Some hospitals think 'lean' when it comes to health care

[mchammer187]

Great Story I listened to today

http://marketplace.publicradio.org/...itals-practice-lean-thinking-for-health-care/

One strategy for fixing the U.S. health care system that's been gaining momentum lately has origins in the Far East.
Aerial view of Barnes-Jewish Hospital

An aerial view of Barnes-Jewish Hospital and Washington University Medical Campus. (surgery.wustl.edu)

Tess Vigeland: Of all the indignities that befall us at the doctor's office or in a hospital, the interminable wait is probably the most universal. It costs you time, money, agony. And guess what? It costs the hospital time and money, too. You'd think a solution to this constant and unsustainable economic problem would have revealed itself long ago.

But David Weinberg tells us the wait may be over -- based on lessons learned from a car manufacturer.

David Weinberg: I'm walking through Barnes Jewish Hospital in St. Louis, with Kent Rubach, a hefty man in a shirt and tie with a notebook under his arm. He's not a doctor. In fact, he has no background in medicine.

Kent Rubach: We kind of started our journey hospital-wide about four years ago.

Rubach is what's known as a sensei. It's Japanese for master. Barnes hired him in 2006 to teach the hospital what's known as "lean management." Rubach picked up his skills at a Toyota plant in Kentucky, where he did everything from run a new model launch to hang mufflers on Corollas. We started at the strategy room.

Rubach: This is kind of our wall over here -- you can see how we keep track of our progress.

One entire wall of the conference room is covered by a complicated diagram of the hospital. It's made up of hundreds of hand-drawn lines connecting dozens of pink and yellow post-it notes.

Weinberg: So if you were to go into a strategy room at Toyota would you see a similar chart like this?

Rubach: You would see the exact same thing -- for a part going from raw material to finished good.

The map at Barnes traces the process of a patient who comes to the hospital's emergency room with a stomachache. All those pink post-its represent points in the process where the patient has to wait.

Daryl Williams: So if we do have wait, we are trying to add value to that wait.

Daryl Williams heads the Emergency Department at Barnes.

Williams: Can we give the patient education? Can we get their labs done ahead of time to where, when they get to see the doctor, all that stuff's back?

Before the staff mapped this process, the average stomachache visit took three hours. Today it takes two. That means Barnes can treat more patients, increase patient safety, and cut down on it's payroll. Another key principle of lean is to encourage staff to make suggestions about how things can be done better. At Barnes, family members often spend the night in the waiting room while a loved one is in the ICU.

Linda Henderson: My name is Linda Henderson. I am here with my fiance Alfred Moss. He had a stroke.

When I spoke to Linda Henderson she had practically been living in the ICU waiting room for eight days. But thanks to a suggestion by ICU nurse, she could sleep in a chair that reclines into a bed. Instead of an air mattress on the floor.

Henderson: And then I can lay back. And I had my blanket and my pillow. Or even my teddy bear for my pillow. Then I snooze and go to sleep.

Lean health care got its start back in 1998 at Virginia Mason Medical center in Seattle. That year the hospital started losing money. And its CEO started scouring the country's medical institutions for a solution. But he didn't find one.

Charles Kenney: Think about that. This is a very smart physician who goes around the country looking for a great management system and doesn't find one.

He found it in Japan. At first there was a lot of resistance. A hospital run like a car company?

Kenney: There was a lot of anger from people within his organization, led by the doctors of course.

When the staff met with their first sensei, he took out a ball of blue yarn and a map of the hospital and told the staff to trace the path of a cancer patient through a typical visit for a chemotherapy treatment.

Kenney: What was happening was they were taking these patients for whom time is absolutely the most precious thing in there lives and they were wasting huge amounts of it.

By cutting waste, the average time for a chemo treatment fell by 50 percent. More patients could be treated, and they got in an out more quickly. The new system is also much safer. As a result, the hospital's insurance expenses declined.

Kenney: So the Virginia Mason Production System is now viewed throughout the world by many people as a very viable alternative to the current system.


