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"Lean Healthcare:" Using mechanical systems for medical efficiency


Throughout the country a number of hospitals have been looking to Toyota auto plants to learn how to make healthcare safer and more efficient. Among the dozens of institutions adapting the Toyota Production system to healthcare is Barnes-Jewish Hospital here in St. Louis.

Reporter David Weinberg brings us the story of how Far East auto plants are changing the face of hospitals in the west.

“Lean Healthcare”

For the past four years, officials at Barnes-Jewish Hospital have been redesigning their buildings and their management style based on a new way of operating hospitals. It's often referred to as “Lean Healthcare.” It's adapted from the Toyota Production System, which focuses on eliminating waste and improving efficiency in the production process.

The first hospital in the country to adopt the Toyota Production System was Virginia Mason Medical center in Seattle. At the time, Dr. Gary Kaplan, the head of Virginia Mason, saw an opportunity to turn around his failing hospital.

Efficiency expert Charles Kenney explains:

"And he turned to the Toyota Production System because it was clear to him that taking these principles and tools and adapting them to healthcare could significantly make Virginia Mason a more efficient operation," Kenney said.

Making each step more efficient

Kenney is the author of "Transforming Healthcare, Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience."

Kenney writes that one of the first Toyota concepts Kaplan instituted was value stream mapping -- essentially taking a complicated process, and breaking it down into its individual steps and finding ways to make each step more efficient.

The system has been adopted by dozens of hospitals in United States, including Barnes-Jewish here in St. Louis.

“Well for us here we started our journey hospital wide about 4 years ago,” Kent Rubach said.

Rubach is one of the senseis Barnes-Jewish hired to guide them on what they call their learning journey. The first change he made was to set up a strategy room for hospital staff.

“This is our wall over here you can see how we keep track of our progress,” Rubach said.

Above a long conference table is a complicated diagram, taking up one entire wall of the room. It is made up of hundreds of hand drawn lines that connect dozens of small pink and yellow sticky notes. Ruback says it's just like the charts in Toyota's strategy rooms.

“Similar, yeah you would see the exact same thing for a part going from raw material to finished good,” Ruback said.

Adding value

But in this case, the diagram illustrates the process of a patient coming into the hospital with a stomachache. Each one of the pink notes represents a point in the process where a patient has to wait.

“So if we do have wait we are going to add value to that wait,” Daryl Williams, who heads the Emergency Department at Barnes-Jewish, said. “Can we give the patient education? Can we get their labs done ahead of time to where they get to see the doctor? So if we do have to wait we are going to add value to that wait and not just have them sitting and doing nothing.”

Williams says under the old system an acute abdominal pain visit typically took three hours. Today it's two hours.

The room for improvement

A key principle of the “Lean Healthcare” is to encourage staff members to speak up whenever they see a part of their job that can be done more efficiently, or a process that could be improved.

An employee who worked in the Intensive Care Unit had an idea to help patients' families, who often spend day and night in the waiting room while their loved ones are in the ICU.

“My name is Linda Henderson I am here with my fiancé Alfred Moss. He had a stroke to the brain.”

Henderson has been living in this waiting room for the past 8 days.Before the “Lean” changes she would have had to sleep in a chair or on an air mattress on the floor but based on the employee's suggestion, the hospital replaced the furniture in the waiting room with special chairs that recline into beds.

“I can lay back and I have my blanket and my pillow or my teddy bear for my pillow and then I snooze and go to sleep,” Henderson said.

Although Barnes-Jewish, Virginia Mason and other hospitals have had noticeable success, “Lean” management is not for everyone. It requires a tremendous investment of time and resources to do properly, and leadership that is willing go forward in the midst of harsh criticism.

And - its proponents note - it never ends. As the Toyota sensei's say, they live in the biggest room in the house, the room for improvement.