Full speed ahead: How hospitals saw more patients by learning from a carmaker

Process has cut medication errors, saved hospitals money

Several hospitals have cut down on wait times and achieved other efficiencies by adapting Toyota's production system to fit their needs, Anna Gorman reports for Kaiser Health News.

Toyota's philosophy—known as Lean management—focuses on staffers regularly working together to reduce inefficiency and increase quality.

Want to make the most of Lean? Engage your frontline staff.

A number of private hospitals have been employing the method for at least a decade, Gorman writes. But safety-net hospitals are increasingly utilizing Lean strategies, too, as they face mounting financial pressures.

According to Gorman, some clinicians are skeptical that lessons from a carmaker can effectively be applied to health care, or that any changes that result from Lean will be sustainable. And DeAnn McEwen, a health and safety specialist at National Nurses United, says that the process limits nurses to carrying out various standardized tasks that treats patients like "widgets" and nurses like "robots."

"Nursing care is not a commodity but a service," McEwen says. "It's a process that requires critical thinking and the application of judgment."

Still, many providers have seen results from using Lean management techniques. Before Los Angeles County Harbor-UCLA Hospital began utilizing the system, its equipment closet "looked kind of like a dog pile of equipment," says Dawna Willsey, a clinical director at the hospital. "It was every man for themselves trying to find anything."

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Employing the Lean system at its outpatient eye clinic, Harbor-UCLA made several changes, including:

  • Using color-coded folders to help staff quickly determine why a patient was at the hospital and which clinician he or she needed to see;
  • Halting the practice of sending patients to and from the waiting room during visits; and
  • Placing a locked box in every examination room with medications and prescription pads to cut down on doctors needing to seek out needed supplies.

And Gorman says that within several months, the average number of new patients staffers saw at the clinic per day had increased twofold, the average time spent by patients at the facility decreased from about four-and-a-half hours to slightly more than two hours, and patients had surgeries scheduled quicker.

According to the California HealthCare Foundation—which provided funding for Harbor-UCLA and four other California hospitals to work with Toyota to implement the Lean system—the new process has also helped reduce medication errors and saved hospitals money.

Susan Black is now chief promotion officer for kaizen—a Japanese word meaning continuous improvement—at Harbor-UCLA, and works with administrators, frontline staff, and other workers on standardizing and streamlining care. Employing the Lean philosophy "is not a flavor of the month," Black says. "We have a real need to do better, to do more, improve our access and do it for less. That is part of our survival" (Gorman, Kaiser Health News, 8/5).

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