I'm always happy to see success stories where healthcare organizations solve problems that matter through Lean concepts, practices, and principles. Today, I'm blogging about two articles I saw about this recently.
One of the problems that needs to be solved in healthcare is long waiting times, whether that means waiting for care in the emergency department, waiting for an appointment, or waiting for test results.
The first article I saw is from Ireland:
With a sub-headline of “Beaumont patients offered prompt surgery in Cavan, thanks to Toyota.”
From the article:
“A new management system for dealing with waiting lists in Cavan Hospital – based on an efficiency model pioneered by car giant Toyota – has been so effective that patients on Beaumont Hospital's lengthy waiting list are now being offered the choice of having their surgery done immediately in the north-east.”
Again, it's great to see waiting times reduced or eliminated. As the article says,
“While the average length of a hospital stay in Ireland was 6.1 days in 2014, in Cavan it was 3.87.”
It's great to reduce length of stay and I'll assume the hospital is doing it “the right way” and isn't pushing patients out the door too soon. A shorter LOS means better throughput for patients (which also affects the operating rooms)… more throughput means shorter waiting times.
I want to highlight how it's wrong to just refer to Lean or the Toyota Production System as “an efficiency model.”
The two pillars are:
- Jidoka — building in quality at the source
- Just-In-Time — improving flow
Hospitals (or their consultants) often get it wrong when they think or say that Lean is just about cost.
Lean and TPS are about quality AND flow. You can't have one without the other.
Improving flow (the right care at the right place at the right time) isn't about “efficiency” (as measured by outputs divided by inputs). A focus on that traditional measure of efficiency often leads to an organization wanting to keep everybody busy (or every machine busy)… which is really bad for flow.
The Lean focus is on FLOW — not having the patient be idle is the main goal. Sometimes that requires staff or equipment actually be idle… 100% utilization leads to very long waiting times, as basic Industrial Engineering and queuing theory would teach us.
Productivity, the word Toyota uses, can be an end result.
As Toyota explains:
“Based on the basic philosophies of jidoka and Just-in-Time, the TPS can efficiently and quickly produce vehicles of sound quality, one at a time, that fully satisfy customer requirements.”
The article from Ireland, frankly, gets it wrong:
“Lean is a management model first used by Toyota in the 1950s and created to cut costs and improve efficiency by eliminating waste.”
Where is the mention of quality there? Note that the Toyota webpage does NOT contain the word “cost.”
The Irish article also says:
“Canada and Australia are two countries that have used the system to virtually eliminate waiting lists.”
At least for Ontario, a province in Canada, that statement is completely incorrect, as you can look at the government's own data on patient waiting times.
Speaking of Ontario, here's the second article:
Here we go, just efficiency? Improving quality is a great way to improve efficiency and reduce waiting times. Does the article mention this?
“Family doctors in Eastern Ontario are learning the business lessons of banks and carmakers as a way to make their practices more efficient.”
That's sort of weird to mention banks before automakers, but it does help make the point that Lean is not just about improving the way we build cars.
“Nearly 30,000 patients in Eastern Ontario will see the benefits of things like “queue theory” and Toyota's “Lean manufacturing” philosophy thanks to a three-year project aimed at cutting wait times and improving the efficiency of front-line health-care providers. The training is being provided for free by the Champlain Local Health Integration Network and the philosophy behind the project is simple: Helping people stay healthy longer is one of the best ways of reducing the burden on the health-care system down the road.”
How does the article define Lean and TPS?
The “Lean management” system pioneered by Toyota improves efficiency by eliminating unnecessary or duplicated work. The solution can be as simple as putting a printer in each examination room, saving the doctor a minute or two spent at each appointment walking to a central printer. Those minutes add up over the course of a day, Jackson said.
Sigh. No mention of quality, unless they are including that as a form of “waste” or as a type of “unnecessary work.”
I do like how they seem to be engaging staff in improvement:
“A lot of [staff] feel they're drowning in work. That's where we can provide support. We can pull them out of their practice for an hour or two and take a look at the forest, not just the trees, and think about ‘what might make your work easier?'”
That's a classic Kaizen starting point question. How can we work together to make your work easier? Solving those problems usually leads to improvements in both quality AND flow.
As one doctor said:
“While some of his colleagues have wait times for appointments of four weeks or more, Sardana tweaked his practice to meet his goal of having wait times of less than five days. Though his consultations with Jackson are done, the tools he learned help him keep his practice running smoothly.”
I applaud their efforts to get waiting times down… again, that's a great example of solving a problem that matters. Now, will they also work on safety and quality?
The Ontario program is called “Primary Care Quality Practice Facilitation,” so let's hope there's some quality improvement.