Leave it to the South Africans to write one of the best articles I've seen detailing some examples of lean healthcare success in the United States. While many in the U.S. are thinking about ditching the power of markets to drive new technologies and access in favor of single payer systems that almost by definition ration health care, some health care organizations are already improving themselves.
A new body of research is pointing to Lean tools - techniques that stem from the manufacturing sector, most notably the Toyota production system - as a possible aid in the battle for greater [healthcare] efficiency. Companies in the manufacturing realm have earned a reputation for quality and efficiency unparalleled in other industries thanks to Lean process tools. The methods have helped make businesses such as Toyota great by enabling them to do the seemingly impossible: reduce costs while increasing quality.
It is just that counterintuitive nature of lean... reduce costs while increasing quality... that makes it difficult for many folks to understand. Sometimes you have to see it in action to really believe it. Here are just a few of the examples, all in the U.S., from the article:
In a presurgical nursing unit at the Western Pennsylvania Hospital, the results of the application of the tools were: the time between signing in and registration went from two hours to zero; the time spent registering patients went from between 12 and 60 minutes to three minutes; and the number of daily unnecessary blood bank reports issued went from between 10 and 11 minutes to zero.
In the Allegheny General Hospital, Pittsburgh, the number of patients suffering from intravenous infections declined from 37 in one year to six the following year, and associated deaths fell from 19 to one. In the Southside Hospital, Pittsburgh, iterative trials and experiments in the pharmacy resulted in time spent searching for medications falling by 60 percent and stockouts falling by 85 percent - with no investment in technology.
The Shadyside Hospital in Pittsburgh learnt from Southside, but conducted its own iterative trials and experiments. In the case of nurse-time spent on patient-controlled anaesthesia pumps, an estimated 2,900 nurse-hours a year were saved. In the same hospital, a patient fall occurred on average every 12 hours - a dramatic decline. At one point, the unit went 95 days without one.
A study by Dan Jones of the UK Lean Enterprise Academy found the following improvements typical... not the exception:
A 70 percent reduction in the number of steps needed to complete most tasks; a 40 percent reduction in the floor space needed; up to 90 percent reductions in the time taken for the department to do its job - and all achieved with less staff and limited capital investment.
The article goes on to describe several real-world examples from hospitals in South Africa and Australia. Instead of creating more regulation and controls that will limit technology, increase wait times, and simply redistribute costs, we should be looking harder at reducing actual waste.
Other lean bloggers have written more extensively on lean healthcare than we have. In particular check out the healthcare category at the Lean Blog and the Gemba Panta Rei blog.