What Toyota Can Teach The Healthcare Industry
from the lean-meat dept
The healthcare industry has all kinds of challenges ahead of it, but at the core of its problems is the matter of cost. If the industry were able to bring costs down across the board, many other problems would fall by the wayside. The Wall Street Journal has an interesting article about hospitals, and how they're increasingly turning to experts from outside of the industry (via Evolving Excellence) to produce better results. In particular, hospitals are hiring manufacturing experts that are familiar with defect reduction and 'just in time' logistics. Naturally, there are some skeptics that don't believe that a hospital is like a factory, and who feel that patients shouldn't be treated like a widget on an assembly line. But it's hard to imagine anything more anti-patient than a high defect rate coupled with long waiting periods. Changes in the healthcare industry have been hard to come by, in part because people don't like to think of it as just another business. But in order to bring about change, providers will have to keep borrowing from what's works elsewhere.
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An interesting idea
The idea certainly has merit, and having studied lean systems in college, I've been intrigued by it. The only caveat I would mention, based on my experience is that these initiatives have a tendency of going too far.
The biggest problem with lean is their relative fragility and lack of slack. The hospital enironment is unfortunately a terribly chaotic and rapidly changing one. Our facility more than once found itself on the wrong end of the guessing game about how much extra capacity in machines, workers, or supplies we would need. This was often not out of incompetence but the incredibly random nature of patient care. taking lean thinking too far could cripple many critical systems, such as ER's, high risk surgical units, and emergency measures, that in the hospital system, tend to require a lot of wiggle room when it comes to a crisis.
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you also cannot fix healthcare when its not ok for a hospital to be "for profit" while drug companies, insurance companies, medical supply companies, doctors all make insane profits.
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Re:
There is not a single ER in the country, in my opinion, that will ever, under any circumstances, be able to operate profitably. the nature of the medical cases seen in these settings, the clientele they see, creates a system where money inherently gets flushed down the toilet quite often. Yet few people would dispassionately argue that hospitals should make the business sensible decision of dumping their emergency departments to reduce costs.
Your comment automatically assumes that hospitals are choosing to run themselves in an unefficient and fiscally irresponsible manner. I'll be the first to admit that sort of thing does happen. If I had a dime for the number of times we had bite significant costs to stock some exotic part obody made for a machine that one doctor in the entire facility used, I'd be a rich man. But on the whole we do try to provide efficient care, and spend the money we have wisely.
My real point here is, look to the community around you and the rest of the health care system before assigning the entirety of the blame for fiscal problems on a hospital. Asking hospitals to behave like a business ignores the reality that communties and the current health care system expect them not to act that way.
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JIT
Few critical care patients, however, can wait for a few hours for needed medicines or equipment.
And there's always traffic accidents, train derailments, and industrial accidents that can spike things in a hurry.
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JIT Deaths
Men are most likely to die at 2pm, women are most likely to die at 11am. White boys who die at 8am are the most likely to have their organs harvested of any demographic group.
Old people are far more likely to die in the winter, while children die year-round. Girl babies tend to undergo Sudden Infant Death Syndrome in the winter, while boy babies tend to die all year round.
Can you tell I love my job?
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Interstate JIT Organ Traffic
Overall, deaths occur most often in the afternoon. Sunday afternoon has the highest spike, which then has falling spikes for the rest of the week.
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Its the Bureaucracy (private health care system)
My anecdotal opinion is that "money" has lost its economic meaning in the health care system. To explain, the health care system is funded through many individuals contributing to various health plans, these plans have many layers of bureaucracy to provide "oversight" and each layer takes its cut of the revenue stream. I often have wondered how much a doctor actually gets in net revenue for a patient office visit after factoring out the costs of malpractice insurance and the processing of medical claims. If medical insurance where to be abolished we might see a re-emergence of free market operations at hospitals. (A major problem of course, what happens when you have a catastrophic medical issue.)
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Re: Its the Bureaucracy (private health care syste
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Re: Re: Its the Bureaucracy (private health care s
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Re: Re: Re: Its the Bureaucracy (private health ca
However, high school graduates can be "certified anesthesiologists" or "certified heart surgery technicians".
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jit
As an engineering and management professional, I am a big advocate of defect reduction efforts, focus on customer (read patient) requirements and outcomes. There are certainly some JIT efforts that would help hospitals, but as has been noted, it comes down to how responsive the JIT system is to spikes. Perhaps there is a balance between stock-'em-up and lean-and-mean. Perhaps some standardization would pay off.
Health care is one of the most difficult delivery systems I can imagine. I have had great experiences as well as the requisite number of frustrations with the system.
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Lean thinking isn't all about manufacturing/JIT
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Efficiency
No, thanks.
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Is this really a "sensible" discussion
The health care system sucks, unless you're rich or in a public union. JIT supplies won't fix that.
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Re: Is this really a "sensible" discussion
Nor is there any of this "global competitiveness" nonsense at hospitals -- high school graduates have lifetime employment, and rarely take the heat for malpractice. MD's and student nurses are shown the door if they screw up more than once. There is no threat from foreign workers, since patients don't want foreign idiots taking care of them. They are hired only as a last resort when there aren't enough high school graduates.
Every law of economics that you can think of is turned upside down in the health care industry. Many business types have gone into the health care business thinking they can improve efficiency, but walked away frustrated. Countries that force the health care system to have low costs for patients suffer from lower quality treatment and severe personnel shortages.
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Make no Mistake
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Toyota & Healthcare Industry
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JIT in the NHS
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And they should, as long as they are providing necessary goods and services. But if they are not, then cut them out of the picture.
Guess who should be cut out.
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.
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You guessed the insurance companies? Good for you.
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It mgith be worth noting
Our hospital was a pretty typical example. We still stockpiled medicine and supplies. I was talking with a pharmacy tech who told me we probably had at least 2 weeks worth morphine level pain medication stockpiled. (She was explaining why security in the pharmacy was so strict, honestly!) The very nature of manufacturing processes and distribution for many medicines on large scale tends to work against any type of JIT delivery. (Most medicine are still batch produced due to scaling and logistical concerns)
Our hospital's form of JIT was basically stockpiling the components of medicines, and only mixing them up and delivering them as they are needed by the patients.
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JIT IN HEALTHCARE
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