What Health Reform Can Learn From Cleveland Clinic | Newsweek Health | Newsweek.com
Although it's not the primary focus of the article, Lean gets a mention early in the article:
A century after Henry Ford began building cars on an assembly line, Cleveland Clinic has brought that technique to medicine, updated to reflect the latest Japanese-inspired thinking on “lean manufacturing” and “continuous-cycle improvement.” Cleveland Clinic is a hospital trying to be a Toyota factory.
It's nice to have the mention in Newsweek, but I worry there will be misperceptions:
- Can we please get past the idea that Lean is “Japanese”? Toyota learned from Henry Ford and Dr. Deming and others. Toyota has been successful with its management system around the world. Not all Japanese manage like Toyota.
- I don't like the notion that Cleveland Clinic is trying to be like a Toyota factory — at least the common notion of “assembly line medicine.” If they are trying to be like Toyota in the sense that they build quality into the process and everyone is involved in kaizen, then the simile is fine to me.
The article states that Cleveland Clinic is using multiple improvement methods and that's great — it doesn't have to be “Lean or nothing.” Whatever leads to sustainable improvement:
In his efforts to improve the efficiency of medical care, Cleveland Clinic president and CEO Dr. Delos M. Cosgrove, a former cardiac surgeon, has enlisted every tool of modern management, obsessively tracking metrics of performance from blood-bank usage to market share, even redesigning hospital gowns in an initiative to “improve the patient experience.”
And results are what they get:
The evidence was in the 2008 Dartmouth Atlas of Health Care, which reported that of the five medical centers ranked best by U.S. News in 2007, Cleveland Clinic provided the most cost-efficient care, measured by expenses incurred during the last two years of life—$31,252, nearly 50 percent below the most expensive.
Many aspects of the Cleveland Clinic approach are covered including the fact that doctors are salaried — I think Dr. Deming would approve that they aren't be paid on a piecework system. Incentives to provide the best patient care at the lowest cost have to be better aligned.
A longer discussion of using Value Stream Mapping to improve a process and reduce waiting time:
Cosgrove established a department called Strategic Planning and Continuous Improvement with 50 employees, headed by Darryl Greene, a systems engineer with experience in appliance manufacturing. Here is how Greene and chief medical operations officer Dr. A. Marc Harrison approached the problem of managing patients on blood-thinning drugs. These patients have a variety of underlying conditions, but they all face the same problem, Greene says, “that you don't want them to bleed to death, and you don't want them to clot, either.” So the clinic created a unit just to manage their anti-coagulant levels, but it quickly had more patients than it could handle. By analyzing the steps involved in a visit and assessing their contributions to patient care, a process Greene calls “mapping the value stream,” his team cut the standard visit from 30 to 15 minutes. Doctors were giving the same introductory talk to every patient who came in, so they made it into a DVD instead.
The DVD… sounds like an example of “standardized work” in classic Lean thinking. I wonder how the patients respond to being given a DVD… you can't ask questions of a DVD, so I'd assume (or hope) that they provide that opportunity.
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