Critial Path Network
Lean production efforts help save $7.5M in 1 year
Each service line has a dedicated director
Park Nicollett Health Services (PNHS), a health care system based in St. Louis Park, MN, has demonstrated savings of $7.5 million in 2004 as the result of adopting the Toyota Production System — also known as "Lean Production." The system’s success stories include:
- reducing average patient waiting times at its St. Louis Park Urgent Care facility from 122 minutes to 52 minutes;
- increasing the number of phone calls answered within 30 seconds by 560%;
- reducing by 79% the cycle time between when a request is made to the organization’s designated phone line for prescription refills to when the pharmacy receives authorization;
- reducing the number of medications prepared but not needed by 30%;
- decreasing the amount of paper phone messages filed in the paper medical record by 100%, as messages automatically become part of the patient’s lifetime electronic medical record;
- processing 40,000 fewer surgical instruments per month, after analysis of variation in instrument preferences and agreement on standard instruments for each case.
- In the PNHS Cancer Center, patient flow improvements resulted in capacity for 10 additional chemotherapy and antibiotic infusion patients per day.
"Most of our focus is on our lean’ efforts," notes David Abelson, MD, vice president of strategic improvement at PNHS, noting the "lean" move is about 2 to 3 years old. "This coming year, we will have 150 rapid process improvement workshops (RPIWs) — detailed examinations of processes used to find evidence of waste, develop standard work, and improve safety and efficiency); we have 7,000 people devoted to lean." Each service line, he explains, will have a dedicated "lean" director and three to four support personnel.
Abelson says lean production is significantly different from traditional continuous improvement methodologies, and even from the more recently popular Six Sigma. "Lean uses very specific principles on the best way to do work," he explains. "It’s not just about continuous improvement but about CI using very specific principles for work, such as leveling the load; matching your capacity to demand; eliminating all different kinds of waste; pulling vs. pushing; making the work visible."
For example, he notes, two of the more successful improvements were focused around prescription refills and phone messages. "In both instances, we used the lean approach. The [RPIW] involves three weeks of prep work, where two people who are leaders (at least at the management level) don’t do their other duties but focus just on the background of the problem," he explains. "They go to the worksite for measures, of which time is the main metric." This is one thing that distinguished lean from Six Sigma, he notes. "It specifies the main metrics as time, whereas Six Sigma’s is defects," says Abelson.
Another key metric, he continues, is cycle time — the amount of time that is spent actually doing the process. "Most of the time, that is much less than the lead time," he notes. "If a lab result takes five days, the amount of staff time involved is probably 20 minutes, so the rest of time is probably wasted time."
In an RPIW, one site is chosen as a pilot. Using stopwatches, the leaders determine how long the process takes from the patient’s point of view. "This is essential for any kind of lean effort," notes Abelson.
So, for example, when examining prescriptions, they looked at how many refills came in within a reasonable time, how they were processed, and how long the doctors, nurses and pharmacists spent on the process. "Then, in the fourth week, a team of stakeholders is assembled [in this case doctors, nurses, pharmacists, and a receptionist] and given one morning of training," says Abelson. "In the first half of the day, they are expected to make changes and come up with idea sheets." So, for example, if the problem is lost papers, the idea sheets would note ways of solving that problem. "Over the next two to three days, they make as many changes as possible, using lead time and cycle time as the main metrics," Abelson adds.
So, in terms of refills, the team noted that the hospital had some existing software for phone messaging. "They thought it would be a great way to communicate that a refill request had been submitted," Abelson recalls. "They did not want to have the physicians spending time on every single refill request, so they developed some protocols nurses could use that would enable them to refill about 75% to 80% of the requests with just an FYI’ for the doctor."
So, instead of the physicians looking at 100% of all refill requests, they now look at perhaps 15% to 20%. "It not only eliminated a lot of work for the doctors but long waits for the patient," Abelson observes.
Park Nicollett Health Services (PNHS), a health care system based in St. Louis Park, MN, has demonstrated savings of $7.5 million in 2004 as the result of adopting the Toyota Production System also known as Lean Production. The systems success stories include:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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