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Lean Healthcare West Case Studies

Examples of problems addressed using the principles of the Toyota Production System:

1. Problem: Orthopedist did 4 joint reconstruction surgeries on Mondays, could do 5 but there was a bottleneck in the recovery room. Action: Activities in recovery room were observed; some activities were changed (with staff input) and patient time in recovery room was reduced from 90 minutes to 57 minutes. The orthopedist now does 5 joint replacements on Mondays.
See the Diamond Care Presentation

2. Problem: Patient satisfaction survey results for “hot food” were in the low 70%'s. Action: Rehabilitation unit and kitchen staff observed the processes for assembling trays, found that food was fine, but thermostat was malfunctioning in coffee maker and coffee was poured early in the assembly process. Thermostat was replaced; work was reordered in tray assembly to require_once pouring coffee last (immediately before loading on transport cart). Patient satisfaction survey results for the next week were 100% for hot food. (This not only affected the rehabilitation unit food trays, but every tray in the hospital).

3. Problem: Cardiology program was adding 2 more cardiologists and cardiac echo lab had a capacity of only 8 exams a day. < Action: Work was redesigned (without adding staff or buying new technology) and capacity was increased to 16 (in one day!)

4. Problem: Sometimes patients with acute chest pain walk into the diagnostic heart center (center usually sees stable patients by referral) and the secretaries/nurses needed a plan to assist these unexpected urgent patients . Action: Work was specified and a drill was conducted (and succeeded) to insure that acute patients were not overlooked in the waiting room, and that their immediate care was expedited.

5. Problem: Lab turn around times for emergency patients are delaying care and extending patient time in the emergency department (ED). Action: Activities in ED and lab were observed and waste was recognized in both departments. Adjustments in work activities were made and ED time for patients was decreased by 10%.

6. Problem: Patients were experiencing delays of up to 6 days between the time that they were seen in the cardiologist’s office and when they could be seen in the stress/echo lab for a treadmill exam. Action: After observing the flow of patients from the cardiologists office to the diagnostic (stress/echo) lab, it was decided by 2 physicians to see patients in the stress/echo lab primarily (patients make appointments to see the cardiologist at this location); the daily schedule for diagnostic exams was limited to the first 3 hours of the day for scheduled patients, and the rest of the day is filled with patients as they are seen by the cardiologists, the same day. Initial diagnosis-to-exam time for treadmill exams was reduced from 2,743 minutes to 64 minutes.

7. Problem: Patients in the emergency department (ED) were experiencing delay of medication administration for medications that were not stocked in the ED and the pharmacy was interrupted by nurses looking for undelivered medications. Action: Time delay that this caused was observed, med orders were faxed to pharmacy by the ward clerk instead of being called by a nurse. Calls to pharmacy for un-stocked urgent medications were reduced by 81%.

8. Problem: Head injury rehabilitation unit moved off-campus; because of efforts to reduce spending, their request to purchase a piece of software (previously shared with inpatient therapists) that enabled therapists to design communication tool for head injured patients was denied. Cost of travel and therapist time to create the boards on campus was documented and it was observed that all patients who could have benefited from the tool were not getting customized boards. It was also noted that the boards had to be created outside of therapy time. Average cost of each board $74.62. Action: Software was purchased; secretary work specified to do construction after therapist did design with the patient during therapy time. New cost per board: $10.11. Savings for 1 year: $2,854 (this reflects therapist time only, does not consider that the boards are now being constructed with the patient (better product) during billable time.

9. Problem: Cardiac stress/echo lab was receiving frequent calls to re-send cardiologists dictated reports of stress tests. Senior nurse in stress lab went to medical records to observe, and discovered that records were being coded incorrectly which caused not only the initial problem but it was discovered that patients were not being billed for the stress portion of their exam. Action: Cost recovery for 6 months of lost charges and cost of re-doing charts: $128,000

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