A Carmaker As A Model For A Hospital?

Seattle's Virginia Mason Hospital Studies Toyota For Efficiency Ideas

(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.

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.

[nofoolling]

"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.

Someone paid this doctor alot of money to say that with a straight face.

Because that would rank about 99th out of 100 on the list of why health care has become unaffordable.

The top 10 would read something like (not in any particular order):

Because Abraham Permanente and Richard M Nixon conspired to foist the HMO concept upon the American public.

Because we have corporations attempting to please stockholders and investors of health care related industries by maximizing profit at the expense of the rest of us.

Because profit is more important to these corporations than the well-being of the patient.

Because the insurance companies continue to bribe our leaders to maintain the status quo of profiting off the misery of others.

Because our leaders continue to protect the obscene profits of these slimy parasites because they are paid to do so.

Because greed often times trumps caring and compassion.

Because someone who is profiting off the misery of others, pays the less than honorable among us to make such statements as the one quoted above.

Because hospitals and doctors make so many mistakes they have to charge a fortune to cover their mistakes in court and still make obscene profits.

Because someone suffering and in pain will pay most any price for relief of that suffering.

Because you have to make alot of money working 1/2 days, to be able to spend the other 1/2 at the golf course.

[voxpopulus]

Well, as long as they don't study GM or Ford.

[Beyond-The-Spectrum]

alphaa10000 wrote: "Sorry, this is American business." I think you're on the losing side of this particular argument. Yes, this is America, but health care shouldn't be about "business." I think if fewer people thought outside that particular ethos/mindset, we could come up with more solutions.

[longtree-2009]

was recently visiting relative in hospital over several months. chronic issues since birth. anyway, it is supposedly one of the best hospitals, with high patient ratings and awards, in the area. was shocked at how dirty patient rooms were, nurses spent more time at the station, or with each other, than doing rounds. there was a finite division of patient care. nurse 1 only did A, nurse 2 only B, nurse 3 only C. there were people of various scrub colors. some only did lifting, transporting of patients, others just did bedpans and such. there were janitors that did a poor job of cleaning. never a supervisor, of any kind, doing subordinate checkup. head nurse, floor head nurse, sat on their behind at the nurse's station. response to patient call was terribly long. made me double my efforts to remain as healthy as possible to never end up in a hospital, would rather die than end up for months in a hospital bed. there is no dignity, no privacy. patients are just things that all practice on to treat. doctors were dressed like they just came out of gym class. rarely was there a doctor who was dressed clean. saw one and complemented doctor on dress code. doctor reported training was at Mayo where there was a dress code. most doctors and nurses look like they just got off the soccer field. nurses are fat, long fingernails, dirty scrubs, uniforms. no wonder hospitals have so many germs that are passed from patient to patient. awful place, and it was one of the best.

[wdh3007]

If socialized medicine ever hits U.S. hospitals and your condition is serious you might aswell find a nice plot to lay your casket in because you will suffer to the end without being treated in time.

Efficiency and streamlining are up against a really hard case here. A lot of expensive tests are
ordered by interns and residents who are concerned about "missing" something. A culture of
built in overkill, lingers from the old days when medicare, or insurance paid for pretty much
anything a hospital or doctor sent them a bill for. Cookbook medicine, ambiguous rationale
and total total disconnect from financial reality permeate a good deal of medical care. While
excellent doctors and nurses do exist, the culture and model for medicine has been largely
untouched, save for lip service. This model has existed for years in a virtual monopoly that
makes any significant, meaningful improvement impossible. The best docs and technologies in the world cannot help unless they are deployed in an appropriate and
efficient manner.

[melchg07]

It will probably take some time to fully evaluate this hospital's approach. I doubt they'll utilize any procedures that are too risky - the threat of malpractice claims will keep them on their toes.

Quality of care should not be confused with quantity of care. If intense treatment over a short period results in better overall results, who can complain?
Posted by jrc007 at 7:44 PM

Absolutely not.......instead what happens is that they get all people involved to brainstorm ideas to make processes more effiecient.

For instance......say they have a patient that has a cold.

First off say they have the patient see nurse A to take the temp.......nurse B to take its blood pressure........nurse C to get a urine sample.......and nurse D to take the patient to the room to see the doctor.

By holding a Kaizen event Nurse's ABC&D would voice their opinions and conclude that one nurse could do all these things. Meanwhile the other 3 nurses could take care of the rest the patients in the waiting room.............

This is a VERY simplistic version of what Toyota preaches, but it really does work........EVERYONE......should hope this catches on..........its about the best thing that has happen to capitalism........well......since Capitalism.........It PROMOTES EVERYONE involved getting involved and sharing ideas.

Our companies has started holding them on a regular basis and you'd be amazed at the waste of time and resources that are found and eliminated.

[melchg07]

What they are doing are Kaizen events.........they work virtually everywhere......our company which build truck bodies and hoists (hydrualic lifts) started doing them and one would be amazed at how when you get a group of the supervisors along with the ones 'on the ground' (the ones actually doin the work) how many ideas pop up with ways to cut inefficiencies.

A person who helped out that we hired said in a previous company that they did one of these events to brainstorm how to make a process of manufacturing a part and they eliminated a process that once took several hours into doing the process in several minutes.............a lot of things that had once worked just never changed even though the company changed around it and over time the process never changed because " ITs just how its always been done.".........if healthcare starts doing this........WOW.......it could make a HUGE...HUGE...HUGE difference..

[retiredgustav]

Taking advice from a company that LOSS $ 8 BILLION last year.

[merlgrey]

how about good old fashioned human compassion and caring as a model?