March 2004, In This Issue:
- LEAN health care enterprise as a new Hot Team.
- Engaging LEAN in Iowa's health care industry - focused priorities.
- Iowa Health Buyers Alliance.
- The LEAN enterprise meets health care: Hospital and Health Networks, February 2004.
- Keeping Patients Safe: Transforming the Work Environment of Nurses, report of the Institute of Medicine.
- Key attributes of successful LEAN enterprise.
- "The Right Decision - And Good Advice", Iowa Health Facilities Council.
- Ten simple rules for a new health system for the 21st century.
- Joining HPCI.
The Iowa Coalition for Innovation and Growth (ICIG) is incorporating the HPCI Task Force on LEAN as a new Hot Team. The ICIG is co-sponsored by the Iowa Business Council and the Iowa Chamber Alliance. As a Hot Team, the Task Force work will get more support, yet the work will be very flexible under this approach. Dave Speer, with the Maytag Company, has agreed to chair this effort. More information will be forthcoming as this Hot Team is rolled out. All current members of the Task Force are invited to continue to be part of the elevated initiative.
The leadership group of the Iowa Task Force recently identified the following priorities for the near term:
- Pursue education as a high priority to raise consciousness about LEAN and how it adds value. Work with the Iowa Hospital Association, Iowa Medical Society and other health professionals and groups.
- Demonstrations in Iowa are underway and should be expanded. Successes will be measured and data gathered. At the appropriate time, this information should be shared with CEOs of hospitals, health organizations and other health professionals.
- Establish the website for use by early adaptors, demonstration sites, task force members and other supporting organizations.
- Operationalize LEAN principals on the customer side using the accountability model, QCDS (Quality, Cost, Delivery and Safety) Metrics and similar tools. Consider quality and cost purchasing projects underway in Iowa and elsewhere.
- Pursue the idea of the Task Force being part of the Iowa Coalition for Innovation and Growth as a new Hot Team - see above.
The new alliance of public and private employers, unions and other customers has been created. It is the Iowa Health Buyers Alliance. Co-sponsors are the Labor Management Health Care Coalition of the Upper Midwest, the Dubuque Area Labor Management Council and the Health Policy Corporation of Iowa. For more information regarding the Alliance, please contact the HPCI office.
The "LEAN Enterprise Meets Health Care" article appeared in the February 10th issue of Hospital and Health Networks . The article, based upon work done by numerous hospitals in the Pacific Northwest, starts out with the following quote, "Imagine an increase in surgical case-cart assembly accuracy of 118%, or reduction in IV pump clearing costs from $12.50 to 67 cents. Such dramatic improvements are commonplace in the LEAN health care enterprise. Health care executives are experiencing renewed hope as LEAN practices from the Toyota Production System bring dramatic improvement of 50 to 100% in employee satisfaction, quality, safety and cost." It ends with the following, "The promise of the LEAN organization brings renewed hope for the entire health care industry. Imagine our health care organizations with errors near zero, where everyone has quick access to diagnosis and treatment, where year-by-year costs are stable or even decreasing, and where revenues are rising. Sound like a fantasy? The early pioneers of LEAN manufacturing envisioned a similar "fantasy". Those who were bold enough to embrace the LEAN revolution early have left their competitors behind."
The article "LEAN Enterprise Meets Health Care" can be found here.
In November 2003, the Institute of Medicine, which is part of the National Academy of Sciences, issued a report, "Keeping Patients Safe: Transforming the Work Environment of Nurses." It identifies solutions to problems in hospitals, nursing homes and other health care work environments that threaten patient safety through their effect on nursing care. The report puts forth a blue print for action that all health care organizations which rely on nurses should take.
Based upon our work so far in Iowa, the following are some key attributes for successful LEAN Enterprise in health:
- Buy-in and participation by top leaders of the organization. Leadership has identified their "burning platform" and is passionate about the results LEAN can deliver.
- Cultural change: a new way to do the work. LEAN is an integral part of the organization.
- There is ongoing problem solving in the course of work, done by the people doing the work, supported by a coach.
- Various tools are used to better understand the way the work really happens, based on a direct observation of the work, such as value stream mapping and A-3 problem solving documents. Also, other tools under the LEAN umbrella are appropriately applied, i.e. QCDS Metrics (Quality, Cost, Delivery, Safety), Kaizen events and 6S.
- Not consultant dependent. Have dedicated staff and in-house training and coaching. Rarely requires an increase in FTEs.
- Have clear strategy and meaningful goal(s) that connects from the bedside to the executive suite. Develop goals for quality, delivery, cost and safety and policy deployment that align all efforts toward achieving these goals.
- Are customer focused. All problems are addressed through the eyes of the customer, and all system redesign in patient centric. This objectivity and focus removes interdepartmental blaming and bad feelings.
- Understand and use supply chain integration. For health care organizations, they have a supply chain that they depend upon, but they also recognize that they are a supplier to their customers - the patient/policy holder and employer. Consistent standards, performance measures and expectations are critical and should be consistent up and down the supply chain.
Related terms: Six Sigma, LEAN Sigma, Toyota production system principals (TPS), adaptive design, customer focused, etc.
"The right decision - and good advice" was how the Des Moines Register summed up the recent decision by the Iowa Health Facilities Council which unanimously denied a request from Iowa Methodist Medical Center to build a hospital in West Des Moines. The advice centered on the need for a coherent vision for health care in the Des Moines metropolitan area. What will the region look like in 2020? And what will be the health needs of its population? Those questions are important ones all across Iowa. Health care costs are becoming unaffordable and there is growing recognition that the current systems are unsustainable.
Iowans have a way of coming together on a public and private sector collaborative basis. It may be time to create a vision for Iowa's health care system for the 21st century. As was stated in our testimony before the Iowa Health Facilities Council, HPCI stands ready to assist in these matters. A good place to start may be to consider the six aims and Ten Simple Rules for a New Health System for the 21st Century - see below.
A New Health System for the 21st Century - Ten Simple Rules.
Private and public purchasers, health care organizations, clinicians, and patients should work together to redesign health care processes in accordance with the following rules:
- Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the Internet, by telephone and by other means in addition to face-to-face visits.
- Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.
- The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision making.
- Shared knowledge and the flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
- Evidence-based decision making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or place to place.
- Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.
- The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice or choosing among alternative treatments. This should include information describing the systems performance on safety, evidence-based practice, and patient satisfaction.
- Anticipation of needs. The health system should anticipate patient needs rather than simply reacting to events.
- Continuous decrease in waste. The health system should not waste resources or patient time.
- Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.
Excerpted from "Crossing the Quality Chasm: A New Health System for the 21st Century", Institute of Medicine, National Academy of Science 2002.
HPCI works for quality, affordable health care in Iowa. Individual employers, other purchasers and consumers use many strategies for addressing health care costs on their own. HPCI adds value by helping focus attention and mobilize actions that are best done on a collective or coalition basis involving numerous employers and other purchasers across local Iowa markets. HPCI collaborates with health care professionals and other Iowa stakeholders. For membership information, please send a request to firstname.lastname@example.org. Join HPCI today!
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