Kenney says lean health care is not for everyone. It takes a tremendous amount of work to do properly and the process never ends. As the Toyota senseis like to say, they live in the biggest room in the house -- the room for improvement.

In St. Louis, I'm David Weinberg for Marketplace.

 

[spidey07]

Yeah, that's great. Just ask how and the impact just in time and being "lean" did to toyota from a supply chain disruption from a single earthquake.

You want that when people's lives are on the line? NOT.

Kaizen is good, being so lean and not having redundancy or inventory can cripple you in unforseen cases which can and WILL happen.

Oh, and cutting wastes is "muda".

 

[bfdd]

Sounds cool. Efficiency is something we drastically need in the health care industry in order to lower costs.

 

[Doppel]

I fvcking hate the waits at doctor's office. I guarantee you that way WAY more people are on time and kept waiting than those who are late and the doctor waits. And I'd make my doctor wait to test but I'm not as much as an ass. Really their time is worth no more to them than mine is to me. I guess I didn't go to medschool though so I play the card I was dealt as a prole

 

[spidey07]

I fvcking hate the waits at doctor's office. I guarantee you that way WAY more people are on time and kept waiting than those who are late and the doctor waits. And I'd make my doctor wait to test but I'm not as much as an ass. Really their time is worth no more to them than mine is to me. I guess I didn't go to medschool though so I play the card I was dealt as a prole

Find a better doctor then. I've never had to wait more than 10 minutes. Called up my eye doctor today and said I need to be seen TODAY, ASAP. Went in, got checked out and out the door in under an 40 minutes.

If you see more than 4-5 folks in the waiting room, you need to find another doctor.

<---mom was a doctor, she taught me what to look for.

 

[bfdd]

Find a better doctor then. I've never had to wait more than 10 minutes. Called up my eye doctor today and said I need to be seen TODAY, ASAP. Went in, got checked out and out the door in under an 40 minutes.

If you see more than 4-5 folks in the waiting room, you need to find another doctor.

<---mom was a doctor, she taught me what to look for.

This isn't for people like us who have good private health insurance with our own private doctors. This is for the gen pop, I hope you can see that. Hell even those of us with insurance can feel the bite when we hit the emergency room. I could pay for it unlike probably 80% of the rest of the people who were Harbor UCLA run offs, yet I still had to wait damn near 2 hours to get in to get my jaw infection checked out. More efficient and lean health care centers is what we need. Time = money or have you forgotten?

 

[mchammer187]

Yeah, that's great. Just ask how and the impact just in time and being "lean" did to toyota from a supply chain disruption from a single earthquake.

You want that when people's lives are on the line? NOT.

Kaizen is good, being so lean and not having redundancy or inventory can cripple you in unforseen cases which can and WILL happen.

Oh, and cutting wastes is "muda".

So you are saying improving coordination so you don't have to things multiple times for no reason is a good thing.

How can the ball of yarn exercise hurt things. The way I see it than it can only help.

Your attitude of my doctor is good so the whole healthcare system is fine is exactly the problem. The system as a whole needs to address inefficiencies on wide scale.

 

[spidey07]

So you are saying improving coordination so you don't have to things multiple times for no reason is a good thing.

How can the ball of yarn exercise hurt things. The way I see it than it can only help.

Your attitude of my doctor is good so the whole healthcare system is fine is exactly the problem. The system as a whole needs to address inefficiencies on wide scale.

I don't disagree with eliminating muda or to kaizen the process. We can heijunka and learn.

But Toyota Way dictates we find the root cause of this muda. What is root cause after 5 why analysis? If you want me to go through the 5 why analysis and prepare an A3 I can, but only if you pay me.

Government regulation, that is root cause. Countermeasure?

 

[ProfJohn]

Yeah, that's great. Just ask how and the impact just in time and being "lean" did to toyota from a supply chain disruption from a single earthquake.

You want that when people's lives are on the line? NOT.

Kaizen is good, being so lean and not having redundancy or inventory can cripple you in unforseen cases which can and WILL happen.

