St. 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?