A recent article in The New York Times highlights the important role that process improvement and lean initiatives can play in health care sector. The article illustrates how Seattle Children Hospital was able to improve its operations on several accounts by implementing "continuous performance improvement" (C.P.I.). Some of the examples are as follows:
1. Before implementing C.P.I., nurses in the intensive care unit used to stockpile several tools, such as catheters in the closet, surgical dressings in patients' dresser drawers and clamps in the nurse's office. This resulted in shortages and an increased time spent in searching for these tools at times of need. With the implementation of a new supply system these issues have been favorably resolved. A system similar to Kanban has been used to ensure availability of tools. There are two bins for each item. When one bin is empty, the second bin serves the need. Empty bins go to the central supply office and the bar codes are scanned to generate a new order. By implementing this new approach, the hospital storeroom is now half its original size, and fewer supplies are discarded for exceeding their expiration dates.
2. C.P.I. examines every aspect of patients' stays at the hospital. As a result, amid rising health care expenses nationally, the program has helped the hospital to reduce costs per patient by 3.7 percent. The total savings by this cost reduction is estimated to be $23 million. By using the facilities more efficiently, the hospital avoided $180 million expenditure on capital projects and was able to serve 38,000 patients last year (up from 27,000 in 2004) without expansion or adding beds.
3. In the department of psychiatry and behavioral medicine, the team started to arrange outpatient resources as soon as children enter the unit, rather than waiting until they are ready to leave. This has resulted in an increase in satisfaction ratings and helped to cut the average time in the hospital from 20 days to 10. The unit now serves 650 children instead of 400 as was the case before implementing C.P.I. program.
4. The hospital has reduced the waiting time for many surgeries from three months to less than one. As a simple example, the C.P.I. initiative identified that the bottleneck was a lack of available inpatient beds for recovery (and not surgeons' time). An examination of hospital's census revealed that there were empty beds on weekends. Accordingly, the hospital decided to schedule more surgeries on Fridays so that patients could recover over the weekend, when more beds were available. This change not only resulted in reduced waiting time for surgeries but also benefited parents and patients who would miss fewer work and school days.
5. The hospital had planned to spend $500,000 on renovating the recovery room. However, the C.P.I. initiative suggested that if a child's parents went to a common waiting room during surgery, instead of an individual recovery room, more surgeries could be scheduled. The parents were given beepers to alert them when their child would arrive in the recovery room. Maps and colored lines on the walls helped point the way. With this change, the renovation plan was scrapped.
6. The hospital is using the C.P.I. project to design a new $70 million clinic and surgical facility in Bellevue, WA. The team used C.P.I. to map out common paths that patients, staff members, supplies and information would flow through. To plan the design, the team worked in an empty office building, using cardboard mock-ups of surgical sites, recovery rooms, anesthesia areas and waiting rooms. Fifty members play-acted various scenarios to test the design's effectiveness. As a result of this thorough analysis, the final design has reduced 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 initiative helped in reducing the space requirement by 30,000 square feet and a reduction of $20 million.
Source: Weed, J. "Factory efficiency comes to the hospital." The New York Times, July 9, 2010.