their water filter system and space privacy but I see a lot of the Neill’s Deal in the attitude of the techs and the nurses. Only one nurse and one tech bother me and they are day shift and usually gone by the time I get there. Thanks for all your research.

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