he origins of lean manufacturing lie in heavy industry. Automaker Toyota is
a pioneer. But as the concept of teaching industrial workers to methodically improve
efficiency bears fruit, companies in other sectors are taking note. That includes
Meadows Regional Medical Center, an 87-bed hospital in rural Vidalia, Georgia.
Alan Kent, Meadows Regional’s CEO, preaches the gospel of
health-care-based lean principles with religious zeal, and it’s easy to understand
why. Since 2005, when Meadows Regional first applied lean operating procedures in
its emergency room, the average length of stay for ambulatory ER patients has been
cut by 44 percent.
That in turn has led to a 10 percent boost in the number of
ER patients who received care, a likely contributing factor to patient satisfaction
scores that have soared above 90 percent.
"Literally, all we’ve done is taken an established body of
knowledge and applied it to a very high-cost, difficult environment," Kent says,
referring to Toyota’s renowned principles of lean production.
Steering the change is a small multidisciplinary team of Meadows
employees, including registration clerks, emergency room physicians, nurses, lab
techs, pharmacists, X-ray technicians, case managers—even representatives from the
information technology and housekeeping departments.
Guided by lean specialists from Georgia Tech’s Enterprise
Innovation Institute, the team of about 20 people brainstormed on simple yet effective
ways of improving the flow of patients through the ER. An original list of about
80 suggestions was whittled down to 45 actions to be implemented.
Some suggestions were so simple—such as attaching color-coded
paper "flags" that provide an alert on a patient’s status—it’s a wonder they hadn’t
been thought of already. Another concept is "5S," which stands for sort, straighten,
shine, systemize and sustain—a way or organizing workspaces that aims to raise morale
and improve efficiency.
Other more complex actions required expensive investment,
such as an electronic medical records system that enables ER staff to see at a glance
whether a patient is in the waiting room, headed for X-rays, visiting with a doctor
or has been discharged.
A hospital setting may seem like an unlikely place to implement
the industrial engineering concepts behind lean manufacturing. Hospital administrators
are notoriously averse to major changes. Since it is fraught with waste and inefficiency,
however, the health care industry in general would seem to be ideally suited for
the less-is-more, employee-empowered philosophies.
"Corporations don’t get to pass along their costs to consumers,
but health care organizations have been immune to those pressures. That isn’t right,"
Kent says.
Meadows Regional is a not-for-profit hospital in southern
Georgia, situated between Savannah and Macon. Roughly 27,000 people visit its emergency
room each year, or a brisk pace of about 75 patients per day.
For fiscal year 2007, Meadows posted gross revenue of $155
million, a dramatic rise from $46 million in 2000. Kent attributes the increase
to employees’ commitment to dramatically improving patients’ experience.
"When people see improvements are possible, it changes their
attitude about making suggestions," Kent says.
The culture of hospitals is for cost-reduction or process-improvement
projects to get initiated at the top, and then get pushed down lower in the organization.
It is a model that critics say often leads to projects dying before they can be
implemented.
"Our approach is to involve front-end people in coming up
with ideas, so that they have some ownership of the lean process," says Frank Mewborn,
the project manager who facilitated Meadows’ lean team. Mewborn is with the Healthcare
Performance Group, a newly created part of Georgia Tech’s Enterprise Innovation
Institute.
Mewborn helped Meadows’ employee team analyze every activity
used when patients are admitted to the emergency room. The goal was to identify
which processes contribute value to patients and which ones don’t.
Once wasteful processes were identified, the team’s next chore
was to devise a plan to reduce or eliminate them. Using the scientific method of
learning, they also were instructed to analyze the potential impact before making
any changes.
Thus far, Meadows has limited its lean practices to ER processes,
largely for reasons of logistics and practicality. The efficiency gains of industrial
techniques are promising, but unlike in manufacturing, each patient in a hospital
is a "custom job," Kent says.
"We can’t do the same thing two times in a row, much less
100 times in a row," he says. "But we can take certain processes and reduce their
variability."
Beyond the visible improvements, hospital officials say emergency
room employees take responsibility for making changes that improve their daily work—a
hallmark of the lean system.
"Staff members realize that it’s not just the ER’s problem,
it’s everyone’s problem. Whatever we can to do improve the process makes everyone’s
job easier," says Peggy Fountain, the hospital’s ER director.
Meadows’ management plans to incorporate lean health care
principles in its new hospital, which is currently under construction. The facility
is being designed to optimize processes using lean techniques, even before architects
draw up the building, Kent says.
Among the features intended to smooth patient flow are bar-coding
tools, self check-in kiosks and an online patient registration system.
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