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About Us
Based in Ann Arbor, Michigan, Blue Cottage Consulting is an independent, woman-owned healthcare consulting firm specializing in visioning, strategy, operations, and facility planning (programming, design review, transition and activation planning).

Blue Cottage Consulting is different - we have vision, knowledge, experience, and a point of view. Our professionals have held executive and management positions at some of the best medical centers in the country. Most importantly, we seek projects and clients that want to transform healthcare.
 
Cottages are about relationships, respite, and reflection. Blue Cottage Consulting is about creating a space for our clients to think, dream, and truly see the ocean of possibilities that exist for any given project. We coach leaders to embrace the possibilities, balance real versus perceived risk, and articulate a bold strategic vision – in other words, Be Transformational.  We get to know you, we work alongside you, and we create an intimacy in our partnership that fosters honesty, challenge, and innovation. It is an exercise that brings out the best in you and your team so that together, we can discover breakthrough solutions with practical implementation, explore global concepts with local applicability, and clearly articulate what success looks like and how we are going to get there.
 
Our consulting professionals challenge the status quo by applying lean efficiency standards to reduce waste, achieve mind-blowing operational innovations, and create an environment where clinical teams can achieve their full potential. We combine robust analytic tools and performance-driven measurement metrics, with real-world experience and active listening techniques to allow both data and people to guide each project to its highest probability of success. Our capabilities come from graduate training in healthcare management, nursing, planning, and architecture, as well as certification and professional training in special skills such as lean operations, six sigma, and executive coaching.
 
We are Blue Cottage Consulting and we are working to transform healthcare one project at a time.
ABOUT US


Where the Eyes Go, the Body will Follow… Leadership focus from my Bikram Yoga practice

March 5th, 2012 by Juliet Rogers

I have been practicing Bikram Yoga for about three months, which means I am still a newbie. I still fall out of many poses, still don’t know exactly what I am supposed to be doing much of the time. Despite my inexperience, Bikram has been an incredible experience for me so far. For those who haven’t tried it, a Bikram class consists of a 90-minute practice of 26 Hatha yoga postures in a room that is heated to 105 degrees. The script is the same at every class, in any studio, anywhere in the world. The predictability is comforting and the workout is challenging for both body and mind.

Each time I practice Bikram, I find myself incredibly focused and for the hours that follow. I enjoy a level of insightfulness, positivity, and creativity that is very similar to the high that I achieve during and after a great run. I’ve recently spent a great deal of time reflecting upon a Bikram phrase, “Where the eyes go, the body will follow.” The phrase is a simple one and is very useful guidance when trying to get into a backward bending posture or a cobra pose. The overarching message however, transcends the yoga studio.

As a parent, a partner, a business owner, a boss, and a project leader, finding time to focus is always challenging. What many of us fail to realize, however, is that we are focusing whether we are conscious about it or not. In actuality, I am focusing on whatever my eyes are looking at. Thinking about it in these terms, I have become more conscious (dare I say ‘mindful’) about what I really am looking at during various parts of my day. If my eyes are reading senseless and unnecessary emails, watching TV, or are mindlessly scanning Google search results – that’s where my body (my attention, my energy) ultimately is and wow, what a waste of time. In Bikram, my body follows my eyes. In the workplace and in this company, my eyes really need to be squarely and intentionally focused because “where the eyes go, the company will follow.” I hope that we can bring this type of laser focus to each and every one of our clients, so that together, we can set our focus on exactly where we all want to go.

Juliet L. Rogers, PhD, MPH, is President & CEO of Blue Cottage Consulting.

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Why health care competition won’t work

February 27th, 2012 by Andrew Mychkovsky

“This blog is the personal opinion of a Blue Cottage team member. Blogs posted on our website may or may not reflect the view of the owner, the CEO, or the company as a whole, but I strongly believe in everyone’s right to voice his or her opinion. I also believe that controversy and dialogue are key ingredients to innovation and improvement. If you disagree with anything written in our blogs – please write us! We’d love to engage with you,” Juliet L. Rogers, PhD, MPH, Blue Cottage Consulting President & CEO.

