A Lean Machine

Virginia Mason Medical Center in Seattle has become famous as the hospital in America that has most dramatically endorsed the Toyota Lean Production System. The senior administrative and medical team, led by CEO Dr. Gary Kaplan, started the process with a visit to Japan and then designed a hospital-wide program to bring greater efficiency to many aspects of the institution's operations. They entitled their program the Virginia Mason Production System and made significant improvements in many aspects of health care delivery.

At BIDMC, we were not prepared to go quite so far as VM, but we did create a small office to test out the heart of the Lean process, Rapid Process Improvement Workshops. In these short-term intense exercises, a team of people from a variety of jobs categories in a given service or production area get together to map out every step in a customer service or production process. Each step is labeled as "value added" on "non-value added", i.e., with regard to accomplishing the objectives of the area, and then the group decides on strategies to eliminate NVA steps. Then, they actually put them into practice to test their efficacy towards meeting goals of service quality and/or efficiency. Other, longer terms plans and objectives are also decided upon and put in place.

One target area for us was our orthopaedic clinic. Like most clinics, there would be check-in, delays waiting to see a doctor, delays waiting for an X-ray, delays waiting to see the doctor again after the X-ray, and so on. In sum, the average time for a clinic visit was about three hours. Is there any doubt as to why there were disgruntled patients, cranky front-desk staff, frustrated X-ray technicians, and angry doctors?

With great support from our Chief of Orthopaedics, a team was assembled, and they went to work, aided by our Lean coordinator and other helpers. The top chart above shows how many NVA steps (the ones with red dots) were in the "before" process, i.e, the "current state". (Observers often find that over 90% of steps in any service or production process are NVA.) The "final state" chart underneath shows the change in relative NVA and VA steps after the Lean review.

The third chart shows the overall improvement in the amount of time a patient has to spend getting that X-ray and physician consult: Down from three hours to about an hour! Let's repeat that. Previous time for a visit -- 187 minutes. Hoped for target by the Lean team after its analysis -- 84 minutes. Actual results -- 6o minutes or less.

Of course, patients were happy. The staff was very pleased, too. Fewer cranky patients at the front desk complaining about long waits. Efficient use of X-ray equipment and Rad Techs' time. And, doctors being able to stay on schedule all day long. And then being able to add additional appointment slots because they knew they could stay on schedule.

The biggest problem: Patients finished their appointments so quickly that their spouses were nowhere to be found. They were still downstairs at the cafe having a cup of coffee, without enough time to read the whole newspaper!