Until their most recent quality stumbles, Toyota’s production techniques were the darlings of the management consulting world. The Toyota process is embodied by the concept of kaizen, a Japanese notion of continuous improvement. The latest gurus have even applied the production techniques to the health care arena (see Designed to Adapt). A Health Affairs article by John Toussaint (2009) shows how Wisconsin has used Toyota-style production techniques to improve quality.
Some of the problems an improved production process could solve include:
- A large fraction of steps in the health care process have no apparent value for the patient. Touissaint estimates that this figure is currently 90%-95%.
- A lack of trust of less-qualified peers. Cardiologists often do not trust ED physicians to accurately diagnose a heart attack, resulting in a repetitious diagnosis process.
- Most physicians are “…more loyal to their specialty than to the team with whom they work every day.”
Some of the solutions the Toyota production system offers include:
- Decreasing wasted time can increase quality. “In 2002, for instance, our morality rate for coronary bypass surgery was nearly 4 percent. After several kaizen projects in this area, typically removing 40 percent of the waste each time, mortality dropped to 1.4 percent in 2008 and has been 0 percent through six months of 2009.”
- Making medical care more collaborative can improve care. For instance, in one hospital’s Collaborative Care wing, the nurse owns the care process. “The nurse remains in contact with the doctor but does not wait for instruction. Often, it is the nurse who instructs the physicians about a needed step or a critical time in the patient’s care.”
This quality improvements are sound good on paper, but take serious efforts to implement in practice. In addition, current insurance payment schemes are not conducive to collaborative care. Touissaint claims that Medicare pays $2,000 less per patient on average in Collaborative Care than in a traditional medical wing.
- Source: John Toussaint (2009) “Writing The New Playbook For U.S. Health Care: Lessons From Wisconsin,” Health Affairs, 28(5):1343-1350.