News / USA

US Hospitals Turn to Toyota for Management Inspiration

Carmaker's lean management style helps boost efficiency

Virginia Mason Hospital adapted Toyota’s Lean Management style to streamline patient care while boosting the bottom line.
Virginia Mason Hospital adapted Toyota’s Lean Management style to streamline patient care while boosting the bottom line.

Multimedia

Audio
David Weinberg

When Virginia Mason Medical Center in Seattle started losing money in 1998, its CEO began a search for a new management system that would get the hospital back on track.

After two years of visiting hospitals around the U.S. and talking with many of the smartest minds in the health care industry, he concluded that there wasn't a single medical institution in the entire country that had a system worth emulating. Instead, he turned to a Japanese carmaker for inspiration.

Lean management style

Dr. Gary Kaplan, head of Virginia Mason Hospital in 2001, thought he could adapt Toyota’s lean management style - which focuses on eliminating waste in the production process - to improve healthcare.

"He turned to the Toyota production system because it was clear to him that taking these principles and tools and adapting them to healthcare could significantly make Virginia Mason a more efficient operation," says efficiency expert Charles Kenney, author of "Transforming Healthcare, Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience."

One of the first Toyota concepts Kaplan instituted was value stream mapping, which involved taking a complicated process and breaking it down into individual steps to find ways to make each step more efficient. Virginia Mason hired several Japanese consultants, called senseis, to help them with their first value steam map: a cancer patient’s visit. In his book, Kenney recounts how the senseis instructed the staff to trace the patient’s journey on a map of the hospital, using a piece of blue yarn.

Toyota developed the Kanban system to keep supplies stocked and organized. Each blue bin is divided in the middle. When one half is empty, it signals the staff to reorder supplies.
Toyota developed the Kanban system to keep supplies stocked and organized. Each blue bin is divided in the middle. When one half is empty, it signals the staff to reorder supplies.

"And at the end of the process, the blue yarn was snaking around this piece of paper - the schematic on the floor - and it was this immensely powerful visual experience for the entire team," says Kenney, "and they realized that what was happening was they were taking these patients, for whom time is absolutely the most precious thing in their lives, and they were wasting huge amounts of it."

So the team used the lean management approach to refine the process of administering chemotherapy treatments. By sorting out the steps, simplifying and standardizing them, they were able to cut the amount of time it takes a patient to receive treatment by 50 percent. Then, they turned to other departments, finding ways to increase efficiency and improve safety.

"So the Virginia Mason Production System is now viewed throughout the world by many people as a viable alternative to the current system," Kenney says.

It has been adopted by dozens of hospitals in the United States, including Barnes Jewish in St. Louis, Missouri.

Hand-drawn lines connect dozens of small pink and yellow sticky notes in the strategy room at Barnes Jewish in St. Louis, Missouri.
Hand-drawn lines connect dozens of small pink and yellow sticky notes in the strategy room at Barnes Jewish in St. Louis, Missouri.

Kent Rubach is one of the senseis Barnes hired to guide them on what they call their learning journey. The first change he made was to set up a strategy room for hospital staff. Above a long conference table is a complicated diagram which takes up one entire wall of the room. It is made up of hundreds of hand drawn lines that connect dozens of small pink and yellow sticky notes. It’s just like the charts in Toyota’s strategy rooms.

"You would see the exact same thing, for a part going from raw material to the finished good," Rubach says.

But in this case, the value stream map illustrates the process of a patient coming into the hospital with a stomach ache. Each one of the pink notes represents a point in the process where a patient has to wait.

"So if we do have wait, we're trying to add value to that wait, and not just have them sitting and doing nothing," says Daryl Williams, head of the Emergency Department at Barnes. "Can we give the patient education? Can we get their labs done ahead of time so when they get to see the doctor all that stuff is back?"

According to Williams, under the old system, an acute abdominal pain visit typically took three hours. Today it’s two hours.

A key principle of the Virginia Mason Production System is to encourage staff members to speak up whenever they see a part of their job that can be done more efficiently or a process that could be improved.

John Davis sleeping in a chair that reclines into bed while his wife is in the ICU.
John Davis sleeping in a chair that reclines into bed while his wife is in the ICU.

An employee who worked in the Intensive Care Unit had an idea to help patients’ families, who often spend day and night in the waiting room while their loved ones are in the ICU.

Linda Henderson, whose fiancé suffered a stroke, has been living in the waiting room for eight days. Before the lean changes, she would have had to sleep in a chair or on an air mattress on the floor. But based on the employee’s suggestion, the hospital replaced the furniture in the waiting room with special chairs that recline into beds.

"I can lay back and I have my blanket and my pillow or my teddy bear for my pillow and then I snooze and go to sleep," says Henderson.

