Improving Healthcare Delivery by Studying Toyota

By Jon Miller | Post Date: March 17, 2008 4:53 AM | Comments: 4

The Seattle Post Intelligencer had a good article a few days ago giving an update on the lean journey at Virginia Mason Medical Center in Seattle, titled To build a better hospital, Virginia Mason takes lessons from Toyota plants

When you think of a hospital, what comes to mind? Patients, emergency rooms, technology and medical advancements. Making the sick and injured well again.

When officials at Virginia Mason think of hospitals, they think of cars. A car manufacturing plant, to be exact.

Virginia Mason stands out from the rest of hospitals implementing lean healthcare not only in the fact that since starting in 2000 they have been an early adopter and leader, but also in the fact that they unabashedly call their lean management system the Virginia Mason Production System, giving more than a nod to the Toyota Production System which they are copying. As part of this they have taken hundreds of physicians and hospital administrators to Japan to learn kaizen on the shop floor. Their approach was radical surgery in the minds of some, but it has absolutely turned VMMC around in terms of profitability and speed of positive change.

" 'People are not cars' is very common for me to hear," Kaplan said. "We get so wrapped up in the seriousness and specialness of health care, but we also have to open our eyes to other industries -- we're way behind in information specialists and taking waste out of our process. Toyota is obsessed with the customer and customer satisfaction ... all those things Toyota was about was what we wanted."

The article gives specific examples of how kanban systems, standardization and other lean tools being used to eliminate the 7 types of waste to improve quality of care and reduce the patients' waiting time. Their adaptation of the jidoka concept of stop and fix is particularly inspiring:

Another adaptation from the Toyota model is a patient safety alert system. At the manufacturing plant, if there's a problem, the whole line is stopped and the problem is fixed immediately. Virginia Mason's practice had been to identify and fix problems after the fact, perhaps leading to mistakes recurring many times before a solution was found. The alert system allows nurses and physicians to signal a problem when it happens and fix it immediately. Virginia Mason's Kirkland site has about 10 alerts each day.

Although lean was not to everyone's liking and some left VMMC rather than cope with the new way of working, Virginia Mason cites overall benefits of 85 percent reduction in patients wait time to get lab results back and lower inventory costs of $1 million, as well as reduced overtime and temporary labor expenses by $500,000 in one year and increased productivity of 93 percent.

The CEO has a vision:

Kaplan's vision is to have patients start their appointment in the parking garage with a smart card that triggers their entire appointment process. No more waiting rooms, just move directly from the garage to an examination room.

That's the kind of service I want if I need to visit a hospital.

"We have more than enough resources in health care," Kaplan said. "We just need to stop wasting it and only do what's appropriate and value-added and we'd save billions."

Now if only our government could adopt Dr. Kaplan's philosophy...

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