Transforming health care

Our healthcare system is under unprecedented strain. The population is growing and thanks to advances in medicine and improved diet we are living longer; advances in medical technology mean that our expectations for what the NHS can deliver are increasing. But there are financial constraints. Government wants our hospitals to become more efficient – to do more for less, without sacrificing quality of care or patient safety.

It is a big ask.

Those looking for inspiration should take a look at what one hospital in the United States has achieved by applying lessons learned from car manufacturing to the delivery of high quality health care.

In 2002, Virginia Mason Medical Center – a not-for-profit provider with a 336-bed acute hospital in Seattle, Washington – embarked on an ambitious programme to change the way it delivered health care and in the process improve patient safety and quality. It did so by adopting the principles of the Toyota Production System (TPS).

TPS is a philosophy of continuous improvement, with the aim of ‘designing out’ unnecessary processes, removing inconsistency and eliminating waste. The focus is on delivering the best possible product to the customer. Workers are empowered to halt production in order to avoid defects being passed down the line. Every car should come out of the factory fault-free.

While treating patients is obviously not the same as producing cars, delivering health care involves multiple sets of complex processes and in most hospitals these are not standardised. This creates inefficiency and increases the threat to patient safety. Virginia Mason has adapted TPS principles to create VMPS – the Virginia Mason Production System.

Standard practices are applied wherever standardisation will create a safer, higher quality, more efficient process. For example, before VMPS the hospital had 10 surgeons who performed laproscopic surgery. They wanted their instrument trays laid out in 10 different ways. This has now been standardised to a single layout. This eliminates wasteful process, saves time (and money) and reduces the possibility of error – it is easy to see that the correct instruments are in the correct place for every single surgery.

A seemingly obvious change to how supplies are managed – putting the most commonly used items on every ward, removing the need for nurses to walk across the hospital to fetch them – contributed to an overall reduction in staff walking of 60 miles a day and freed up more than 250 hours of time for direct patient care.

When the hospital designed its new cancer centre, it put a pharmacy and a laboratory on-site. This saved patients’ time as they no longer had to visit different departments to have tests and collect medicines. In the cancer centre, treatment comes to the patient.

But perhaps the most arresting development of VMPS is the patient safety alert (PSA) system. Any member of staff can raise a PSA to report an issue that threatens patient safety. If the issue cannot be quickly resolved, the hospital will ‘stop the line’ on the particular treatment until it has been dealt with. Putting the patient first means that staff are actively encouraged to raise PSAs – a significant and transformational cultural shift.

Overall, implementing VMPS has produced impressive financial results:

– $11 million in planned capital investment has been saved by using space more efficiently and freed an estimated 25,000 square feet of space using better space designs.

– Reduced inventory costs by $2 million through supply chain expense reduction and standardisation efforts.

– Reduced premiums for professional liability insurance by 56 percent.

– Reduced expense in overtime and temporary staff by $500,000 in just one year.

But the most important improvements have been in patient care.

– The time it takes to report lab test results to the patient has been reduced by more than 85 percent.

– The breast clinic lead times — from initial patient call to diagnosis — has fallen from three weeks to three days

– Nurses spend more than 90 percent of their time with patients, compared to around 30 percent in most hospitals

– The length of a chemotherapy visit has been reduced from 10 hours to 2 hours

– The number of hours the emergency (A&E) department was closed to new admissions has reduced by 90 percent

Clearly, these improvements were not delivered overnight. Indeed, many of them have been ten years in the making. But by taking an innovative approach and learning lessons from a seemingly unrelated industry Virginia Mason has shown that high quality healthcare can be delivered more efficiently and with better results for patients.


Image with thanks to JD Lasica