Assembly line efficiency
The image of patients sitting on a conveyor belt and being whisked through a hospital like widgets on an industrial assembly line might seem comical to some people, but it is serious business at Virginia Mason Medical Center in Seattle. No, this facility's patients aren't actually put on a conveyor belt, and they certainly aren't treated as impersonally as a machine part might be. In fact, when patients realize this “assembly line” strategy shaves hours off their time spent at the hospital, they practically do handsprings down the hall.
The inspiration for this system? Toyota Motor Corporation. “When you think of Toyota's production system, you think of high customer satisfaction, a low number of defects, and stable financial performance,” says Todd Johnson, vice-president of facilities at Virginia Mason. “Those are the things we wanted in healthcare, to identify and eliminate waste and defects in all of our systems to achieve better care for patients.”
The concept was delivered to Virginia Mason by Gary S. Kaplan, MD, the hospital's chairman and CEO, and J. Michael Rona, president, who made trips to Japan to study under Chihiro Nakao, an expert in the Japanese management concept of Kaizen, which emphasizes quality, effort, involvement of all employees, willingness to change, and communication.
Although this new concept has been applied throughout the hospital, it is especially apparent in the new Floyd & Delores Jones Cancer Institute. The distance that patients travel for treatment has been minimized because the services are now brought to them. Offices are adjacent to treatment rooms, which also serve as exam rooms. Every service used to deliver care is centralized.
“In the old configuration, patients would come in, visit a physician on the 14th floor, then go to the 6th floor for a blood draw, then to the 12th floor for infusion therapy, then to the basement of a different building for radiation therapy, then back up to the provider,” says Johnson. “It was almost a mile that very sick patients traveled. Now, it's just a matter of steps.”
Patients had also previously wasted a lot of time waiting between stops, and since the distance between stops was so great, they often took time to rest along the way. All of this wasted time has been eliminated. For instance, blood draws used to be done on the 6th floor, where an employee would have to pick up the sample and deliver it to the 12th floor, wait for it to be analyzed, then return to the 6th floor with results. All told, this took an hour—time that the patient spent waiting. Now, thanks to a pneumatic tube system that connects the cancer facility with the lab, the turnaround time for a CBC blood test is 10 to 15 minutes.
The plan for the cancer institute started as a team effort, involving everyone from doctors to patients. “We started with a team of physician representatives, nurses, an architect, and two cancer patients who modeled the flow that patients follow to get treatment,” says Johnson. “The design evolved from streamlining that flow.”
The team divided into smaller groups and actually built models with toy people that were moved around in the paths they would take to get treatment. During this process, the team was able to uncover bottlenecks and formulate the ultimate floor plan. Most of the treatment and exam rooms are located right off the elevator corridors, so that patients simply come up to the floor, turn right, head to the turnaround area, receive treatment, and leave.
The rooms for patients who must stay all day are dispersed around the floor and have better views than the treatment and exam rooms. Located on the perimeter of the building, these rooms face either south or west and therefore receive a great deal of natural light. Two patient rooms share one toilet. Each contains a small refrigerator and all the necessary medical gasses. They also feature attractive sink counter units and wood-grain finishes.
The physicians in a number of the clinics share offices, but Johnson says they're more than happy with the arrangement. “They've found it's a good thing because they can collaborate more effectively and don't have to hunt each other down,” he says. “And they don't spend much time in their offices anyway.”
Initially, it was the MDs, Johnson says, who, when presented with the Kaizen model of efficiency represented by Toyota, said, “We're not making cars here, we're caring for people.” “But that was all the more reason we wanted to produce a defect-free product,” he says. “This was a new concept, and one that the medical schools didn't teach. But when the MDs saw that we were going after waste and not simply a value-added process, they found it liberating. They could spend more time with patients and not work so hard.”
The enhanced aesthetics of the new cancer center have turned heads at the hospital, according to Johnson, with employees on other floors asking, “When is our floor going to be remodeled?” Features include wood paneling, ceilings with recessed lighting, wood-grain flooring, waterwalls, original artwork, and a color palette that's bright and warm because, Johnson says, “We're in Seattle and we have a lot of gray days.” A cyber café and a patient/family reference center and waiting area were also added.
This new approach to patient care at Virginia Mason initially has been deemed a success after, according to officials, saving $6 million in planned capital investment and freeing 13,000 square feet of space. In addition, Virginia Mason has cut inventory costs by $360,000 by using the concepts of just-in-time delivery. By working with its suppliers and distribution vendor, the facility can have more frequent deliveries of materials in smaller quantities. Virginia Mason has also used consignment approaches in the Cancer Institute, meaning the facility does not have to pay for inventory, such as expensive oncology drugs, that simply sit and await use. There are essentially zero Virgina Mason Medical Center dollars in inventory in the Cancer Institute because the vendor owns the inventory until the point of consumption.
Other benefits include a 34-miles-per-day reduction in staff walking distance. This is the result of having “one stop” for the patients, all services consolidated on one floor, and the efficiencies in the room arrangement. The facility has also reduced bill collection times in some instances by 99% by eliminating defects and non-value-added activity. For example, for claims that have been billed but not yet paid, Virginia Mason has an efficient electronic spreadsheet tool designed with the help of its partner, Premera Blue Cross, meaning no more copying and mailing of hard copies. Infection rates have also been slashed. It remains to be seen whether these benefits will stand the test of time, but the prospects look good, according to Johnson.
“For it to work, we need the commitment of the entire organization. We have that here, and that's the foundation for the whole thing,” Johnson says. “Some organizations might take a little time to build that, but Virginia Mason has a sense of urgency to eliminate waste and defects to create a safer environment and more sound financial performance. Many institutions are delivering suboptimal financial performance that might threaten their future, and that, to me, should create a sense of urgency.” HD
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