“We must increase the level of competition in health care,” is quite possibly the most overused and exaggerated statement this year in the realm of health policy. From presidential campaign voucher programs to free-market, libertarian blog posts, the nation seems fixated on this principle that competition will absolve all our nation’s health care woes. And although I encourage such political participation, I find these statements completely irrational. Increasing health care competition will have a marginal impact at best on cutting overall cost.

Peers who disagree often remind me, “competition works every day.” I agree with that statement. Millions of consumers purchase items or services from various sources, ranging from oil changes to toothpaste. The relative importance of price versus quality is judged. Each product is used, evaluated and then discarded. Those products or services meeting satisfactory standards are repurchased.

A prime example of this is the automobile industry. Potential buyers test drive and then review car ratings from consumer reports. The individual can effectively compare the specifications, price and reliability of similarly desired models, with the guarantee that all products are standardized. Car manufactures Honda and Toyota have surely benefited. Following market principles, by offering quality cars with high fuel efficiency and lower costs, they took huge market share, while drivers got sweet deals.

Unfortunately, do not assume the consumer reports approach will work for health care. It won’t. Hospitals offer too large of a range of services with various complications and medical jargon. In today’s world, it has become exceedingly difficult to pick the right professionals outside one’s area of expertise. Being a good attorney does not mean you can pick a good Hematologist. In addition, hospital report cards can be misleading. For example, mortality rates cannot be considered a strong indication of medical performance unless patient age, “do not resuscitate” orders, and health complexity issues are taken into consideration.

Health care services just follow a different set of rules. Coronary bypass surgery or limb amputations are huge decisions with irreversible consequences if the “wrong” purchase is made, which is much different than switching your internet provider. The risk of no trial runs, coupled with high emotion from the patient and sphere of influence, sometimes cloud best judgment.

Then there are those who argue competition will be attributed to insurers. Problem is coverage plans differ in everything from medication deductibles to procedure co-pays to specialist referrals. Patient safety, cost, coverage, and effectiveness of medical intervention must be considered. Using comparison charts and graphs for different plans will become overwhelming for the average American. In order to have a high-level discussion and evaluation of health insurance, one must have the capacity to evaluate an extremely confusing process.

Instead of focusing all of our attention on increasing health care competition, we must discuss less televised, more pertinent issues. Here are some examples:

  1. Cap the rise of high-deductible insurance plans. Such high-deductibles have become the crux of the health insurance scheme and negatively impact the middle to lower income citizens who pay $1000 plus deductibles right off the top. Executive government leadership could hold costs flat for the year and publicly report the findings.
  2. Ensure that money saved by Lean hospital practice is returned to the patients. Innovation and efficiency should and must be reinvested to help lower the costs of patient payments, not support health system endowments.
  3. Advocate for the implementation of bundled payments to encourage a more comprehensive care approach. For example, a patient would pay for surgery plus the next 60 days of care. Ensuring broader payments may result in better overall care.
  4. Continued discussion of research done by the Agency for Healthcare Research and Quality on applying value purchasing to the private practice.

The biggest problem of our health care system is by design. Health care is driven by a high market share business model. Health systems succeed by offering more things to more patients. If we desire true reform, it requires systemic improvement to addresses this overarching principle. By incorporating a “flooding the zone strategy,” a wide portfolio of changes can be implemented to improve many facets of the problem all at once. Much better than this disingenuous claim that competition is the health care reform magic bullet.

Andrew G. Mychkovsky is a Project Coordinator at Blue Cottage Consulting.

