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.
The collaborative care model would also fail for liability reasons…No physician would take on the added risk of knowing someone without a college degree (like many nurses) and no medical training (as opposed to nursing) was taking decisions…Frankly, this would bother most patients including myself for obvious reasons…Cutting costs by this model is basically another way of saying just give no care at all (after all, most patients survive most things) and it will be cheaper except we will pretend we are by having someone in a uniform play doctor…
I am dubious about that 0% mortality rate. Dont they do emergencies?
Steve
1/ 0% motality rate on six months. Don’t go in this institution for a CABG the next six months because they had only some chance during the first half year; according to the present indications of CABG the population of patients is older riskier than 5 yeras ago, so 0% is difficult to swallow especially for non scheduled cases.
2/ Nurses are able to manage a medical department, consultations is the core of medical practice not the hospitalisation. On the other hand the medical demography will without doubt push for new legal advances in this field. These advances will solve the liability problem.
As a matter of facts I am more impressed by the approach of authors of Innovator’s Prescription than from those of the transfert of TPS to Health care. I mean TPS is a mean to make some marginal changes and IP is a vision which encompasses the tremendous evolution of biology and medicine and the high level of complexity in comparison to industry.