The Wall Street Journal (Aug.2, 2011) writes: “To speed patients through the system, emergency rooms are adopting lean-management principles pioneered by Toyota to increase efficiency, cut costs, and provide better service”. It’s certainly about time. Waiting times in ERs that can run into several hours have become a fact of life in the US. And while the number of ER departments has dropped by 1/3 over the past 2 decades, the number of patients seeking care has gone up by 40%. To boot, there are fewer doctors doing primary-care even as more uninsured patients show up (who must, by law, be treated).
The lean production changes (see Ch.16) include: (1) streamlining the traditional methods of triaging, which means no longer providing a bed for non-critical patients,(2) staffing with less-costly nurse practitioners and PAs so ER doctors can avoid paperwork and focus on care, and (3) posting ER waiting times on-line , in waiting rooms, and even on highway billboards.
The 2 metrics ERs use to judge their efficiency are: LWBS (“leave without being seen”) and AWT (“average wait time”). The latest national LWBS number is 2.7%, up from 1.7% in the prior decade. (California is closer to 20%). “We don’t want them to walk out the door for their own health, but it’s also not a good business model”, says one ER director. Revenue drops about $450,000 if even 1% of patients walk in a typical ER.
With lean changes, one Phoenix hospital chain (Banner Health) saw its LWBS drop from 8% in 2007 to 0.5% this year, while volume increased 4%. At Ochsner Medical Center (New Orleans), AWT went from several hours down to 33 minutes, while the LWBS rate dropped from 15% to 1%. The process analysis tools we discuss in OM can indeed make a major difference in the quality of health care.
Discussion questions:
1. What tools in Ch.7 (Process Strategy) can be useful in reengineering in the ER?
2. What other JIT/Lean/TPS approaches discussed in Ch.16 can be employed in the ER?