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Distinguishing Between a Project and Process Improvement for Lean Operations Planning in Healthcare

December 5th, 2011 by Anastasia Vogt

I recently attended the Lean Healthcare Certification Program at the University of Michigan’s College of Engineering. During one of the classes, a question came up from one of the participants about the use of a project charter for process improvement initiatives. Apparently, the purpose of a charter or even whether a process improvement initiative could be considered “a project” had been a hotly debated topic back at their facility amongst the project managers. What’s the difference between them and does it really matter? To paraphrase, Dave LaHote, President of Lean Education at the Lean Enterprise Institute and a speaker during the certification program, “Everyday, people are faced with a moment of truth where they have to make a decision. Will they choose to make their decision by design or do they make it by default?” I’ve come to the conclusion that there are important reasons to delineate between projects and process improvement.

Process improvement initiatives are like projects in many ways. They make use of many of the same analytical tools such as fishbone and pareto diagrams, swim lanes, decision trees (and are often tracked using the same methods of monitoring scope, budget and schedule). More importantly, they share the same practice around dedicated and advance planning, defining requirements and setting objectives prior to initiating or executing activities. In fact, many people define additional activities above day-to-day operational duties a “project,” especially when it has a specific objective.

The Project Management Institute’s definition of a project is “a temporary endeavor undertaken to create a unique product, service or result.” While I will accept there is substantial flexibility in how to define a project. For example, our seven year-old’s concept of a project is to make a robot out of empty cereal and shoe boxes with tape and glue. And while superficially process improvement initiatives and projects feel similar in many ways, their overarching objectives are substantially different, and I believe it is good that they are.

Process improvement initiatives are fundamentally all about change and the creation of new behaviors that support problem solving and continuous improvement within an organization. It’s risky to define these initiatives as projects because, no matter what definition you subscribe to, projects inherently have an end and by design they run out of time and resources. Process improvement initiatives may require several trials over long periods of time and patience while the organization strives to widen its circle of alignment around improvement practices. Projects, with their temporary resources and mandated timelines, may not have enough stamina to endure a change process. You definitely don’t want the change you’ve initiated to cease when the project is over, the goal here is continuous improvement.

So, if a process improvement initiative can’t be a project, can a project be “lean”? Sure. The successive processes by which a project are performed can be improved upon and often are through examining lessons learned and conducting a debrief at the close-out phase. These processes provide an opportunity to reflect and document what can be improved upon in the next project and serve as a valuable resource for the organization and for the project manager. As of late, more standardized “lean” project management methodologies such as “The Last Planner” are becoming more popular. These systems have surfaced to respond to a need in the industry to increase the value of project management processes and eliminate the wasted steps that frequently occur in projects either due to over-planning or through attempts to meet the needs of project stakeholders.

At the root of it, projects are finite. Process improvement is infinite. Both have their appropriate applications in the effort to create change within a system.

Anastasia Vogt, PMP, is a Senior Healthcare Consultant at Blue Cottage Consulting.

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Supreme Court to decide fate of “Obamacare”

December 2nd, 2011 by Andrew Mychkovsky

It is official. The highest court in all the land will decide the fate of health care reform! One can only hope it is from a purely constitutional and not partisan perspective. Arguments are expected in March, with a decision in late June, 2012. Here is why the Supreme Court of the United States of America should uphold the constitutionality of the Patient Protection and Affordable Care Act individual mandate:

The individual mandate functions not only as a punitive measure, but also a means of raising revenue otherwise lost to uncompensated care. It is a direct interpretation of the 16th Amendment. The Necessary and Proper Clause grants Congress the right to make all laws necessary and proper for carrying into execution the foregoing powers. The individual mandate provides funding for the entire law. That is the definition of necessary and proper.

Traditionally, the Commerce Clause has granted Congress the right to broadly regulate business with significant interstate commerce. During the landmark case Wickard v. Filburn, the Courts decided Congress could regulate a farmer’s personal wheat production based on the threat of every other farmer following suit and lowering national wheat consumption. Health care has an even larger national component. Not only do citizens constantly travel interstate, uncompensated costs result in billions of dollars, but almost all medical supplies, drugs, and equipment have significant interstate commerce.

