Imagine a health care system with zero falls, no medication errors and not a single death from a hospital-acquired infection. Upholding health care's “do no harm” oath isn't easy in today's modern hospitals. In 1999, a landmark Institute of Medicine report found that as many as 98,000 patients died each year from preventable medical errors. Nearly a decade later, a 2010 investigation by the U.S. Department of Health and Human Services put that figure closer to 180,000 patients for Medicare beneficiaries alone, and estimated the annual hospital care costs for these events at $4.4 billion.
Efficient Health Care
So what can we do to make health care safe and affordable?
The answer for some health care leaders, especially those at Virginia Mason Medical Center, can be found on a Japanese assembly line at the Toyota auto manufacturing headquarters. Pioneers of Lean manufacturing, Toyota follows a production process they developed called TPS (Toyota Production System) that’s focused on creating the highest possible value with the least amount of waste. Michael Glenn, M.D., chief medical officer at Virginia Mason in Seattle, Wash., believes this process can be applied to health care, too—with nothing short of transformative results.
On the brink of financial ruin 13 years ago, Virginia Mason began adopting Lean as a last-ditch effort to save their medical center. Since then, they've become a national leader in health care quality and sparked a new Lean health care movement that’s gaining momentum nationwide.
Lean Operations
“The Toyota production process really clicked for us,” says Glenn. “It's not based on feelings. It's a data-driven, scientific method.” But skeptics are concerned about an assembly-line approach to patient care. Are there really any similarities between making cars and taking care of patients? Can complex medical problems truly be solved with manufacturing processes?
“We're not trying to re-engineer how hospitals take care of patients, but all the other processes that surround their interactions with patients,” says Lucy Glenn, M.D., chief of radiology at Virginia Mason. The goal is to remove every ounce of waste from the system so physicians can focus on solving problems for patients, instead of struggling to practice medicine in an inefficient workplace. Improvements include everything from creating mechanic-style shadow boards for surgical instruments to developing “flow stations” that keep documentation, emails and messages moving through the system throughout the day.
Working Toward a Target of Zero
Hundreds of other manufacturing-based best practices, almost all adapted from the Toyota Lean playbook, have been implemented at Virginia Mason. Some of the most powerful tools for transformation have included:
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Value stream mapping—examining where processes start and end, measuring the amount of time each process takes and eliminating steps that cause delays.
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5S methodology—organizing the workplace for maximum efficiency using the five S's of Lean manufacturing: sort, simplify, sweep, standardize and self-discipline.
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“Poka yoke” mistake proofing—preventing, correcting or drawing attention to medical errors as they occur.
“It's pick and shovel work,” says Lucy Glenn, who concedes that it has taken nearly a decade to chip away at misperceptions, get staff buy-in and shift the culture. But that work is paying off. Costs at Virginia Mason have been reduced significantly in many areas. Profits have consistently improved. And patient safety has never been better.
“We're not just working toward a target of 'better,'” he says. “We’re working toward a target of 'zero defects.'”