Original Article appears at http://www.mddailyrecord.com/article.cfm?id=12256&type=UTTM
Streamlining at St. Joseph Medical Center
Daily Record Business Writer
August 25, 2009 7:38 PM
St. Joseph Medical Center has taken notice of the Toyota Way.
The Towson-based hospital has adopted the automobile maker’s innovative strategy for streamlining car production and applied it to its emergency department, reducing the length of time a patient waits there by 25 percent over the last year through more efficient communication systems.
Lean manufacturing techniques, pioneered by Toyota, cut waste by improving the pace of the production cycle, bringing more value to customers at a lower cost. In hospitals, lean techniques translate to cutting down patient wait times, improving patient flow and upgrading the patient experience.
Two years ago, St. Joseph brought in Dave Norton, a 37-year auto industry veteran who worked for Toyota and General Motors, to lead its lean efforts.
The hospital fully implemented the program in its emergency department last year after word came from management that the hospital needed to shrink the length of emergency department stays.
“If you’re coming into the emergency department, your main value is probably not to die first, and second is to get in and out of there quickly,” Norton said. “So coming in and doing a half an hour registration or waiting for an hour or two is a waste.”
St. Joseph cut the average emergency department visit down from 5 hours and 57 minutes to 4 hours and 30 minutes in fiscal 2009, which ended June 30, said Durenda Juergensen, assistant vice president of nursing.
Now, instead of waiting to take blood until a bed opens up, patients get their blood drawn immediately. A major emergency department obstacle is knowing when a patient can move to the next step of the process, whether that’s reviewing lab results or getting discharged. St. Joseph implemented a color-coded patient tracker system that gives doctors, nurses and technicians visual cues on patient status, for example, by changing the color in each letter of the word “lab” to show when blood has been taken, dropped off for testing or the full lab results are available.
The hospital achieved the reduction last November and has sustained the drop, Juergensen said.
“We’re constantly pursuing perfection,” Norton said. “It’s focused on what the Japanese call kaizen spirit. It’s developing that continuous improvement.”
Clogged emergency departments have become a major issue nationwide, and many hospitals say the problem is a lack of beds.
But St. Joseph found that streamlining the process of moving patients from the emergency department to inpatient beds freed up space in the emergency department. The hospital cut the average move to an inpatient bed to 50 minutes — down from 1 hour and 50 minutes — by creating a system that sends a page to hospital staff when a bed has been assigned, instead of requiring multiple calls between staff to see if the bed is available.
“You have built capacity of your emergency department without building anything with bricks and mortar,” Juergensen said.
St. Joseph is certainly not the first hospital to employ lean techniques. In the last decade, businesses have popped up worldwide offering job placements in hospitals and other fields for former Toyota employees and students of the lean philosophy.
Jason Stiles, president and chief operating officer of Stiles Associates LLC in New Hampshire, a lean-focused search firm founded in 1991, said his company started getting calls for placing lean experts in hospitals in 2006.
Stiles said the use of lean systems in hospitals is growing rapidly, a likely result of more transparency in hospital data.
“It can be very impactful if applied correctly,” he said. “If it’s not [applied correctly], people can view it as a headcount reduction program, so it’s really important for hospitals to have the right people guiding them.”
St. Joseph plans to implement lean processes in operating rooms next. While the process will save the hospital money, Norton said that is not the priority.
“I’d like to think we’re saving lives rather than focusing on saving dollars,” he said. “Obviously the monetary savings come later, but the point is saving lives.”
According to Press Ganey, a leading national provider of patient satisfaction data, the average stay in Maryland’s emergency departments was 4 hours and 23 minutes in 2008, from the time patients walk in the door until the time they leave. The national average was 4 hours, 3 minutes.