To Better Protect Patients, Health Care Needs More ‘Lean Thinking’

As the Supreme Court debates the fate of “Obama Care,” we should recall the formal name of the law: the Patient Protection and Affordable Care Act (PPACA). Most of the public debate has been about the cost of health care, losing sight of the urgent need to fix the ongoing crisis of quality and patient safety. More health care organizations need to adopt the lean management philosophy to “bend the cost curve” and save lives, as some innovators have proven during the last 10 years.

The most highly touted aspects of the PPACA include attempts to protect patients by increasing their access to health insurance. A 2009 Harvard Medical School study estimated that 45,000 Americans die each year due to a lack of coverage. Even if patients can get appointments or get admitted to a hospital, there are dangers that are underappreciated by the public. The Department of Health and Human Services reported, in 2008, that 80,000 Medicare patients die each year due to preventable medical errors. Other studies estimate that 90,000 patients are killed annually by hospital-acquired infections. Ironically, we are granting easier access to a very dangerous system.

The good news is that the system need not be dangerous, and some hospitals are demonstrating that patient safety and health care can be dramatically improved while simultaneously reducing costs. Health care organizations like the Cleveland Clinic and Florida Hospital have worked to learn and adapt lean process improvement and management systems based on the famed Toyota Production System.

Another such system, ThedaCare, in Wisconsin, has results that we should all hope to duplicate. For example, patients with chest pain are better protected by more timely treatment for their heart attacks (waiting just 45 minutes compared to 91 minutes in 2005). As they say, “time is muscle,” and the faster care saves lives and reduces damage to patients’ hearts—which speeds recovery times and reduces treatment costs.

To get these results, staff members study the way care is provided, and they are fully engaged in fixing processes. Improvements include weeklong “rapid improvement events” and a method called “continuous daily improvement.” ThedaCare has demonstrated gains in patient access, quality and safety, and cost in areas ranging from cardiac surgery care, outpatient orthopedics, inpatient, and primary care.

Dr. Richard Shannon, of the University of Pennsylvania, has led efforts to reduce certain types of deadly hospital infections by 90 percent. Beyond the benefit to patients, the hospital saves millions each year. The hospital stay for patients who would have previously gotten infections has also been reduced, freeing up beds for other patients. Reducing infections is a far more affordable way to create bed space compared to the construction of a new hospital tower.

Hospitals using the lean methodology have everybody working together to reduce waste that otherwise consumes the days of harried nurses and staff, such as running around searching for supplies, equipment, and information. While some might say the hospitals are understaffed, it’s often not realistic to increase costs by hiring more people (if you can even find them, given the shortages of key medical professionals). The smarter approach is to free up staff time through process improvement, as Shannon frees up beds at the University of Pennsylvania. Lean hospitals have more time for patient care, so patient satisfaction and health outcomes improve.

Hospital leaders must realize that, despite all the strengths and talents of their organizations, we can’t solve problems by using the same kind of thinking we used when we created them. It’s time to reach out to quality and safety leaders in other industries, including aviation and manufacturing. It’s easy to shun these proven methods by saying, “We are different.” Yes, health care is different. Lives are on the line, and families are shattered when a preventable medical error kills a patient. That’s all the more reason to adapt, spread, and share what works: a lean management system.

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