Page 126 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 105

Delos M. Cosgrove, CEO of Cleveland Clinic, was one of the first to make a
serious commitment to putting patients first and measuring that commitment.
“At first,” says Thomas H. Lee, “the new data were available only to insiders;
now they are published, warts and all, on the clinic’s website.”
Seattle’s Virginia Mason Medical Center took the patients first idea to heart
and added a corollary: Physicians and everyone else come second. Instead of
making cancer patients commute all over for care, clinicians come to patient
care rooms filled with natural light.
“These organizations understand that medical knowledge is now too volumi-
nous to be stored in the heads of individual physicians,” says Richard M. J. Bohmer
of Harvard, “and must instead be embedded in protocols and routines.”
Intermountain Healthcare in Utah found that about 70 conditions make up
90% of its caseload. Having protocols for these vital few conditions helps
improve care, outcomes, and turnaround times.

How Is It Possible to Get a Faster Hospital in 5 Days or Less?

It Takes a Team

Health care organizations around the world are guided by the question “What care can
we provide with the resources we have? The question should be reversed: “What resources
are required and how should they be configured for the care we need to provide.”
— Richard M. J. Bohmer

1. Gather a team that believes it’s possible to improve patient flow (e.g., ED
doctor, ED nurses, ED clerk, and ED admissions). Some people just don’t
believe it’s possible; if so, they won’t be useful on the team. Don’t load the
team with skeptics.

2. Prework. Use pedometers to gather travel data about the clinicians. Identify
and collect wait times for patients between steps in treatment.
3. Have a trained facilitator assist the team in identifying the major delays
and unnecessary movement of people or supplies using tools like value
stream mapping and spaghetti diagramming. Have the team identify pos-
sible countermeasures to these problems.
4. Implement the countermeasures and measure results.

• Implement process-oriented improvements immediately
• Move machines or supplies to more convenient locations immediately
• Schedule and manage more complicated changes (e.g., IT systems
changes, hardware changes, etc.)