What could a manufacturing philosophy concocted by a car maker have to offer a beleaguered emergency department staff? More than you would expect.
“Lean manufacturing” is a method used in the 1960s and 1970s by Toyota to improve quality on its assembly lines. The idea was to empower all the workers to have the authority and confidence to stop the line and address quality and efficiency issues. In the decades since, it’s made its way to other industries beyond manufacturing, including software development.
When Amir Dan Rubin, MHSA, MBA, came on board four years ago as president and CEO of Stanford Hospitals and Clinics, he brought the lean management mentality with him.
Marlena Kane, MPH, executive director for performance excellence & medicine services at Stanford Hospital described the process as “looking at things from the patient’s perspective and getting people to talk to each other.”
The hospital’s emergency department implemented the lean methodology, and a year later, wait times dropped dramatically and patient satisfaction shot up. Kane, along with David Pickham, PhD, director of research at Stanford Hospital, and their colleagues reported their experience in a paper in the Journal of Nursing Administration last month. And Rubin spoke about the changes they’ve implemented at this year’s Medicine X conference.
The median length of stay in the ED fell by 17 percent, despite a 7 percent increase in patients. And there was virtually no increase in the cost of running the department. “We all want the same thing, to take care of patients well,” Kane said.
The main change the department made was to teach front-line staff to solve problems as they cropped up. Those front-line staffers were able to have discussions with other groups when they noticed inefficiencies or slow-downs. This required several teams to work together to find solutions – from nurses and residents to transporters, housekeepers and translator services.
Training the teams on the new approach was no small feat. For the day-long trainings, additional staff had to be called in to back-fill staff members who would be away from the emergency department.
She pointed out that the lean approach has to have leadership buy-in and commitment to work. “You have to start with the executive team,” she said. “They have to be invested and give time to let staff do it. It can’t be grass roots.” When the lean approach fails at an organization, it’s often because the leadership team isn’t fully invested in the process.
Kane noted that handing the power to solve problems to front-liners frees up leadership staff to tackle long-term problems. “If we keep solving problems for our teams, they won’t be empowered,” she said. “We are always fire-fighting, not thinking strategically.”
Previously: Speed it up: Two programs help reduce length of stay for emergency-room visitors, Stanford’s “time banking” program helps emergency room physicians avoid burnout, and An emergency medicine physician’s take on honoring your emotions
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