Ontario’s Peterborough Regional Medical Centre is about 18 months into their Lean transformation. They are being featured in a series of four articles in their local newspaper, the first two of which are already out.
Article one: LEAN machine at PRHC
Article two: New RX remedy
Some highlights of the first story, as it starts with a framing of their financial challenges:
For the past 18 months Peterborough Regional Health Centre has been applying a new management system to patient care in an attempt to streamline and improve service while paring $27 million out of its annual operating budget.
Unlike traditional “cost cutting,” Lean gives hospitals a methodology to improve quality and service… which leads to financial improvements in cost and revenue.
Some of their results:
- Reducing turnaround time for CT scans from 4:44 to 2:51, a savings of almost two hours
- Savings of $870,000 in the first year from supply expense reductions and capacity improvements
The CEO says:
“You can’t use lean methods to downsize your staff,” he said. “You have to figure out how to continue with these processes with the staff you have. That’s what lean has done for us.”
That’s right, but the hospital (driven by the province?) laid off 182 people in March. It sounds like those layoffs weren’t the result of Lean productivity improvements (being driven by budget cuts?), but it’s hard to separate Lean from layoffs, even when they are just correlated as opposed to being cause and effect. I wonder how those layoffs are interfering with the embracing of Lean by front-line staff? It’s too bad that they couldn’t find enough benefits from Lean quickly enough to avoid the layoffs. Given that the layoffs happened… I guess Lean is the best strategy for improving the workplace to get by with fewer people… but it’s not the best circumstances for Lean.
The first article also has a good summary of the Lean management system and philosophy:
The lean system of management also relies on a series of basic principles which, while they seem obvious, are often paid little heed:
* The employees actually involved with the process are the best source of information about how the system works or doesn’t.
* They must be able to speak up without fear of repercussion.
* Making the customer, (the patient) the priority, not the service providers.
* Total involvement, from the CEO to the team on the floor, in the constant pursuit of improvement.
Article number two in the series features improvements in the pharmacy. The article starts with the sad story of an elderly patient who was given the wrong dose of a medication in the emergency department and then fell and broke her hip, as an inpatient, when the rails weren’t properly put up on the side of her bed. Process errors leading to harm.
Before the Lean improvements, the medication ordering process was broken. It sounds like people and systems were overburdened… so quality suffers as an unexpected result.
Inevitably, the orders backed up. Facing lag times of between 24 and 48 hours, doctors and nurses were increasingly forced to turn to the override system, which is intended to be used only in emergencies.
“It was a broken system,” says nurse Laura Cranley.
The override of the system led to the medication error mentioned above.
It wasn’t an isolated case:
As well as acknowledging the override safety issue, the document reported that, “Patients are experiencing between 80 and 120 medication incidents [wrong dose, med, and/or time] a quarter.”
The hospital has used Lean to reduce turnaround times and improve service:
Pharmacy personnel visited and observed the area of the hospital where drug orders originated, and staff on the wards traveled to the pharmacy. The “ah-ha” moment was the realization that the system could be fixed by putting the pharmacy techs in the nursing units, embedding them with the rest of the on-the-ground health-care providers at the point where patients were being treated.
Instantly, the units had real-time access to the drug dispensing side. They were talking to people, not firing off faxes. Orders could be filled by techs who floated among their assigned units, typically two or three. Orders could be adjusted more efficiently, with the techs having access to the doctors on the floor.
And, best of all, no more faxes.
I’m looking forward to reading the next two stories in their series… I hope you’ll give the first two a read.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus. He lives in San Antonio, Texas.