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Improving Value and Reducing Errors in Healthcare: Lessons from the Automobile Industry

Explore how the principles of lean production and efficiency used in the automobile industry can be applied to healthcare delivery, with a focus on reducing errors and improving value. Discover the potential benefits of adopting a new model of service delivery in healthcare.

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Improving Value and Reducing Errors in Healthcare: Lessons from the Automobile Industry

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  1. Improving Value and Reducing Errors: What does making automobiles have to do with your practice? Wentworth Douglass HospitalMay 1, 2007 8:00 AMwww.davidnovis.com

  2. Agenda • Why looking at new ways of health care delivery is worth your time • An industrial model of service delivery • Applying lean production to improve health care delivery • Keep it practical and local

  3. Do we need fresh ideas?

  4. Medical Errors 1999 2001 2006

  5. Facility Growth Rising Costs • Single rooms • Expanding services • Expanding population • Aging population New Technology

  6. Diminishing Reimbursement : www.themha.org/advocacy/2005budget.htm

  7. Percentage of Hospitals with Negative Total Margins 1981 - 2004 Source: The Lewin Group Analysis of the American Hospital Association Annual Survey data, 1981 – 2004, for community hospitals

  8. Nursing Shortages www.anamericanrn.com/pages/5/index.htm

  9. Physician Shortages www.consumerhealthjournal.com/articles/regula...

  10. Declining Income

  11. Nurses Stagnant Income

  12. Another model of service delivery?

  13. Perspective Does not imply that doctors are robots or patients are engine blocks….the difference between doctoring and service delivery

  14. Why Toyota?A Business System Designed to Achieve a Universal Ideal • Low Cost • High Quality • Safety • On Demand Sound familiar?

  15. Profitability Toyota Projections: • 3 M vehicles/year in US [1] • Produce 75% of all vehicles in NA (↑ from 60%) [1] • 8th assembly plant in North America [1] • Earn > any other Japanese company[2] • Predicted to pass GM as world's #1 seller of autos. [2] [1] Toyota Sees Three Million U.S. Vehicle Sales by 2010, Daily Auto Insider May 23, 2006 [2] Toyota profit may be tops in Japan Bloomberg News  November 8, 2006

  16. Quality: Vehicle Problems Consumer Reports April 2007

  17. Vehicle Reliability Consumer Reports April 2007

  18. SAFETY SPORTY CARS Audi A3 LARGE SEDANS Toyota Avalon FAMILY SEDANS Honda Accord SMALL CARS Toyota Corolla UPSCALE SEDANS Acura TL LUXURY SEDANS Infiniti M35 SMALL SUVs Subaru Forester http://www.consumerreports.org/cro/cars/consumer-reports-cars-best-in-class-safety/index.htm Accessed 12/1706

  19. Products on DemandEFFICIENCY Industry Week, December 2006

  20. Continuous improvement People Lean Production Business Philosophy Adapted from: Liker, JK. The Toyota Way. New York: McGraw Hill, 2004. Page 13

  21. Business Philosophy Sacrifice short term profitability in order to achieve long term goals VS Hospital Owned Medical Practices

  22. What is Lean Production? Taiichi Ohno — Father of the Toyota Production System Lean • ELIMINATE WASTE • BUILD QUALITY INTO THE PRODUCT • MAXIMIZE EFFORT OF #1 RESOURCE: PEOPLE MIT Henry Ford W. Edwards Deming

  23. LEAN PRODUCTIONCARDINAL WASTES IN MANUFACTURING • Overproduction • Excess inventory • Unnecessary transport • Unnecessary movement • Waiting • Over processing and Incorrect processing • Defects • Unused employee creativity Adapted from Liker, JK. The Toyota Way. New York: McGraw Hill, 2004. Pages 28-29.

