When it comes to delivering life-saving care, optimizing the entire system–not just individual components–can make all the difference. This principle is exemplified by the work done at New London Medical Center, a ThedaCare-affiliated critical access hospital, in improving care for Code STEMI patients.
This post is based on material from the 3rd edition of my book “Lean Hospitals.” The case example was shared during a 2017 visit to the ThedaCare system in Wisconsin. I also discussed this with then-CEO Dean Gruner, MD in my Lean podcast, episode 286.
The Challenge: Time Is Muscle
For patients experiencing a STEMI (ST-elevation myocardial infarction), every second counts. The standard of care emphasizes reducing “door-to-balloon” time, which refers to how quickly a patient can receive a catheterization procedure to restore blood flow to the heart. New London Medical Center lacked an on-site cath lab, meaning STEMI patients required transfer to Appleton Medical Center, 20 miles away.
Initially, the hospital focused on minimizing “door-to-transfer” time, ensuring patients were moved to Appleton as quickly as possible. Traditionally, this involved using a helicopter for transport–a seemingly logical choice given the urgency. However, the system wasn't optimized for the broader goal: minimizing the time from arrival at New London to treatment in the cath lab at AMC.
The Insight: System Thinking Over Local Optimization
A deeper analysis revealed that the helicopter, despite its speed in the air, introduced delays on the ground. Patients often waited for the helicopter to arrive while precious minutes ticked away. Leaders at New London asked a crucial question:
What if the helicopter wasn't the best solution? What if the patient could simply be driven to Appleton instead? Would that actually be faster?
This broader system view uncovered a surprising truth: loading patients into a waiting ambulance and driving 20 miles took the same amount of time as the helicopter process, with no difference in clinical outcomes. As one leader insightfully noted,”
“What patients care about is getting the care; they don't care about the helicopter.”
The Result: Better Outcomes, Lower Costs
Armed with this insight, New London Medical Center switched to ambulance transport for STEMI patients. This change reduced costs while maintaining the high standard of care. The new process consistently enabled patients to receive catheterization within 90 minutes approximately 95% of the time, with an average time of 75 minutes–better than national benchmarks.
Key Takeaways for Leaders
This case study offers valuable lessons for healthcare leaders and organizations in any industry that are striving for operational excellence:
- Optimize the System, Not the Parts: Local optimizations, such as focusing solely on helicopter transport, can create hidden inefficiencies. A systems view often reveals better solutions that align with the ultimate goal.
- Focus on Patient-Centered Outcomes: The best solutions are those that prioritize patient needs, not assumptions about what's “best.” Patients cared about timely, effective treatment–not the mode of transport.
- Question Assumptions: The initial assumption that helicopters were faster wasn't supported by the data. Challenging these assumptions led to a more cost-effective and equally efficient process.
- Measure What Matters: Clear metrics, such as door-to-balloon time, guided this improvement effort and ensured that the new process delivered the desired results.
Closing Thoughts
The work at New London Medical Center is a powerful reminder that continuous improvement often requires stepping back to see the bigger picture. By focusing on the entire patient journey rather than isolated steps, healthcare leaders can find innovative ways to save time, reduce costs, and, most importantly, improve patient outcomes.
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