American auto maker shows hospitals how to redesign systems
GM workshop stresses immediate improvement
Building cars and rebuilding people’s bodies have much in common, say productivity experts at General Motors (GM). They both can be broken down into a series of processes. And most processes can be streamlined to provide better service for less cost, whether quality customers want a new car or a treatment for pneumonia.
This principle is the root of a system the Detroit-based auto maker is using to help hospitals and other health care facilities redesign processes to provide better care at a lower cost.
Named PICOS, Spanish for "mountain peaks," the system is a series of workshops in which a team made up of hospital staff is taught how to identify and eliminate waste in a problem area, then design a new process that can be implemented immediately, either for a zero- to six-month span or a longer term of six months to a year. The system, which GM teaches for free, can be used anywhere in the hospital, in nursing, in finance, or in administration.
"It looks similar to other [quality improvement] initiatives, but what makes it different is the sense of urgency. We’re looking for changes we can implement now," explains Linda Bradshaw, manager of supplier development at General Motors. "It’s exhaustive and intense. At the end, they’re on a high. They made change happen."
GM has taught the system to health care organizations nationwide. It has conducted workshops in such high-profile facilities as the Mayo Clinic in Rochester, MN, and the Memorial Sloan-Kettering Cancer Center in New York City, and to health plans such as Blue Cross/Blue Shield. It has targeted facilities that treat the bulk of GM employees, such as the Detroit Medical Center and the affiliated Karmanos Cancer Institute. At Karmanos, also in Detroit, administrators say the workshops have stimulated a redesign that will boost productivity by as much as 30% to 50%. Another recent client, the Cleveland Clinic Foundation (CCF), used the system to slash discharge time from eight hours to two. (See related story, p. 52.)
"Health care organizations are looking to accelerate their improvement initiatives," explains Leslie Sabo, director of service relations at CCF. "Taking 12 to 18 months for data collection, reporting, then acting in these turbulent times is too long. Everyone is looking for more flexible methods."
An unlikely resource at first glance, GM actually has been teaching these workshops to such industries as Hughes Missile Systems and Electromotive, as well as using them to turn around its own business.
Method started in European division
GM’s European division developed the method in 1989 and brought it to the domestic division in 1992. GM applied the process internally to streamline its operations then brought it to its manufacturers and suppliers to further reduce costs. It also applied the process to its dealerships, all successfully.
That’s when GM decided to test it on its largest expense health care. GM’s health care bill for active and retired employees adds $1,200 into the cost of every vehicle it produces. The company spends $3.5 billion a year for health care and covers 1.5 million lives, Bradshaw says.
"I’m asked a lot why we got into health care, and those figures show you why," Bradshaw says. "We’re hoping that by improving their quality and service while reducing costs, that they will return the benefits to GM by lowering our health care costs."
Bradshaw explains the one-week workshop process (see chart of process, p. 51), as listed below:
• Identify the problem.
Almost any process can be tackled in the workshop. CCF used it to analyze its discharge process, preparations for same day/next day surgeries, laboratory performance time, chart retrieval, and ancillary flow. And, Karmanos restructured its organization, breaking up traditional departments and grouping together people who treat the same patients. GM’s system also helped Karmanos create a single-computerized patient record to replace a cumbersome process of pushing papers through departments.
• Assemble the team.
The team should be composed of eight to 10 people who represent all those involved in the functions of the process. "These are the key players," Bradshaw says. "They can be physicians, the nurses, the secretaries everyone who will have a direct impact on the process."
• Analyze lead time.
The team walks through the problematic process, looking for waste. Here are the seven waste areas GM defines and examples of each:
correction: inspection reports;
motion: poor department layout;
material and information movement: excessive handoffs;
inventory: documents, forms;
overproduction: excessive work in process between functions;
processing: microfilming;
waiting: long process time.
The team identifies every step in the process, establishes the time required for each step and defines each step as value or nonvalue added.
"We look at the process and what’s happening to the patient. For many people, this is the first time they’re looking at it from the patient’s point of view, and they are surprised at what they put the patients through," Bradshaw says.
• Brainstorm solutions.
The team returns to its meeting room and scrutinizes the process it just charted, looking for ways to cut waste by reducing, eliminating, or combining steps. Key discussion areas are employee tasks, workplace organization, visual control, and facility and office layout.
"They’ll wallpaper the room mapping out the process," Bradshaw says. "A lot of things surface, [such as staff realizing] how much time they spend running up and down hallways looking for equipment."
• Analyze and select solutions.
Sift through the brainstorming papers and pick out solutions that can be implemented. "They’ll have 150 ideas," Bradshaw says. "Now you need to bring them back down to earth and identify the actionable items. Things they can do immediately."
• Redesign the process.
Discuss the plan with stakeholders. Implement the plan immediately, focusing on what can be done in that week. Apply zero- and low-cost ideas first. "This isn’t a typical path to redesigning a process," Bradshaw says. "They don’t wait weeks or months for someone to approve it. The key people have already said you find what you want to do and do it.’"
• Verify and adjust.
Tweak the process as needed. Establish a system to measure improvements. The team must also follow up to ensure the plan is implemented. "It’s not a one-week process," Bradshaw says. "We hope that once we leave they’ll continue doing this on a regular basis. We’ll help support them and come back, but eventually they should be running their own workshops and continually trying to improve processes."
[Editor’s note: For more information on the fast track discharge process or PICOS programs at The Cleveland Clinic Foundation, contact Leslie Sabo, director of CCF’s service relations, (216) 445-5434.
For more information on using PICOS in the health care setting, contact Linda Bradshaw at General Motors, (810) 986-6738.]
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