  24. Overproduction

  25. Excess Inventory Stock of size large gloves in laboratory… …..even though • stock replenished daily • no size large hands among technologists

  26. Over Processing Admitting Physician Note Hospitalist Admitting Note Specialist Admitting Note

  27. Unnecessary Movement Kenagy: how many steps does it take to give a patient an aspirin? http://www.kenagyassociates.com/

  28. Unnecessary Transport

  29. Defects 1999 2001 2005

  30. Unused Employee Creativity “I don’t know why we do it this way. It would be so much simpler if….”

  31. Common Reactions to Waste Workarounds and Camouflage Increase overhead rather than concentrating on eliminating waste

  32. PROCESSCommon Reactions to Excesses Warehouse Building and Capacity Labor force Overtime

  33. Value FlowWHAT PROVIDES VALUE TO THE CUSTOMER?

  34. Removing Waste Also Reduces Errors Audit of Transfusion Procedures in 660 Hospitals A College of American Pathologists Q-Probes™ Study of Patient Identification and Vital Sign Monitoring Frequencies in 16 494 Transfusions Novis, Miller, Howanitz, Renner, Walsh, Arch Pathol Lab Med. 2003:127, 541–548.

  35. Complete all 4 Identification Procedures Patient’s stated ID Blood bag Requisition ID • Wristband Novis, Miller, Howanitz, Renner, Walsh, Arch Pathol Lab Med. 2003:127, 541–548.

  36. Complete all required vital sign measurements Beginning 1st 15 minutes 15-20 minutes Novis, Miller, Howanitz, Renner, Walsh, Arch Pathol Lab Med. 2003:127, 541–548.

  37. Transfusion Audit Novis, Miller, Howanitz, Renner, Walsh, Arch Pathol Lab Med. 2003:127, 541–548.

  38. Transfusion AuditBest PracticesEliminate Errors: Cut out wasted steps • Routine monitoring of transfusions • Nursing/couriers receive transfusion/ID training • Transfusionists use checklists • 2 transfusionists read ID aloud • Transporting blood directly to patient bedside • Having only 1 person handle blood units in route Novis, Miller, Howanitz, Renner, Walsh, Arch Pathol Lab Med. 2003:127, 541–548.

  39. ELIMINATING WASTE • Remove Silos • Construct Value Flow Diagram • Remove Non-Value Components • Augment Value Components

  40. Build Quality into ProductMake errors visible Sakichi Toyoda

  41. Build Quality into ProductMake Errors Visible STANDARDIZATION REDUNDANCY

  42. STANDARDIZATIONUNIFORM PRODUCT AND FEWER ERRORS

  43. STANDARDIZATION IN HOSPITAL UNIFORM PRODUCT AND FEWER ERRORS

  44. REDUNDANCYCATCH ERRORS BEFORE THEY BECOME DISASTERS Halt Production

  45. CREATING REDUNDANCY INSPECTIONS • Judgment inspections • Informative inspections • Source inspections . [Shingo, Zero Quality Control: Source Inspection and the Poka-yoke System, Productivity Press, 1985.]

  46. JUDGEMENT INSPECTIONSDISCOVER DEFECTS AFTER THEY OCCUR

  47. JUDGEMENT INSPECTIONS • Too Late—damage has occurred • Longest intervals between occurrence and correction • Allow rotten environments to persist • Analysis too focused • Least value in reducing defects * • More common inspections system in health care? *Shingo, Zero Quality Control: Source Inspection and the Poka-yoke System, Productivity Press, 1985

  48. INFORMATIVE INSPECTIONS↓INTERVALS: ERROR OCCURRENCE AND CORRECTIONDETECT DEFECTS BEFORE THEY OCCUR Self checks Statistical quality control • Successive checks

  49. INFORMATIVE INSPECTIONSLimitations of… • Statistical quality control Measurable parameters only • Self checks Memory Bias

  50. SUCCESSIVE CHECKS • Reduce defects by (80-90%)* • Used infrequently in health care *Shingo. Zero Quality Control: source Inspection and the Poka-yoke System. Productivity Press. New York 1985. Shingo, A Study of the Toyota Production System from an Industrial Engineering Viewpoint, Productivity Press, 1989.]

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