Matthew W. Mell, Sridhar B. Seshadri, Tarina Kwong, Ronald L. Dalman
Surgery, Stanford University, Stanford, CA.
OBJECTIVES: Toyota Production System (TPS) methods have been advocated for use in medical settings. We sought to improve operational efficiency in the vascular clinic and vascular laboratory by instituting these lean management principles.
METHODS: To operationalize rapid change, the TPS principles were introduced and implemented with our management and entire clinic and lab staff. These principles included value stream mapping, 5-S, standard work and continuous improvement processes. The desired changes were evaluated after 6 months using appointment availability, clinic and lab volumes, patient satisfaction and employee engagement metrics as the outcomes variables.
RESULTS: Over the study period, clinic visits increased by 7% (383 to 410 visits per month), while new patient visits increased by 15% without increasing staff support. Improved efficiency resulted in an increase in available vascular lab appointments by 29% without extending work hours. Coordination with the clinic appointments also improved: total lead time for those with dual appointments decreased by 56% (126 minutes to 55 minutes), proportion of lab visit starting late decreased by 72%, and lab visits ending after scheduled start of clinic appointment decreased from 50% to 18%. Even with increased clinic volumes, employee job engagement improved (score 93 vs. 55, p<0.0001) and patient satisfaction was maintained (score 91.3 vs. 93.1. p=0.14).
CONCLUSIONS: Adoption of TPS management strategies can rapidly improve patient care processes. Implementing programs that increase efficiency in delivering healthcare without increasing costs will become more paramount as health care dollars become scarcer.
AUTHOR DISCLOSURES: R. L. Dalman: Nothing to disclose; T. Kwong: Nothing to disclose; M. W. Mell: Nothing to disclose; S. B. Seshadri: Nothing to disclose.
Posted April 2013