A Carmaker As A Model For A Hospital?

(CBS)  While health care costs have been going up most everywhere else, at Virginia Mason Hospital in Seattle they're coming down by driving out waste, reports CBS News correspondent John Blackstone.

"This is one of the reasons health care has become unaffordable in the United States is that we are wasting time and we're wasting valuable medical assets," said Dr. Robert Mecklenburg.

The hospital wasted no time treating Beth Lauderdale. She was getting physical therapy for severe back pain just two hours after she phoned in.

"I called at 8:30 and they said they had a 10:20 appointment," Lauderdale said.

She didn't get an expensive MRI or have a long wait to see a specialist - a big change from the way things used to be.

"Five years ago, a person might wait a week or two for an appointment and they might see several docs," Mecklenburg said. "They might see a primary care physician, they might get an MRI."

It's the way things are still done in too much of America's health care system says Sen. Max Baucus, a Congressional leader in health care reform.

"We in America pay for hospitals or doctors on the basis of quantity," Baucus said. "The more tests ordered the more procedures performed, the more the doctor and hospitals get reimbursed."

Virginia Mason changed the way it practices medicine based on an unlikely model - the way Toyota builds cars.

"At the end of the day, the Toyota production system is all about the customer," said Dr. Gary Kaplan, the CEO of Virginia Mason Hospital. "For us the patient."

Kaplan takes staff to Toyota's factories in Japan every year and practices what the car maker preaches. Just as the automaker's executives spend part of each day on the factory floor, Kaplan tours the hospital daily looking for problems and solutions. Everyone is encouraged to look for changes to make work more efficient. Nurses developed ways to spend most of their time with patients instead of at the nursing station.

"They are using Computers On Wheels, what we call COWs," Kaplan said.

At a meeting each week the staff reviews the results of what Toyota calls "Rapid Process Improvement Workshops," looking for ways to increase efficiency.

In their four day workshop, with the help of a home video camera, the staff of one clinic acted out what happens to a new patient. They came up with 10 things they would start doing differently immediately.

Virginia Mason reached out to area employers like COSTCO and asked them what they needed most from hospital visits.

"I care about quick treatment," said Katrina Zittnick with Costco. "Immediate appointments, the right treatment at the traumatic, acute time."

So at Virginia Mason's back clinic there were dramatic changes, where treatment time was cut from an average of 66 days to 12.

While Virginia Mason doesn't make cars, the hospital is heading down a road that may lead to America's health care future.

[chrisaaron2]

d7767w-----
regarding your post about the British waiting lists for care, surgery specifically. What kind of surgery? and why not compare apples to apples when talking about the two systems? Your are conflating premises. If the surgery folks are waiting for in Britain (by the way, taking what you wrote at face value, knowing full well that if this was on the editorial page of the WSJ, it is worthless, though sometimes they have good reporting) are elective surgeries, and certainly not life-threatening corrections, um, there is NO WAY that the insurance-less people in the US would get those surgeries, um, EVER, by going to an ER. So your point is moot. If you are bleeding out or having an MI, you'll get care at the ER. Otherwise, good luck. That is the reality here. Those waiting lists VS. ER care is a non starter for debate.....

[hologram5]

jaykay3141, Thanks for your post, I have been saying that about the post, fire service and police for some years, it is all social programs but people that cry "Socialist" do not seem to see these things. A breath of fresh air.

[chrisaaron2]

As with all complex topics, folks are reading into much of what the doctor said in a biased way, partly because of how the story is presented and the people quoted. Virginia Mason Medical Center is doing what needs to be done, period. It is an amazing system they are using to cut waste and improve safety and quality of care. No question about it. Now, by putting the doc in the same article with Max Baucus, who is against a public option for national health care, people are are assuming that that is what this effort is about, and also that this effort is new. This effort is not new. VM adopted the system years ago, seeing this unbelievable rise in health care costs and deciding what it could do about it. The doctor is no HMO shill; VM is a non profit entity, that too is not mentioned in the article. I find it sad that, as per usual, we get an article about the great work VM is doing, and we get it ridiculed in the comments, somewhat understandably, because it is presented as a substitute for other reforms that are equally needed, or a public option for health care. This article, in this climate, is automatically seen by some as a way to get around the "real" health care reform we need. But it is not. Waste removal and process redesign is absolutely necessary. In my opinion, so is the public option that is being debated, and so are many other components to reform. It is unfortunate that VM's work might be used as a conservative talking point, as a substitute for "going Socialist". It is great work and is absolutely necessary. Streamlining processes and making nurses walk hundreds of steps less per day because of a redesigned work flow, for instance, is absolutely crucial, along with many other concepts and ideas not discussed. But it's certainly not a be all end all to the reform needed. To the far lefties here (I am one of your ranks), this effort is an honest one and not well-represented by the article. Read up on VM, people. They are leading the way in some respects, but like all complex issues, there is not one solution, and to think that there is, well you'd have to be a politician, wouldn't you......

