Spring Cleaning--The Bright Side

“Do you remember, Curmudge, that our most recent “Spring Cleaning” posting sounded as if health care was burdened by a host of intractable problems?” 

“Of course I recall, Julie.  That was the one that ended with aircraft carriers being run by 19-year olds.  Then I became distracted and talked about L.A.M.E., LEO, and Lean pretenders.  Sorry about that, but perhaps a senior citizen’s thought processes are sequential distractions separated by momentary profound insights.”

“If you say so, Curmudge.  So now let’s talk about the bright side of Lean in health care.  Books have been written about the Lean success stories in Seattle, Pittsburgh, and the other side of Appleton (1-3).  These show the value of being an early adopter and demonstrate that substantial improvements are feasible.  And there’s also the new book by Bisognano and Kenney, Pursuing the Triple Aim, which describes progress in seeking the best care for the whole population at the lowest price (4).”

  

“To stay on top of progress in the health care universe, one must be an avid reader of blogs and then follow your inquisitive mouse through inviting links.  Sometimes it’s like opening a closed door to reveal a Shangri-La on the other side.”

“So all the time I thought you were sitting at your desk, your head was actually in a mythical Himalayan paradise.  Please tell me some of what you have found on your electronic journeys.”

“I started on the IHI (Institute for Healthcare Improvement) website and ended at a New York Times editorial.  It mentioned improvements at Virginia Mason Medical Center such as using a checklist to justify (and reduce) CTs and MRIs.  Cincinnati Children’s Hospital uses computer models to predict the number of ICU beds needed by patients having surgery.  Other institutions have eliminated inefficient processes such as multiple re-entries of the same patient data for scheduling, admitting, discharge and billing.  It’s interesting to read this in everyday English, but the Times never mentioned Lean by name.  Incidentally, as part of the same wander through the Web, I learned that Virginia Mason has its own blog, http://virginiamasonblog.org.”

“Curmudge, had you ever heard of Hunterdon Medical Center in New Jersey?”

“Not before a few weeks ago.  The Wall Street Journal on 6/05/12 ran this article, ‘Behind One Hospital’s Fight Against Deadly Infection.’  Here are some of the things Hunterdon Medical Center did to reduce the incidence of Clostridium difficile and MRSA among patients: sanitizing rooms with ultraviolet light, scrubbing surfaces with bleach and hydrogen peroxide, washing hands with soap containing chlorhexidine, equipping nursing station computers with washable keyboards, and purchasing new equipment to more rapidly identify contaminated surfaces.  As a result, Hunterdon cut its rate of C. diff infections by 79%.”

“Did it ever occur to you, Old Guy, that some of these great accomplishments in health care quality and patient safety might not have been the product of an organized Lean program?”

“Julie, if one is doing the right thing, the name given to the program doesn’t matter.  Quality and safety go hand-in-hand, and they are outcomes of Lean—as are efficiency, waste reduction, and respect for people.  Now, shall we proceed in our search for the bright side of health care?”

“Lead on, Professor.  By the way, I’m surprised that you were not aware of the great things going on at Denver Health until some of our colleagues went there for a visit.”

“The explanation is simple, Julie.  The older one gets, the more he misses.  I understand that Denver Health’s CEO is a Lean zealot, and they focus their rapid improvement events on 16 value streams.  That clearly shows their inspiration by the Toyota Production System.”  

“I suspect that great things that we don’t know about—Lean and other programs—are occurring all across the country.  ‘Lean (June) is busting out all over,’ probably even in Oklahoma.”

“Julie, I find it hard to imagine any hospital’s not embarking on some program to improve their efficiency, safety, and patient experience.  So the good news might be that there are lots of hospitals out there practicing Lean sub rosa, i.e., hiding under the bushes.  The bad news could be that I am totally wrong.”

“It wouldn’t be the first time, Curmudge.”   

“There’s more good news.  In our April 15 posting we mentioned that med students and residents are learning about quality, safety, and patient-centered care in extracurricular instruction.  Paul Levy’s June 14 posting suggests that programs on those themes are proliferating.  Here’s a quote from another posting on June 14: ‘No organization can succeed at continuous improvement without a mechanism for recognizing where it is not doing well or well enough.  Only those hospitals that cherish the opportunity to learn not only from adverse events, but also from near misses, work-arounds, and plain old inefficiencies in the delivery of clinical care will rise to a level of high quality and will maintain that level.’  Although these links don’t describe recent accomplishments, they inform the listeners/readers of what must be done in the near future.”

“So that’s our story; some good news plus a stimulus to keep up the good work.” 

Kaizen Curmudgeon

(1)  Kenney, Charles.  Transforming Health Care: Virginia Mason’s Pursuit of the Perfect Patient Experience. (2010)

(2)  Grunden, Naida.  The Pittsburgh Way to Efficient Healthcare. (2007)

(3)   Toussaint, John and Gerard, Roger.  On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.(2010)

(4)  Bisognano, Maureen, and Kenney, Charles.  Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs. (2012)