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

An aerial view of Barnes-Jewish Hospital and Washington University Medical Campus.

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.

About the author

David Weinberg is a general assignment reporter at Marketplace.
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Mistakes in healthcare costs big money! AND LIVES!
That's why it's crazy to have a 30 hour shift.
Pass a law that healthcare providers must notify the patient if they've been working over ten hours. We'll see costs/errors drop overnight.

Great Story! This idea needs to become part of the debate on controlling healthcare cost. We can do more with less! There is tremendous wast in Healthcare and in many other industries as well. Visit the ThedaCare Center for Healthcare Value for more information (http://www.createhealthcarevalue.com/about/)

Building design and construction is another industry just now finding the benefits of Lean proceses.

Actually the not-for-profit & safety net providers are the ones making the most use of this. They lack the resources to meet all the patient needs and must be as productive and effective as possible. Waste is particularly tragic when it occurs at the hospitals and clinics used by the poor and underinsured.

This smacks of Taylorism, and the scientific management techniques of Frederick Taylor, who contributed much to the automation, mechanization, and dehumanization of the American worker during the Industrial Revolution. His own children hated him for his obsession with introducing repetition and standardization into their lives. When he died, his watch stopped, as if to say, Thank you, and goodbye. Charlie Chaplin parodied his methodology in his movie Modern Times. It’s outrageous enough to imagine that health care is traded on the NYSE, I don’t think doctors and nurses need to have someone standing behind them with a stopwatch, and I certainly wouldn’t to have surgery in such an environment. If you want cost savings, think not-for-profit health care.

The Toyota ideas have been used for decades by Industrial Engineers. Our IE department at the University of Southern California, where I’m a professor, has been teaching this to students and hospitals with dramatic results. Large cost savings have occurred in the 20 plus hospitals we have worked with. USC gives a master’s degree with plentiful jobs in health care for the graduates.

Statistical process control actually got its start at Westinghouse. Its were Demming trained. Kaiser shipyards building the Liberty Ships in WWII used these techniques to perfect welding and started producing 1-ship per week with a large, highly female workforce. When the war ended, the Japanese shipyards were the only intact industry in Japan. When the Marshal plan got going, the general brought Kaiser, Demming, and Drucker to Japan. The Toyota's had closed the tractor plant during the war and took jobs in the shipyards. They learned from these guru's and it took IHI nearly 25 years to slowly improve their performance to capture nearly 70% of the world's shipbuilding business. It took another 20 years for Toyota to dominate the car business. After WWII we sent all the trained women home and brought back the best methods from the 1930's. A testament to American ingenuity is that it has only taken us 30 years to reintroduce these American invented shipbuilding techniques successfully back into manufacturing and now healthcare.

You won't believe this, and I never comment on your stories, but I was compelled to write about this lean healthcare story as I heard it in the car after waiting 50 minutes at my dermatologists' office before getting up, demanding my records be sent elsewhere, taking my copay back and leaving. Why can't more doctors figure out how to run a real operation?!?

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