Oh, and cutting wastes is "muda".

You are a complete idiot.

It is a hospital not a manufacturing facility. The hospital delays weren't being caused by lack of 'parts' they were caused by poor process management.

 

[ProfJohn]

When I was at Disney we did a complete process improvement program at the restaurant I worked at.

It was a real eye opener when we charted all the steps involved in just getting people from the front door to their seats. When you start chopping off steps and stream lining things it is amazing how much quicker and more efficient you can become.

We should do this to our entire government. Especially things like road construction etc.

 

[Pulsar]

Looks like Spidey got caught in his own web of trying to appear smart.

This is something that the health care industry as a whole needs to learn. From designing and laying out the hospitals so I don't have to go down 6 floors and across half the building for a basic service, to how to organize their lunch delivery so that people actually get warm food, this will only help them.

Of course, the down side is the resistance you'll see when these same people realize that increased efficiency means decreased overtime pay and fewer overall people employed - just like the American auto companies have been fighting for 20 years.

 

[ohnoes]

Holy crap, I actually agree with ProfJohn on something. This was based from a Harvard business case and here's a snippet of the conclusion.

VMPS produced significant improvements. A total of 275 RPIWs from 2002 to 2004 reduced staff walking distances within the medical center by 38&#37;, or 34 miles, and the travel distance of parts by a whopping 77%, or 70 miles. Inventory was cut in half. Lead time within the center decreased by 708 days (53%), which translated to over two years. There was a 44% gain in productivity&#8212;the equivalent
of 77 full-time employees redeployed within the center. (This productivity gain represents the consolidated rollup of the incremental gains of removing non-value-added activities from one or more people. Approximately 20 full-time employees were completely redeployed outside of their process or department.) Additionally, 3P efforts saved between $12 million and $15 million in budgeted capital. Not only did 3P reduce the utilized number of square feet by 24%, but, thanks to the redesign of several units, planned additions and relocations were deemed unnecessary.

 

[PhoKingGuy]

As someone who actually is working to implement something like this in a hospital setting, spidey is clueless as to how much it actually helps.

 

[mchammer187]

I don't disagree with eliminating muda or to kaizen the process. We can heijunka and learn.

But Toyota Way dictates we find the root cause of this muda. What is root cause after 5 why analysis? If you want me to go through the 5 why analysis and prepare an A3 I can, but only if you pay me.

Government regulation, that is root cause. Countermeasure?

You say government regulation is the root cause yet Virginia Mason is legally able to implement these process changes.

By cutting waste, the average time for a chemo treatment fell by 50 percent. More patients could be treated, and they got in an out more quickly. The new system is also much safer. As a result, the hospital's insurance expenses declined.

 

[ProfJohn]

What is sad is that we spent a year fighting over an Obamacare plan that will do nothing to save money and only expands health coverage by expanding the amount of money pouring into the system.

If we had instead spent that time putting programs like this into use we could have greatly expanded medical coverage without having the government get involved.

The main reason people don't have medical insurance is because it is too expensive and the main reason it is too expensive is because it is very wasteful. Programs like this across the country could bring down hospital costs which would bring down insurance which would allow more people to get insurance.

 

[MagnusTheBrewer]

What is sad is that we spent a year fighting over an Obamacare plan that will do nothing to save money and only expands health coverage by expanding the amount of money pouring into the system.

If we had instead spent that time putting programs like this into use we could have greatly expanded medical coverage without having the government get involved.

The main reason people don't have medical insurance is because it is too expensive and the main reason it is too expensive is because it is very wasteful. Programs like this across the country could bring down hospital costs which would bring down insurance which would allow more people to get insurance.

I agree in principle but, I fear reducing costs would do nothing to lower the cost of insurance. Look at the government and the old "paperless office" concept.

90% of what government does is manage information. Healthcare doesn't hit 90% but, I feel confident that it's in excess of 50% in terms of managing information. Since the widespread adoption of computers to manage said information and improve accessibility, costs and bureaucracy have increased dramatically.

