Hospitals Get Lean

March 18, 2007
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GRAND RAPIDS — If lean manufacturing can produce cars, can it also produce satisfied hospital patients?

Saint Mary’s Health Care in Grand Rapids thinks so, and for about 18 months it’s been embracing the waste-not philosophy imported from manufacturing. Saint Mary’s even hosted a delegation from the St. Mariana University Hospital in Tokyo, which met with staff members in January to learn how lean manufacturing concepts can be transferred from manufacturing to the service-oriented business of a hospital.

“How do we eliminate wasted steps and unnecessary procedures and have everything based on the value to the customer?” asked Dr. John J. Collins Jr., vice president and chief quality officer for Saint Mary’s. “If it isn’t something that’s valuable to the customers, why do we do it?

“So in health care, if we’re doing things that a patient or a patient’s family or an insurance company representing the patient wouldn’t want to pay for, how do we figure out a way that everything we do adds value to that patient’s journey through health care?”

Such questions are easy to come by, but the answers require careful examination, added Sandra Rose, manager of lean process transformation at Saint Mary’s, a nonprofit Trinity Health hospital. Rose is charged with leading the hospital’s 2,700 employees through sessions that identify and come up with ways to deal with waste in materials, procedures and time.

That’s an approach that is only recently being embraced in health care, Rose said, as hospitals across the country have been joining the lean movement in the past few years in response to prodding for improved quality by the Institute of Medicine. Often the manner in which tasks are completed in a single department varies from employee to employee and are long-ingrained, she said.

“People will, for whatever reasons … try to find their own creative way to do things,” Rose said. “So once we have lots of different people trying to find different ways, we fall away from the way it’s supposed to be done. And we end up with chaos.”

The first challenge is to get everyone involved in a process to agree on the standard operating procedure, she said.

“It’s only when we can agree to the standard way that we can be creative enough to change it. But once we do that, we all change it the same way.”

Some 13 percent of Saint Mary’s staff has been touched by the lean process so far, Rose said.

Businesses have long utilized both the lean approach to streamlining processes, also known as the Toyota Production System, and Six Sigma, a Motorola Inc. system aimed at reducing defects. In 2000, the Institute of Medicine issued a report stating that medical errors were causing 44,000 to 98,000 deaths annually in the U.S. and threw down the gauntlet to hospitals to cut that rate in 18 months based on its six standards of quality.

“The example I love is the ICU (Intensive Care Unit) nurse saying, ‘We can’t keep taking these patients that come up from the emergency department unless the emergency department agrees to put them in the proper grown and put the proper electrode leads on their chests.’ And I said, ‘What? They have different leads and different gowns in the emergency department than you have in ICU? Why is that?’ All of a sudden you’ve got people that identify very simple but intricate things. Let’s change that — today,” Collins said.

Saint Mary’s is not alone. Metro Health Hospital, with about 2,000 employees, started working with the lean approach in 2004, and Spectrum Health, with about 13,000 employees, got started last year with the creation of a new department.

“Really, everything that we do in health care is a process, and lean really is about improving processes by eliminating non-value-added activities,” said Cindy Allen-Fedor, vice president of outcomes management for Metro Health. “The front-line employees liked lean right away, because I think some of them really for the very first time were being asked to take a look at their job and make it better.”

Some 464 Metro Health employees have been part of lean teams so far — some of them two or three times, Allen-Fedor said. Ten staff members are trained lean facilitators. Over two years, the hospital accomplished 93 lean projects. One of the more successful ventures saved the hospital $600,000 in a single year, she said, by redesigning the pharmacy to avoid duplicate inventories of medicines. Also in the pharmacy, errors were cut to virtually zero by the creation of a safe zone that eliminates distractions while prescriptions are being filled. “All they did was put red duct tape on the floor. When they’re in there, no one can talk to them,” Allen-Fedor said.

Spectrum Health has been on the lean path for about two years, said John Frein, the health system’s interim director of operational improvement, a five-member department created a little more than a year ago. He said several new employees, including himself, arrived over the past few years with a manufacturing background, bringing their skills in lean and Six Sigma with them.

“We call it TPS: Total People System,” Frein said. “It’s the way that people work in their jobs that is at the heart of TPS.”

Among the processes addressed at Spectrum Health have been replenishing supplies, bed turnover and patient transportation, he said. But of the health system’s big payroll, he said, only a few hundred have been through the lean process. “We’ve got a lot to do yet.”

The three local acute care hospitals are all working with lean and Six Sigma, supported by a council of manufacturers. However, the hospitals have done little to share the knowledge they’ve acquired so far, they said.

The anticipation is that using these methods to eliminate waste and improve care quality eventually will pay off in cost savings.

“I think (the goal) is to improve patient satisfaction by improving the quality, efficiency and reducing costs,” Frein said. “If we focus on patient satisfaction, these other things will naturally evolve. We believe by doing those things, costs will go down.”    

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