Tag: lean hospitals

OM in the News: Solving the Health-Care Equipment Supply Shortage

“As we struggle to come to terms with the scale of the Covid-19 pandemic, one of the most frustrating sights is witnessing front-line health-care workers begging for more masks, protective gowns, testing kits, ventilators and intensive-care beds,” writes MIT Prof. Yossi Sheffi in The Wall Street Journal (April 10, 2020).

The crisis has focused attention on just-in-time inventory principles. The discipline and mantra that “inventory is waste” was built out of the Toyota Production System (see Chapter 16 in your Heizer/Render/Munson text) that has become iconic in supply chain around the world.

The JIT philosophy calls for lean inventories and tight connections between companies and their suppliers. It reduces manufacturing and supply chain costs, as well as response times along the supply chain. All sorts of industries have applied its principles, including health care. When hospital JIT supply chains run as advertised, the savings in those costly and high-stakes systems can be substantial.

However, supply chains built on precise and timely deliveries are vulnerable to unexpected and large-scale disruptions. The fallout can become acute when supplies aren’t available when demand spikes. This is one of the main reasons the coronavirus pandemic has crippled health-care supply chains. Clearly, JIT systems haven’t been up to the challenge, and there have been suggestions that medical supply chains should build more “just-in-case” inventory to ensure they are prepared for such outbreaks. Yet the benefits of JIT are just too significant to forgo. Organizations that rely on large inventories won’t be able to compete with facilities that remain lean, and that is true for hospitals.

Instead, says Sheffi, the U.S. must keep a very large, centrally-managed inventory of health-care supplies in several locations around the country to supplement the inventory maintained at each hospital. The parallel here is the strategic oil reserves. We prepare for shortages of oil and weapons in times of crisis. Medical supplies are just as critical.

Classroom discussion questions:

  1. What are the three main principles of Lean/Toyota Production Systems discussed in Ch. 16?
  2. Sheffi’s plan is future-based. What can be done today to help the shortages?

OM in the News: How to Fix the Emergency Room Using OM Tools

Armed with new strategies borrowed from OM, The Wall Street Journal (Sept. 13, 2017) writes that “hospitals are making a push to fix one of the most irritating issues in health care: the emergency room.” Not only are wait times long, but they’re not improving. The median length of stay for patients treated in the ER and then discharged was 138 minutes in 2015-16, the same as a decade earlier. Crowded ERs and long wait times have bad effects for patient outcomes and satisfaction. I suspect that many of your students have had some ER experiences, and will have their own ideas to complement these found in the article:

Eliminate triage. One of the biggest frustrations people encounter in the ER is registration and triage. After signing in and giving information, patients see a nurse who asks questions to judge how urgently they need care and the amount they’ll need, on a 5-point scale. Then patients wait to see a doctor who may ask them the same things all over again. A patient seldom sees an MD in less than 30 minutes, even if the ER is empty.

Eliminate details that waste time using lean management. Use lean (Ch. 16) to look at all steps in the ER processes and figure out how to improve them, cutting out as much waste as possible. For example, one hospital saw nurses were taking time to escort patients to other areas of the hospital for X-rays, so it put up colored tape that patients could follow to where they needed to go.

Quickly help patients with minor complaints and those who probably just need tests. Give people with small complaints, or who need diagnostic tests their own spot in the ER–and not a bed. Redesign the ER to include an area where patients in need of a medication refill or with mild complaints can be seen right away by a professional dedicated to only such patients. Seeing low-acuity patients quickly means there’s not a huge pileup of people in the waiting area.

Classroom discussion questions:

  1. How could software help?
  2. What other stumbling blocks slow down the ER process (eg, prescheduled surgeries or admissions to the hospital, which are also mentioned in the article)?

 

OM in the News: Sweden’s Lean Hospital

st goran hospitalSt. Goran’s Hospital is one of the glories of the Swedish welfare state, writes The Economist. Doctors talk enthusiastically about “the Toyota model of production” and “harnessing innovation” to cut costs. Yet, from the patient’s point of view, St. Goran’s is no different from any other public hospital. Treatment is free, after a nominal charge which is universal in Sweden. St. Goran’s gets nearly all its money from the state.

A temple to “lean management,” the hospital today is organized on the twin lean principles of “flow” and “quality.” Doctors and nurses used to keep a professional distance from each other. Now they work (and sit) together in teams.

One innovation involved buying a roll of yellow tape. Staff used to waste precious time looking for defibrillator machines. Then someone suggested marking a spot on the floor with yellow tape and insisting that the machines were always kept there. Other ideas are equally low-tech. Teams use a series of magnetic dots to keep track of each patient’s progress and which beds are free. They discharge patients throughout the day rather than in one batch, so that they can easily find a taxi.