Certainly, there are other factors that have led to the increase of costs, I just chose this example of an organization having a vested interest in the status quo.

 

[RisenZealot]

This thread is right down my alley as I work in the Business department through the Emergency Room at the hospital where I live. About a year ago our hospital had some of these guys come in and give a conference on the entire lean program.

At first I was skeptical at the entire thought process of putting all this work into the hospital system in the first place. If the auto manufactures who came up with this thing were onto something so great then why was it the auto industry as a whole had been in the gutter lately?

After a year now I will admit I was wrong to a degree. Things haven't really gotten any worse (well they have but through no fault of lean) but they haven't actually gotten better either.

Moving on to wait times I have some info to share about that as well. Now I only speak for ER's at this time as I have never worked in a doctors office and am unfit to comment.

The problem with wait times in the ER has nothing to do with "the process" or whether or not you use lean, but everything to do with the sheer volume of patients coming in. Specificaly mental health patients and others who have no regular doctor they see.

Patients who come in and have no family doctor make up a GREAT majority of patients seen in an ER. 9/10 these are people who do not have insurance of their own and therefore cannot find a reg family doctor to see them. They then come to the ER b/c in this country Emergency Rooms cannot legally turn away anyone who requests to be seen. Now what is interesting about this is if you look up any statistics you will find that a great many times it is these people who complain about the wait time. Now I give them that their wait times are longer but it's only logical to be that way. Why would an ER with a set ammount of rooms bring back a patient who has a sore throat and has been in the waiting room for 2 hours when they have someone coming in who is having a stroke or had a horrible trauma?

People then ask if it's so easy to see the problem then how come Emergency Rooms don't add more rooms or be prepared for the massive influx of patients. This creates an unfair cycle. First when did it become the ER's responsibility to treat minor every day issues that should be taken care of by a family physician? Lastly but most importantly it RAISES the costs of health care. Think about this logicaly for a second. We have established that the majority of ER patients have no insurance and are self pay correct? Well not not only does that increase wait times but it also creates more demand for hospital supplies and workers. Take that a step further and take some time to research how many of these self pay patients ever pay a single dime to the hospital. Hardly none do. So that means people with insurance and people who do pay get raped and end up paying 5 times what something should cost. This is because 1/5 patients actually PAY anything. So those who do have to make up the difference otherwise the health industy (mainly er's) would simply collapse.

More to come, computer is about to go down and I dont want to lose this post...

 

[RisenZealot]

The last point I wanted to touch on was mental health patients. This is a growing problem which is adding strain to most of the ER's. Across the country states have been cutting funding to state run mental health facilities. Chances are your local ER is starting to feel the heat for this.

It used to be that if someone was a mental health patient they had a much easier time being placed into a facility. Now however due to these buget cuts they can no longer house as many patients. So once again just like the self pay people we talked about earlier, where do you go? If you are a mental health patient and can not get in a facility you come to the ER as we can not turn you away.

Here are some stats. These are for my actual hospital. The average wait time for a non mental health patient is between 4 to 5 hours. This is the time from when you walk in the door until you walk out. Now for a mental health patient the average wait time SKY ROCKETS to over 72 hours!! This is because one a mental health patient is in an ER we cannot legaly let them leave a great majority of the time as they are a danger to themself or to others. So they end up having to wait here for however long it takes a proper facility to have an open room.

Further more it's common for us to get at least 3 of these in every night. Now do some math. If the average one stays here for 72 hours that means that the room they are taking up could have in that same time seen 14.4 regular patients. Multiply this times the 3 we see a night (thats a low end) and you get 43.2.

So 43.2 more patients could have been seen in that time. Would it suprise you to know that that number represents close to a third of the total number of patients seen in 1 day? So imagine, if mental health patients were able to go where they can be treated correctly and given the care they should your or the average persons wait time in the ER would be cut by 1/3rd right off the bat.

Sorry for such a long winded post. I just felt like I would share some of what I've learned here.