[Yes_ABWH_Fan]

This is LEAN manufacturing (developed by an American, ignored by America, embraced by Japan) applied to hospitals. It is about driving wasteful processes out of the system, about "outcome-based customer satisfaction", about supply-chain optimization (vendors as well as customers) and about cost-reduction. I have successfully implemented LEAN at several manufacturing sites. I expect, if taken to it's full conclusion, that hospitals could get better results and more profit, using 1/10th of the revenue they currently "expect". Medical, as well as Insurance, Military, and Energy systems have been "cost-gamed" to the point that they amount to legalized theft. Time to get back to truth-in-costing, something *real* competition used to do.

[rrozsa]

I would feel a whole lot better if it was our CAR manufacturers who were trying to learn something from Honda and Toyota.

[stn_sage]

Upon seeing the title of this article, in light of the auto industry crisis(es), I was immediately skeptical about the wisdom inherent in such a situation, but---

I'm not surprised by this---coming from the state of Washington! This state is---arguably---the most, if not one of the most---progressive in the nation!

They offer assisted-termination of the severe pain-inflicted dying and are organizing clean, efficient encampments for the homeless and poor---among other things.

So, it's not surprising that they are also attempting to 'straighten up' their hospitals as well and make them more efficient!

The only point I would make is: that this 'change' revolves mostly around just listening to the employees and utilizing their good suggestions! Was it really necessary to go to Japan to observe what they were doing, to implement this 'self-evident' process of change?!

Anyway, congratulations to this hospital, it's employees, and the people of Washington state
for embracing new ideas and taking action(s) to improve your lives and your state!

[jaykay3141]

alphaa10000, you are ABSOLUTELY CORRECT. When even conservative bastions like the Wall Street Journal decry the fact that roughly a third of every health care dollar is spent on administrative costs, it's a no-brainer that we're in deep trouble. One of the practices I visit has as many staff members handling claims as there are doctors seeing patients. My employer has to battle with over 2 dozen different insurance providers because no single company can write insurance in all the states where we do business.

It always perplexes me that we have universal mail service but no one complains about "the socialist post office". What would it cost to mail a letter from Florida to California if each state - or each part of a state - had its own mail service, stamps, trucks, etc? That's in effect what we have with the current health care system!

In fact, the Post Office model has been cited as one for health care: No one prevents UPS, FedEx, etc. from running private operations that charge what the market will bear and serve what and where their management chooses, but *every* American also can rely on the Postal Service to send mail from anywhere to anywhere using a single system. Sounds good to me.

[monkguy]

Wow, I know Richard Nixon has been blamed and scorned for a lot of reasons, but HMO creation? One check of a website has this:
History of HMOs

The general idea of prepaid medical care dates back to the early part of this century. The first of what we now call HMOs were started in the late 1920s in Elk City, Oklahoma (as a farmers' cooperative), and in Los Angeles, California (where the Ross-Loos Medical Group offered prepaid services to employees of the Los Angeles County Department of Water and Power and their families.) Over time, more HMO-type systems began to grow, typically organized by businesses and community groups eager to make health care available to their workers and members at costs they could better afford.
Richard Nixon would have been seven years old, so, I doubt he was involved in this massive conspracy.
And, alphaa10000, you can continue the hate speech about FOX News if you'd like, but the truth is socialist medicine has been around since the turn of the 20th century.

[ksmit2]

Well, there is a way for everyone to "have their cake.." Two tier coverage option. Consumers
would be able to choose between a form of "national" health insurance or the current insurance
products. The first option would be similar to a medicare but available to all persons, and it
would also have a premium. People with pre existing conditions, or those wishing to start a
new business would be able to do so without the risks associated with insurance price swings.
Those who are happy with the private insurance would continue, unaffected. Also they could
repeal the law that prohibits Medicare from negotiating drug costs, in a Democracy , the
idea that drug companies need to be "protected" from consumers sounds a bit squeemish
at best. Require "not for profit" hospitals to provide a minimum designated percentage of
free care annually, in order to maintain that status. Let them also pay property taxes like
other large businesses to support the local tax base, in turn helping public clinics and
hospitals who provide most of the free care in the community. "Not for Profit" isn't the first
thing that crosses your mind when you see acres of hospital buildings, new office parks
with jogging paths and fountains, and other healthcare mainstays.

[patriot2381]

It's a no brainer isn't it? Health care charges all the traffic will bear, and every one from the printers of health care forms to hypodermic needle providers is on the health care *** milking it for all it's worth.