Tag: ICU

Good OM Reading: Health Care Kaizen

Paula’s husband had just come out of open-heart surgery. Laying in the recovery room with a breathing tube in his throat, he was clearly agitated. He motioned at his arms to try sign language, but the limbs would not move. Paula (a nurse at the hospital) began to panic along with him. When the anesthesia wore off, he said his hands and arms were numb–they remained so for weeks. It turns out that when surgeons performed the procedure, they had leaned over the  man and put pressure on his arms. With a single, small improvement, a nurse found that arm sled “positioners” could be used to tuck a patient’s limbs in place while removing the pressure.

This story is just one of 100’s in a new book called Health Care Kaizen, by Graban and Swartz, that describes small improvements made by those who do the work.  Kaizens are low-cost, low-risk process changes that can be easily implemented. The idea, say the authors, is to challenge and empower everyone in the organization to use their creative ideas to improve their daily work. And what better a place to see improvements than in our health care systems!

It is often said that “people hate change.” But in this readable book, we see that people actually love change when:  (1) they are fully engaged in the process, (2) they get to make improvements that help patients, and (3)  they don’t fear losing their jobs as a result of the changes. At one hospital, the CEO offered to shave his head if employees generated ideas that saved $3.5 million that year. The staff responded with $7 million in savings (such as $22,000 by switching from paper gowns to cloth ones) and the boss shaved in public.

At another, the neonatal ICU had automated paper towel dispensers. A nurse noticed babies flinching from the ongoing noise and decided to study the impact of what turned out to be a 50 decibel sound. The kaizen result was manual dispensers which allowed babies to get more rest, thereby gaining weight and getting home sooner–saving $2,000/day ICU fees.

Whether you teach health care OM or are looking for great examples of kaizen for class, this is a book worth reading.

OM in the News: Bottlenecks in the Intensive Care Unit

The Wall Street Journal (March 28,2011) reports that reengineering  has a big  role to play in the restructuring of Intensive Care Units (ICUs) in hospitals around the country. Many hospitals battle chronic capacity shortages in their ICUs, which are designed to provide constant monitoring and intervention for patients with life-threatening conditions. These critical care beds typically cost $3,000/day, several times what a normal hospital bed costs.

With rising demand and limited resources, bottlenecks in ICUs are often the norm. And they cause backups throughout the hospital. Operating rooms may have to postpone surgeries, and ERs may have to reject trauma victims if there are no ICU beds available.

The article features the Bronx’s Montefiore Medical Center and how it  reengineered its  ICU system. With 300,000  visits annually, the hospital’s emergency room is the 2nd busiest in the US.  But Montefiore is able to get by with only 78 ICU beds (a relatively small number) and claims a 33% lower mortality rate than the average hospital.

The hospital’s makeover included these features:

(1) An update on each patient every 4 hours to see if the ICU patient is really benefitting from ICU care.

(2) Teams of critical-care specialists visit each potential ICU client to determine if they really need ICU level of care. They provide “portable” ICU team coverage anywhere in the hospital if a bed is not available.

(3) Only critical-care doctors tend to patients inside the ICU. This means family doctors are not present (which some families don’t like) but survival rates have increased from 64% to 92%.

(4)  A rapid response team ( a concept pioneered in Australia), is summoned by any hospital staff member who thinks a patient’s condition is deteriorating.

If there was ever an organization in need of OM tools and analysis, of course, it would be hospitals. Hopefully this article will generate good classroom discussion.

Discussion questions:

1. What can ERs do to improve their throughput?

2. Why don’t more hospitals reengineer their ICUs?