Strategy for Success
Today, I showed a movie to our employees that everyone in healthcare should watch. It’s a rerun from a PBS documentary about “The Nun and the Bureaucrat.” Sister Mary Jean Ryan of SSM Healthcare and Paul O’Neil of the Pittsburgh Regional Healthcare Initiative describe the application of the Toyota Production System to their healthcare worlds. Both know what excellence means and how to achieve it. SSM Healthcare was the first healthcare organization to win a Baldrige award, and PRHI has demonstrated impressive results, particularly in minimizing central line infections.
There is, of course no magic bullet. Use of the TPS is one potent tool for process improvement, but not the only one. The focus of TPS is identification and elimination of waste, and that plays well to our efficiency goal. Estimates of waste in the hospitals shown varied from 40 to 50%. And these were from senior people about the hospitals where they worked. Remember that we have previously said that a 25% saving would pay for healthcare for all the uninsured in the country.
Waste is not easy to see--at least not easy to recognize. In the movie, employees regarded waste as part of their job until someone pointed out that it didn’t have to be that way. We have a process in my office where one office receives physical exams done by outside physicians. In roughly 30% of the cases, they must go back to the physician or patient to request additional information. This has been going on for at least 30 years, and no one has ever thought of changing it.
Concepts of “Lean” and “Value stream Mapping” are part of the TPS--another example of an industry technique that’s migrating to healthcare.
It’s curious that more hospitals haven’t endorsed these concepts--until you think about the consequences: Success would mean reduced costs and (probably) fewer employees. That sells well to Toyota, but the average healthcare bureaucrat is judged by the size of his budget and the number of people who work for him. TPS would not enhance his esteem. Better to lobby for insurance for the uninsured. That would increase both revenue and payroll.
There is, of course no magic bullet. Use of the TPS is one potent tool for process improvement, but not the only one. The focus of TPS is identification and elimination of waste, and that plays well to our efficiency goal. Estimates of waste in the hospitals shown varied from 40 to 50%. And these were from senior people about the hospitals where they worked. Remember that we have previously said that a 25% saving would pay for healthcare for all the uninsured in the country.
Waste is not easy to see--at least not easy to recognize. In the movie, employees regarded waste as part of their job until someone pointed out that it didn’t have to be that way. We have a process in my office where one office receives physical exams done by outside physicians. In roughly 30% of the cases, they must go back to the physician or patient to request additional information. This has been going on for at least 30 years, and no one has ever thought of changing it.
Concepts of “Lean” and “Value stream Mapping” are part of the TPS--another example of an industry technique that’s migrating to healthcare.
It’s curious that more hospitals haven’t endorsed these concepts--until you think about the consequences: Success would mean reduced costs and (probably) fewer employees. That sells well to Toyota, but the average healthcare bureaucrat is judged by the size of his budget and the number of people who work for him. TPS would not enhance his esteem. Better to lobby for insurance for the uninsured. That would increase both revenue and payroll.
