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Applying Toyota Production Techniques to Healthcare

“If you can’t describe what you are doing as a process, you don’t know what you’re doing.” – W. Edwards Deming

Deming is well-recognized for his contributions in working with organizations to remove barriers and implement approaches to deliver quality consistently – to always get better in all value-added activities. Whether it is the Toyota Production System or Lean Manufacturing or Total Quality Management, the objectives are similar across the programs. Deming simplified it to the Plan-Do-Check-Act cycle of improvement.

Much of the focus of these techniques has been on the manufacturing industry and, to some degree, the services industry. More recently, the focus is shifting to healthcare, and ThedaCare, a Wisconsin-based community health system, is usually highlighted as achieving results leveraging these methods.

According to the American Society for Quality (ASQ), 53 percent of hospitals report some level of lean management deployment (March 17, 2009 press release). The ASQ benchmarking study found that most of the attention by hospitals is focused on the following areas: surgery/operating room, emergency department, admissions/discharge, and radiology/imaging. Each is a vital area of a hospital’s operations. In each focus area, hospitals are reporting success in their lean management initiatives.

Taking the principles of Deming and Lean Management and applying them to healthcare is novel in approach and results. At the same time, it is practical and long overdue.

Many successful organizations have used these principles to improve cycle times, gain efficiencies, improve customer satisfaction, and reduce costs. Each of these metrics is essential in healthcare as well. In healthcare lingo, it becomes improving turnaround times, streamlining workflow, improve patient satisfaction, and reduce costs (the same across all industries!).

Learning from ThedaCare and other organizations should be paramount for any healthcare organization. Some of the insights and practices are highlighted below as they have appeared in various publications. Lean principles require serious attention as healthcare policies and structures are being debated, decided and, in due course, changed.

Case Study: Lean Management, RT Imaging, December 15, 2008. From the article:

“Implementation of the lean management program has allowed ThedaCare to identify waste and inefficiencies throughout their organization, eliminate them, save money, use their staff’s time effectively and efficiently, and improve patient care.

‘The cost-benefit is secondary to the improved quality and the improved patient experience. It comes with it, but you shouldn’t go into it with the intention of reducing cost; you should go into it with the intention of improving processes and improving quality,’ Barnas [vice president of the radiation oncology department] says.”

ThedaCare’s radiology department has increased gross revenue by 20 percent over 2007 alone and decreased patient waiting time from first consult to first treatment from a baseline of 23 days to 8 days – wasted time that was a primary target of the lean management strategy. These are just two of many gains that emerged from the lean strategy.

‘It’s hard to be inspired after many years of medicine. But when you see real changes happening in a system that affects your patients in a very positive way, it increases job satisfaction,’ says Krueger [a radiology oncologist at ThedaCare].”

Lean Management – Wisconsin’s ThedaCare Improves Its Radiation Oncology Care Process [1], Radiology Today, June 15, 2009. From the article:

“We started with what was a 26-day process, and after our first pass implementing ‘lean thinking,’ we collapsed it to 16,’ says Kim Barnas, ThedaCare’s vice president of radiation oncology. ‘Then we did a second value stream pass, where we actively sought out anything that didn’t add value to the patient’s experience. At the end, we reduced referral to treatment times to seven days. We’re sustaining it at seven, so we went from a 26-day process to a seven-day process.’

While lean management has resulted in significant cost savings and increased productivity, most importantly, it has meant that patients are happier because they are getting the same quality of care with better service, according to Barnas.”

Lean Techniques Boost Efficiency at Rural Hospital,, Georgia Tech, September 25, 2007. From the article:

“The emergency department at Meadows Regional Medical Center in rural Vidalia, Ga., has achieved what would make most hospitals across the nation envious: a 44 percent reduction in average length of stay per patient, a 10 percent boost in patients served and a 92 percent patient satisfaction rate.

The secret? With assistance from the Georgia Institute of Technology, the hospital implemented lean manufacturing principles, a process management philosophy derived mostly from the Toyota Production System and known for reducing wasted time and effort in manufacturing.

‘If you don’t change and innovate, it will kill you,” he [CEO Alan Kent] added. “One of the goals of lean health care is to awaken a new level of thinking and introduce manufacturing approaches that have been proven to produce excellent efficiency and profitability.’”