Here's a news story about a hospital I know people from, LeBonheur Children's Hospital in Memphis. I am have some examples of their in my upcoming book on “Lean Hospitals” (by “upcoming,” I mean that I'm finishing up final touches on the manuscript and it should be available for sale later this year, check back here for more details.)
LeBonheur reconfigured their emergency department flow to reduce patient delays, finding that it also improved productivity for the physicians. One method they used was Standardized Work:
Because Le Bonheur is an academic hospital, there always will be inefficiencies because of teaching, he said, and there always will be complex cases, true life-or-death emergencies that demand the time of a lot of people. But the vast majority of cases can go through a defined treatment process.
What doctors once derided as “cookbook medicine” now is being embraced as “critical care paths,” which quickly diagnose a patient and send him or her through a pre-determined course of procedures.
Sure, Standardized Work might might be applicable in every unique patient situation, but not every patient is a case worthy of the show “House.” Making improvements to the “vast majority” of cases should free up more time to deal with really challenging or unique cases.
Exam rooms were also standardized, which reduces the amount of time employees spend searching for supplies and tools.
The hospital is also being smart and showing “respect for people” by committing to not use Lean improvements to drive layoffs.
One of Schlappy's rules up front is that nobody loses their job. Reductions in the lab, for example, came from attrition and retirement. It's simply inappropriate, he said, to ask people to work hard at eliminating their own jobs.
There are some unique dynamics with ED flow, as reducing delays might actually encourage more demand for care, instead of parents taking kids to primary care physicians.
But, the article says, and concludes with a quote from the chief MD of the ED
Parents are strongly urged to go to their regular providers for follow-up care, he said. Also, federal politicians are starting to scrutinize the nationwide problem of ER crowding and patient diversion. Hospitals have to tackle the problem or they'll face another load of regulations.
“At the federal level the only thing they can do is increase our regulations or decrease our funding,” he said. “It's better if we figure this out ourselves.”
That's a great point — there are many things, in any industry, that we do NOT have control over… better to work on the things we do have control over, such as the design of our processes and Standardized Work!
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Reminds me of the New Yorker article by Dr. Gawande you, and I, wrote about awhile ago.
“Entering the era of Medicine delivery as science” indeed!
A crucial element of making this work is management refraining from demanding that all the cases fit into the standardized workflow (or limit non-standardized work with quotas and such).
A lot of resistance to standardization is because of situations where management heavy-handedly tries to cram every situation into fitting the new paradigm. This results in botched handling of the special situations that aren’t suited to standardization, which damages morale and creates an impression that management is out of touch and lacks credibility in trying to make complex reality fit into a neat little theory.
When medical staff determine that a patient’s situation calls for specialized attention or non-standard handling, respect their determination without intimidation or second-guessing.
I’ll only comment specifically because this is material that’s going in my book, after speaking with the ED chief this morning:
Not all patients are forced through the Lean track process, only when it makes sense for the patient and their care. There are guidelines for which patients would normally go through the Lean track, but there is room for judgment. There is also a kaizen process for evolving the guidelines and a formal “methodology for being flexible.”
Did you see this hospital and story are now featured on the LEI site?
That’s why I come here for breaking Lean news… you were like a month ahead of them.
Maybe they are also reading your blog, Mark? :-)