The improvements at Barnes Jewish, Virginia Mason and other hospitals using lean management techniques have been noticed. A recent study of the nation’s hospitals put Virginia Mason in the top one percent in safety and efficiency for two years running.

But lean management is not for everyone. It requires a tremendous investment of time and resources as well as a leadership willing go forward despite resistance from doctors and staff to the idea of operating like a factory. Also, the process never ends. As the Toyota senseis say, they live in the biggest room in the house, the room for improvement.

 

Note: An earlier version of this story incorrectly reported that Virginia Mason Medical Center is located in St. Louis. VOA regrets the error.

You May Like

Video Experts Warn World Losing Ebola Fight

Doctors Without Borders says world is losing battle against Ebola, unless wealthy nations dispatch specialized biological disaster response teams More

Video Experts: Rise of Islamic State Significant Development in Jihadism

Many analysts contend the group - which grew out of al-Qaida in Iraq - has been rebuilding for years More

US-Based Hong Kongers Pledge Support for Pro-Democracy Activists

Democracy advocates call on Chinese living abroad to join them in opposing new election rules for their home territory More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Larger Than Life Chinese Lanterns Make Southern California Appearancei
X
Elizabeth Lee
September 02, 2014 8:57 PM
Chinese lanterns with a long history are lighting up in 21st century style at the Los Angeles County Fair in southern California. Visitors can see traditional lanterns that hang, but also lanterns in the shape of animals, iconic landmarks and many other objects, all created by artisans from a place in China known for its lanterns. Elizabeth Lee has the details from the fair in the city of Pomona.
Video

Video Larger Than Life Chinese Lanterns Make Southern California Appearance

Chinese lanterns with a long history are lighting up in 21st century style at the Los Angeles County Fair in southern California. Visitors can see traditional lanterns that hang, but also lanterns in the shape of animals, iconic landmarks and many other objects, all created by artisans from a place in China known for its lanterns. Elizabeth Lee has the details from the fair in the city of Pomona.
Video

Video Experts See Rise of ISIS as Significant Development

The Islamic State’s rise seems sudden. It caught the U.S. by surprise this summer when it captured large portions of northern Iraq and spread its wings in neighboring Syria. But many analysts contend that the group - which grew out of al-Qaida in Iraq - has been rebuilding for years. VOA's Jela de Franceschi takes a closer look at the rise of ISIS and its implications for the Middle East and beyond.
Video

Video Israel Concerned Over Syrian Rebels in Golan

Israeli officials are following with concern the recent fighting between Syrian rebels and government forces near the contested Golan Heights. Forty-four U.N. peacekeepers from Fiji have been seized by Syrian Islamist rebels and the clashes occasionally have spilled into Israel. VOA’s Scott Bobb reports from Jerusalem.
Video

Video Ukraine Schools Resume Classes, Donate to Government Forces

A new school year has started in Ukraine but thousands of children in the war-torn east are unable to attend because of ongoing clashes with pro-Russia rebels. In Ukraine's capital, patriotic education has become the norm along with donations to support injured security forces fighting to take back rebel-held areas. VOA's Daniel Schearf reports from Kyiv.
Video

Video US Detainees Want Negotiators for Freedom in North Korea

The three U.S. detainees held in North Korea were permitted to speak with foreign media Monday. The government of Kim Jong Un restricted the topics of the questions, and the interviews in Pyongyang were limited to five minutes. Each of the men asked Washington to send a representative to Pyongyang to secure his release. VOA’s Carolyn Presutti has our story.
Video

Video Turkmen From Amerli Describe Survival of IS Siege

Over the past few weeks, hundreds of Shi'ite Turkmen have fled the town of Amerli seeking refuge in the northern city of Kirkuk. Despite recent military gains after U.S. airstrikes that were coordinated with Iraqi and Kurdish forces, the situation remains dire for Amerli’s residents. Sebastian Meyer went to Kirkuk for VOA to speak to those who managed to escape.
Video

Video West Africa Ebola Vaccine Trials Possible by Early 2015

A U.S. health agency is speeding up clinical trials of a possible vaccine against the deadly Ebola virus that so far has killed more than 1,500 people in West Africa. If successful, the next step would be a larger trial in countries where the outbreak is occurring. VOA's Carol Pearson has more.
Video

Video Survivors Commemorate 70th Anniversary of Nazi Liquidation of Jewish Ghetto

When the German Nazi army occupied the Polish city of Lodz in 1939, it marked the beginning of a long nightmare for the Jewish community that once made up one third of the population. Roughly 200,000 people were forced into the Lodz Ghetto. Less than 7,000 survived. As VOA’s Kane Farabaugh reports, some survivors gathered at the Union League Club in Chicago on the 70th anniversary of the liquidation of the Lodz Ghetto to remember those who suffered at the hands of the Nazi regime.

AppleAndroid