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

    Turkey, West in Standoff Over Syrian Refugees

    Turkish government refuses to admit refugees, the first in a wave of civilians fleeing offensive by Assad regime in northern Aleppo countryside

    Jailed American Testifies About Islamist Involvement in Mumbai Attacks

    David Headley testifies via video link that Pakistan-based Islamic terror group made two failed attempts to mount strikes in Mumbai in months prior to coordinated assault

    Video Denver Wins Super Bowl 50 Over Carolina

    The Broncos vaunted defense stifled the Panthers' top-rated offense the entire game, sacking star quarterback Cam Newton 6 times

    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.
    German Artists to Memorialize Refugees With Life Jacket Exhibiti
    X
    Hamada Elsaram
    February 05, 2016 4:30 PM
    Sold in every kind of shop in some Turkish port towns, life jackets have become a symbol of the refugee crisis that brought a million people to Europe in 2015.  On the shores of Lesbos, Greece, German artists collect discarded life jackets as they prepare an art installation they plan to display in Germany.  For VOA, Hamada Elrasam has this report from Lesbos, Greece.
    Video

    Video German Artists to Memorialize Refugees With Life Jacket Exhibit

    Sold in every kind of shop in some Turkish port towns, life jackets have become a symbol of the refugee crisis that brought a million people to Europe in 2015.  On the shores of Lesbos, Greece, German artists collect discarded life jackets as they prepare an art installation they plan to display in Germany.  For VOA, Hamada Elrasam has this report from Lesbos, Greece.
    Video

    Video E-readers Help Ease Africa's Book Shortage

    Millions of people in Africa can't read, and there's a chronic shortage of books. A non-profit organization called Worldreader is trying to help change all that one e-reader at a time. VOA’s Deborah Block tells us about a girls' school in Nairobi, Kenya where Worldreader is making a difference.
    Video

    Video Genius Lets World Share Its Knowledge

    Inspired by crowdsourcing companies like Wikipedia, Genius allows anyone to edit anything on the web, using its web annotation tool
    Video

    Video Former Drug CEO Martin Shkreli Angers US Lawmakers

    A former U.S. pharmaceutical business executive has angered lawmakers by refusing to explain why he raised the price of a life-saving pill by 5,000 percent. Martin Shkreli was removed from a congressional hearing on Thursday after citing his Fifth Amendment right to stay silent. Zlatica Hoke has more.
    Video

    Video Super Bowl TV Commercials are Super Business for Advertisers

    The Super Bowl, the championship clash between the two top teams in American Football, is the most-watched sporting event of the year, and advertisers are lining up and paying big bucks to get their commercials on the air. In fact, the TV commercials during the Super Bowl have become one of the most anticipated and popular features of the event. VOA's Brian Allen has a sneak peek of what you can expect to see when the big game goes to commercial break, and the real entertainment begins.
    Video

    Video In Philippines, Mixed Feelings About Greater US Military Presence

    In the Philippines, some who will be directly affected by a recent Supreme Court decision clearing the way for more United States troop visits are having mixed reactions.  The increased rotations come at a time when the Philippines is trying to build up its military in the face of growing maritime assertiveness from China.  From Bahile, Palawan on the coast of the South China Sea, Simone Orendain has this story.
    Video

    Video Microcephaly's Connection to Zika: Guilty Until Proven Innocent

    The Zika virus rarely causes problems for the people who get it, but it seems to be having a devastating impact on babies whose mothers are infected with Zika. VOA's Carol Pearson has more.
    Video

    Video Solar Innovation Provides Cheap, Clean Energy to Kenya Residents

    In Kenya, a company called M-Kopa Solar is providing clean energy to more than 300,000 homes across East Africa by allowing customers to "pay-as-you-go" via their cell phones. As Lenny Ruvaga reports from Kangemi, customers pay a small deposit for a solar unit and then pay less than a dollar a day to get clean energy to light up their homes or businesses.
    Video

    Video Stunning Artworks Attract Record Crowds, Thanks to Social Media

    A new exhibit at the oldest art museum in America is shattering attendance records. Thousands of visitors are lining up to see nine giant works of art that have gotten a much-deserved shot of viral marketing. The 150-year-old Smithsonian American Art Museum has never had a response quite like this. VOA's Julie Taboh reports.
    Video

    Video Apprenticeships Put Americans on Path Back to Work

    Trying to get more people into the U.S. workforce, the Obama administration last year announced $175 million in grants towards apprenticeship programs. VOA White House correspondent Aru Pande went inside one training center outside of Washington that has gained national recognition for helping put people on the path to employment.
    Video

    Video New Material May Reduce Concussion Effects

    As the 2016 National Football League season reaches its summit at the Super Bowl this coming Sunday (2/7), scientists are trying to learn how to more effectively protect football players from dangerous and damaging concussions. Researchers at Cardiff and Cambridge Universities say their origami-based material may solve the problem. VOA’s George Putic reports.
    Video

    Video Saudi Arabian Women's Sports Chip Away at Stereotypes

    Saudi Arabian female athletes say that sports are on the front line of busting traditions that quash women’s voices, both locally and internationally. In their hometown of Jeddah, a group of basketball players say that by connecting sports to health issues, they are encouraging women and girls to get out of their homes and participate in public life. VOA’s Heather Murdock reports.
    Video

    Video A Year Later, Fortunes Mixed for Syrians Forging New Lives in Berlin

    In April of last year, VOA followed the progress of six young Syrian refugees -- four brothers and their two friends -- as they made their way from Libya to Italy by boat, and eventually to Germany. Reporter Henry Ridgwell caught up with the refugees again in Berlin, as they struggle to forge new lives amid the turmoil of Europe's refugee crisis.
    Video

    Video Zika Virus May be Hard to Stop

    With the Zika virus spreading rapidly, the World Health Organization Monday declared Zika a global health emergency. As Alberto Pimienta reports, for many governments and experts, the worst is yet to come.