The medical equivalent of a budget airline, there are 4-6 patients to a room (unlike our American system of private and semi-private rooms). The decor is institutional. Everything is done to “maximize throughput.” The aim is to give taxpayers value for money and not pretend that hospitals are hotels. St. Goran’s has reduced waiting times by increasing throughput. It has also reduced each patient’s likelihood of picking up an infection. Scrimping on hotel services means the hospital could instead invest in preparing patients for admission and providing support after they are released.

The average length of a hospital stay in Sweden is 4.5 days, compared with 5.2 days in France and 7.5 days in Germany. Sweden has 2.8 hospital beds per 1,000 citizens. France has 6.6; Germany, 8.2. Yet Swedes live slightly longer.

Discussion questions:

1. How does lean help St. Goran’s improve its performance?

2. Why don’t all hospitals use lean approaches?

OM in the News: Process Improvement In Hospitals

The New York Times (June 3,2012)  writes that there is some good news about our  health care system. A growing number of hospitals, doctors, employers and insurers are using the process improvement tools of Chapter 7 to reduce the cost of delivering medical care while maintaining or improving quality.

Seattle’s Virginia Mason Medical Center, for example, has conducted reviews to eliminate waste and inefficiency. It says that after doctors were required to use a checklist of the medical circumstances needed to justify a costly imaging test, CT scans for sinus conditions dropped by 27% and M.R.I.’s for headaches by 23%. It placed nursing teams and supplies closer to patients, freeing nurses to spend 90% of their time on direct patient care, far more than the 35% at most hospitals. The time needed to process insurance claims was sharply cut by consolidating steps.

Virginia Mason also collaborated with Starbucks and the company’s insurance provider, Aetna, to find better ways to treat patients with back pain, a costly burden to Starbucks. At the start, all patients complaining of back pain typically waited many weeks to see a specialist, who would then prescribe a costly, unnecessary M.R.I. before finally sending them on to a physical therapist. Using process analysis to separate out the uncomplicated cases,  the medical center was able to send them directly to a therapist on the day the patient requested an appointment, and the vast majority were able to quickly return to work.

Premier Inc., a 2,600 hospital group, has also reduced unnecessary laboratory and screening tests and reduced labor costs by eliminating inefficient processes, like multiple re-entries of the same patient data for admitting, scheduling, discharge and billing. It has started  using administrative assistants rather than nurses to call patients to remind them of appointments. Premier reported  that over a three-year period, 157 of its hospitals in 31 states saved almost 25,000 lives and reduced health care spending by nearly $4.5 billion, a 12% savings.

Discussion questions:

1.  What are the benefits to Starbucks, Aetna, and Virginia Mason from their new approach?

2. Why is OM such an important topic in hospitals today?

OM in the News: Health Care Kaizens

Now, more than ever, hospitals are being expected to do more with less.  That’s where lean methodologies come in, says Healthcare Technologies Online (May 2, 2012).   Lean methodologies, as we discuss in Chapter 16, are geared toward continuous process improvement, and there are two predominant lean schools of thought — Six Sigma and Kaizen.   Each takes a slightly different approach to achieving this outcome. Six Sigma incorporates more statistical analysis than Kaizen, focusing on eliminating defects so that a final product is as close to perfection as possible. Kaizen looks to improve all aspects of a business by standardizing processes and eliminating waste.

The Kaizen philosophy also strives to include every employee into the process improvement initiative.  Kaizen stresses that the real experts in any organization are the people who actually do the work each day, and these employees should be intimately involved in improving their own workflows. In healthcare, this could be a nurse in the emergency department, someone working in finance, a surgeon in the operating room, or an IT executive.

Each person has their own ideas for how their specific workflows could be more efficient. The idea of Kaizen is that a lot of little ideas evaluated and implemented at a local level can have a huge impact on an organization and can generally be implemented much more quickly and easily than a single million-dollar idea handed down from corporate. However, many employees don’t feel empowered to implement changes in their organizations, even if they are common sense solutions. Kaizen puts a structure in place that provides employees with this power.

Kaizen changes are often small, but when instituted in masse they can make a huge difference. For example,  Franciscan St. Francis Health of Indianapolis  estimates that its facility implemented nearly 4,000 Kaizen ideas last year that resulted in a multi-million dollar impact to the hospital’s bottom line.

Discussion questions:

1. Find and describe how another hospital has successfully implemented lean techniques.

2. Why don’t all hospitals embrace kaizen and six sigma tools?