I've been reading a lot about lean production process improvement over the past couple months. The lean model got its start in Japan where the geniuses at Toyota created the Toyota Production Process. A process is "lean" when it has no or very few steps that do not deliver value to the customer. A typical lean process improvement will look at every step in a process, determine which steps add value and which don't, and find ways to get rid of the steps that don't add value.
Since I learned about how lean can reduce costs while improving quality, it seemed to me like a natural idea to try to apply it to health care delivery. The leaders of Virginia Mason Medical Center in Seattle, Washington have done just that. Health Affairs recently published a Web Exclusive by Pham, Ginsburg, McKenzie, and Millstein analyzing Virginia Mason's results with lean. Their analysis has so many implications for the health care delivery system, I think you could devote an entire blog to "lean health care", but I'll try to touch on as many as I can.
To summarize, Virginia Mason looked at four main diagnostic groupings to try to lower the treatment costs and improve quality: 1) low back pain; 2) cardiac arrhythmias; 3) gastroesophageal reflux disease; and 4) migraine headaches. They did so many "revolutionary" things (i.e. things that would make sense in any production process but which are practically unheard of in health care), it's hard to list them all.
This post will be about just one of their improvements, with more posts to follow about others.
The article barely mentions it, but what struck me as the most innovative change they made was a "stop the line" mechanism ...in which staff immediately report instances of medical errors or near-misses."
Not to make too big a deal out of it, but this has been a main goal of malpractice reform for years and Virginia Mason just decided to do it and got all of their physicians and other clinicians on board to do it. Usually, hospitals are reluctant to have error reporting mechanisms like this because they don't want a paper trail documenting "negligence" which might come back to haunt them should there ever be a medical malpractice suit associated with the error. Documenting the error might be taken as admission of fault, so many hospitals take the approach that it's better not to document the error or admit a mistake at all.
Virginia Mason realized that this approach was hurting their quality and causing them to make more errors. Without this step, there's no opportunity to learn from mistakes and prevent them in the future. Imagine a production process without a feedback loop to deal with production errors! It would be madness, but it happens in health care everywhere.
So, good for Virginia Mason for treating errors the right way and even better for their doctors for swallowing their pride a little bit and admitting when they made a mistake or had a near-miss.
The next post will deal with why Virginia Mason might lose money with all of their improvements and why they might not.
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