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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