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The customer is king // Making a list and checking it twice is key // A Six Sigma black belt is crucial // And other industry philosophies that inspire better, more efficient patient care.

Borrowing From the Best

By Rebecca McReynolds // Summer 2007
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For most hospital administrators and physicians, good medicine almost always trumps good management. And if that means that too many health organizations are still wed to paper records, that patients are treated brusquely and that an overnight hospital stay is hellish—well, when lives are at stake, smooth-as-butter operations and you’re-the-boss customer service sometimes have to go by the boards.

Increasingly, though, medical consumers seem weary of those tradeoffs. They value medical excellence—in fact, they want to measure it, clamoring for report cards for doctors and hospitals. But now patients expect effective management too. And health care providers, facing ever more scrutiny, need to deliver top-notch service and care in equal measures. Trouble is, most don’t know how.

As a start, maybe they can borrow from the best. A growing cadre of hospitals and medical groups, thinking outside the box of their own walls, have been adopting and adapting other organizations’ management concepts. That has helped streamline operations, improve patient safety and satisfaction, and cut millions from the groups’ budgets. New York–Presbyterian Hospital, for example, has trained more than 200 doctors, nurses and administrators in Motorola’s pioneering Six Sigma management system. Today these “black belts” do nothing but look for ways to make the hospital run better—and they’ve saved an estimated $65 million in the bargain.

Whether they are studying Toyota’s assembly line, the Navy’s submarines or Filene’s mystery shoppers, medical organizations are finding inspiration that helps bridge the gap between medicine and management. Hospitals and doctor groups may owe it to their patients to borrow often and well. 

The Toyota Production System

Courtesy Toyota

Although assembly-line medicine was hardly the goal at Virginia Mason Medical Center, the Seattle hospital admired the efficiency of Toyota, which uses these customized kits of car parts, one per vehicle, to make sure everything is at hand so assembly workers can focus on quality. Virginia Mason sent physicians and administrators to Japan for a crash course in the Toyota Production System, also known as lean manufacturing, which was developed after WWII to eliminate mistakes, reduce waste and empower frontline staff to institute improvements. On the production line, the hospital staff learned how to deconstruct every job into specific tasks, determine the most efficient way to complete each one and, finally, redesign the process so that each step could be reproduced by whoever was doing the job.

Consider the hospital’s new Center for Hyperbaric Medicine. Before construction began on the building that was to house the center, the staff broke down each step of the treatment—from registering incoming patients to evaluating the results—into individual tasks and set quality-control targets for everything: how quickly charts were processed; whether supplies were where they were needed when they were needed; even how far technicians would have to walk between treatment areas. By mapping out a new system for moving patients through the center, managers discovered that a new building was unnecessary because there was enough space in the existing facility. That cut about $2 million in construction costs, and greater efficiencies meant more patients could be treated simultaneously, increasing revenue and eliminating patient waiting time. And with the hyperbaric center inside the hospital instead of in a remote building, there’s no need to transport patients—a change that meant another $55,000 in annual savings.

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