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  • Even surgeons can benefit from quality strategies that world-class manufacturing companies like Toyota have used to streamline business and enhance customer service

Keith Thomas Paige, M.D.
It's true: Patients aren't cars, but that doesn't mean that healthcare practices can't benefit from quality strategies that world-class manufacturing companies like Toyota have used to streamline business and enhance customer service. Keith Thomas Paige, M.D., section head, plastic and reconstructive surgery, Virginia Mason Medical Center, says that the Seattle, Wash., hospital has reaped benefits since applying the Virginia Mason Production System, modeled for healthcare after the Toyota Production System.

"For patients, 'lean' helps create a process that both delivers more value and time spent with patients, as well as greater quality and safety," Dr. Paige says. "For physicians, 'lean' provides a tool they can use to provide greater quality and achieve greater safety. For staff, 'lean' provides processes by which they know what they are supposed to do."

COSMETIC SURGERY SUITED Cosmetic surgery practices—in fact, any surgical specialty that relies on processes and standards—are ideal candidates for "lean thinking," says Joseph Conigliaro, M.D., M.P.H., professor of medicine and health services management at the University of Kentucky, Lexington. Like Virginia Mason, University of Kentucky has developed a management system called UK Health Quality Design. Dr. Conigliaro, who directs the school's Center for Enterprise Quality and Safety, says the two systems are similar in that they take proven best management practices from industry and apply them to healthcare. "When we say a truly 'lean' organization, it is not just how to get your patient from parking their on their way out the door after having their particular surgery. There is a whole long list of things that patient has to go through, and it is how efficiently and safely [you and the staff] get them through that list," Dr. Conigliaro explains.

In applying "lean" principles, doctors' practices and other businesses examine their processes and make improvements by removing waste. Streamlining processes leaves more time for the important parts of what you do, such as talking with, listening to and treating patients, Dr. Paige says.

EYE ALERT For example, visual cues can help make processes more efficient. Dr. Paige and colleagues use inventory control mechanisms—three-by-five index cards placed at the point in the inventory that signals staff to reorder. "Before we run out of an item entirely, a nurse or whoever manages clinical supplies, sees the [card] and orders the supply. They do not constantly have to be checking the inventory. This reduces the inventory you need to have on hand," Dr. Paige says. "Even though we have been seeing the same number of patients, we have been able to reduce the cost of supplies by about 5 percent."

Becoming "lean" means standardizing processes when they are at their best, Dr. Conigliaro says.

"If you could minimize the wasted steps and combine steps in your processes, you could get patients out quicker. You gain from efficiencies, so you might need fewer people to do the same job," Dr. Conigliaro says. "That also improves patient satisfaction. If you have ever had to have surgery, the waiting times are the most infuriating part of getting a procedure. 'Lean' tries to minimize all that."

LEANING FORWARD The real challenge to becoming a "lean" organization, according to Dr. Paige, is human nature's response to change. "People like to do things a certain way and not always the same way. Our culture is set up to embrace continuous improvement and standardize work and changes that will help make healthcare better, faster and more affordable for patients," he says. "Supporting staff and encouraging them to adopt and embrace change is so important to this work."

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