Most constitutional dissent focuses on the right to compel persons deemed “inactive” in the current health insurance market. Often conceding interstate commerce, opponents argue Congress cannot compel the uninsured to purchase health insurance because they are not actively participating in healthcare commerce. This is flawed. No person is inactive when deciding how to pay for health care whether it is self-insurance, private, or public insurance. Those intentionally uninsured cannot guarantee abstinence of incurring exorbitant medical debt and burdening society. Inaction is action.

This concept is incredibly exciting and nerve-wracking all at the same time. As most political junkies know, the current Supreme Court definitely leans to the right. With Chief Justice John G. Roberts Jr. at the helm, I sometimes become cynical of political coercion and judges. However, the conservative base lost a huge ally when George W. Bush appointed Circuit Judge Jeffrey S. Sutton, who opinioned the ACA was constitutional a month ago. Who really knows what will happen.

Andrew G. Mychkovsky is a Healthcare Consulting Intern at Blue Cottage Consulting.

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Hotspots: Dr. Jeffrey Brenner’s Model to Address the Issue of High-Cost Patients

November 14th, 2011 by Andrew Mychkovsky

In 2009, Camden, New Jersey was listed the most dangerous city in America by CQ Press survey. And despite the FBI-compiled crime data and negative perception associated, I view them as thee progressive model for improving quality of care and cutting healthcare costs. Thanks to the Camden Coalition of Healthcare Providers, you should too.

Earlier this year, PBS FRONTLINE correspondent Atul Gawande delivered the story, “Doctor Hotspot,” about Dr. Jeffrey Brenner. A local Camden physician, Dr. Brenner created a model to address the issue of high-cost patients over utilizing the emergency department. Under-insured or uninsured patients receive insufficient coordinated care that they cannot afford and society is burdened with the leftover costs, leading to a double negative.

Inspired by a traumatic neighborhood experience, Dr. Brenner soon devised a plan to statistically map out neighborhoods with high crime rates and the most costly medical patients. The results were astonishing. 1% of the city population accounted for 30% of the total healthcare costs. With this data, Dr. Brenner created colored cost data graphs and maps of the city to locate “hotspots” for high health costs. These would be the areas he would focus on.

To offer some perspective, Camden had 12,000 ER visits for non-emergent issues such as head colds, ear infections, sore throat, asthma, and stomach viruses. To start, Dr. Brenner only asked for the highest-cost patient referrals from the emergency department. Establishing relationships outside the hospital, he developed a high degree of acuity to the level of complexity of each individual. Soon thereafter, Dr. Brenner founded the Camden Coalition of Healthcare Providers. The Coalition now provides in-home organized care for 300 of the highest-cost patients within the city.

Implementing such system into a larger metropolis will be challenging. Replacing a competent and passionate advocate such as Dr. Brenner will be difficult, but we the have responsibility to at least try. At Camden, this approach has revolutionized the coordination of care to a small subset of the most frequent ED patients who cost $10 million a year. Although comprehensive and time consuming, one cannot ignore the legitimacy of hotspot mapping and statistical analysis. Various hospitals and communities have implemented programs to address the concerns of high-cost patients, including Massachusetts General Hospital and Atlantic City Special Care Center.

The current healthcare system is unsustainable. The ED is not equipped nor designed to handle patients who could be treated at a primary care clinic too. As Dr. Brenner so eloquently states, “It’s like arriving at a major construction project with nothing but a screw driver and a crane.” We must explore and expand on all options that show significant gains. And by the way, preliminary results show 40-50% decrease in hospital visits and costs for the patients served by Camden Coalition of Healthcare Providers. I would say at the very least, it is worth looking into.

Andrew G. Mychkovsky is a Healthcare Consulting Intern at Blue Cottage Consulting.

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