Hospitals emulate industry — with stellar results

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There’s so much rotten news about corporations these days — lax safety practices at BP leading to environmental disaster, out-of-control risk and compensation packages on Wall Street bringing down the economy, the once-hallowed Toyota guilty of shoddy workmanship — that we sometimes tend to forget that industry does some things really right.

When it comes to process efficiency, manufacturers the world over have made tremendous strides. And now some of the techniques they’ve honed are being put to use in hospitals, with excellent results. According to the New York Times, a growing number of hospitals are applying “continuous performance improvement” — a cross between Six Sigma and kaizen and Total Quality Management, all programs that have spread like wildfire through the corporate world. And guess what? They work.

Here’s how one hospital made out:

The program, called “continuous performance improvement,” or C.P.I., examines every aspect of patients’ stays at the hospital, from the time they arrive in the parking lot until they are discharged, to see what could work better for them and their families.

Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million, Mr. Hagan says. And as patient demand has grown in the last six years, he estimates that the hospital avoided spending $180 million on capital projects by using its facilities more efficiently. It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.

Apparently, so many hospitals are interested that Seattle Children’s has put together a training program to teach them. Reminds me a lot of the old days, when Toyota used to graciously let GM and others come in to learn its vaunted quality methods (yeah, I know, maybe it needs to re-teach itself). And it reminds me of a trip I took to GE Health Care (back then it was called GE Medical Systems, or Gems) more than a decade ago, to see first hand how they applied Design for Six Sigma. They used it to create a new CAT Scanner, one that was lightyears ahead of existing machines in terms of performance and reliability, yet much less expensive to make.

The system, whether applied at GE or Toyota or Seattle Children’s, is deceptively simple. It involves studying how employees, be they riveters or doctors, do their jobs — and putting needed tools and information at fingertip reach. It also means studying how customers — patients and their families — consume services and products, and streamlining accordingly. In a hospital it means standardizing instrument carts in operating rooms so surgeons always have the right scalpel at hand, organizing supply shelves and automating supply reorder methods so nurses can always find needed tubing and bandages. It means recognizing that recovery rooms are overcrowded on Tuesdays and empty on Fridays, and reskedding surgeries to even out the usage flow. Sounds so simple you can’t figure out why it hasn’t been done all along — except we flawed humans aren’t logical (admit it — are your closets and kitchen drawers optimally organized?)

There’s of course a danger in this. It could too easily devolve into the classic Time/Motion studies, where experts decide that a certain task should take 2 minutes, and workers who take 2.5 minutes are penalized. So much for spending that added time to calm a patient, say, or take a more thorough history. And, of course, if the hospitals use the new efficiencies as an excuse to lay off workers, all you’ll have accomplished is a smaller but resentful, overworked and underperforming staff.

But if the systems are applied humanely, and without total rigidity, they really, really work. And if this type of thinking is built in from the getgo — i.e., when a new hospital is going up — it can create efficiencies from day one. I’ll end with the same hopeful anecdote that ended the Times piece:

Medical buildings often have standard benchmarks — basing the number of examination rooms, for example, on the expected volume of patients. Ms. Brandenberg and her team instead used C.P.I. to map out common paths that patients, staff members, supplies and information would flow through. They worked in an empty office building, using cardboard mock-ups of surgical sites, recovery rooms, anesthesia areas and waiting rooms. Fifty staff members then play-acted various scenarios to test the design’s effectiveness.

The final design reduces walking distances and waiting times for patients by grouping related facilities together and creating rooms that can be used for more than one purpose. The hospital was able to shave 30,000 square feet and $20 million off of the new building, which is to open July 20.