Toyota Is Big Streamliner Of Hospitals
The equipment closet for the operating rooms at Los Angeles County Harbor-UCLA Hospital was a mess. Nurses had to maneuver through a maze of wheelchairs, beds, boxes and lights to find the necessary surgical supplies.
As public hospitals like Harbor-UCLA try to cut costs and make patients happier, administrators have turned to an unlikely ally: Toyota. They are adapting the car maker’s production system to healthcare, changing longstanding practices such as how to store equipment, schedule surgeries and discharge patients. The philosophy, known as lean, depends on a continuous team effort to pare inefficiency and improve quality.
With Toyota’s methods as inspiration, the OR staff re-organized the closet, giving everything an assigned location and affixing easy-to-read labels. The result? Nurses and doctors could find what they needed when they needed it. And that meant the OR team could mobilize more quickly.
Private hospitals in places like Seattle and Wisconsin started using Toyota’s system a decade or more ago. But the idea is newer to safety net hospitals — medical centers that historically have served large numbers of poor people. With the Affordable Care Act, these patients are gaining insurance coverage, and safety net hospitals are facing pressure to keep them from going elsewhere for care.
In California and elsewhere, some medical professionals have expressed skepticism that a process used to build cars can be translated into treating patients. Others are put off by the use of Japanese vocabulary in the hospitals’ hallways, such as muda (waste) and jidoka (automation with a human touch). Still others doubt whether the changes are sustainable.
DeAnn McEwen, a health and safety specialist with National Nurses United, said lean management reduces nursing to a series of standardized tasks, as if nurses were robots applying nuts and bolts to identical patients.
“The problem with that is patients, of course, are not widgets and nurses are not robots,” she said.
Research and experience from around the country, however, has shown that using Toyota’s techniques in hospitals has can improve quality and safety for patients, said Kelly Pfeifer, director of high-value care at the California HealthCare Foundation. The foundation helped fund the project at Harbor-UCLA and four San Francisco Bay Area hospitals — San Francisco General Hospital, Contra Costa Regional Medical Center, San Mateo Medical Center and the Alameda Health System.
Changes inspired by the Toyota process had direct, positive results, such as reducing the time patients spent at the hospital and decreasing medication errors, according to the foundation. They also saved money. For example, reducing surgery cancellations at the San Mateo hospital saved nearly $500,000, the foundation said.
Harbor-UCLA happens to be just a few miles from Toyota’s U.S. sales headquarters in Torrance. After approaching the automaker for help, Harbor opened an office in 2013 dedicated to kaizen, the Japanese word for continuous improvement and a main tenet of the auto company’s philosophy.
Toshi Kitamura, a Toyota advisor, said he sees natural parallels between auto production and patient care. Organizing the equipment rooms and supply cabinets is the perfect example, he said.
“There was a clear translation,” he said. “Just as in the hospital environment, in our environment … we need to make sure we have all the tools and materials we need and we need to be able to find them quickly.”
Unlike in a car plant, however, Kitamura said saving time can spare people pain and even save their lives.
At Harbor-UCLA, the effort started with an overhaul of the outpatient eye clinic. Administrators there said some patients were going blind while waiting for surgeries to be scheduled. And during clinic visits, some had to have their eyes dilated twice because they waited so long to see a doctor.
Working with Toyota, staff members picked up the pace: They created a system of color-coded folders so it became clear what patients were there for and who they needed to see. They stopped sending patients back and forth to the waiting room during their visits. They put a locked box in each exam room with prescription pads and other medications so doctors could spend more time with patients and less fetching what they needed to treat them.
Within several months, staffers doubled the average number of new patients seen each day. In addition, the time patients spent at the clinic dropped from 4 ½ hours to just over two. Surgeries also got scheduled more quickly.
Antonio Camargo, 49, a patient at the eye clinic, said he waited months for his first surgery, a corneal transplant. But recently, when he needed another operation, he had it within days. “It was a long process before,” he said. “Now it’s better.”
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
