Toyota’s Lean Approach Might Be Beneficial to Medical Procedures

In study, ‘turbo’ surgical theaters increased patient turnover by one-third

Published: Friday, December 16, 2011 - 12:07

Japanese vehicle manufacturer, Toyota, is well-known for developing the principles of lean manufacturing. Research published in the International Journal of Technology Management suggests that the lean approach might also be beneficial to medical procedures, making hospitals more efficient and cutting waiting lists.

Management engineer Kasper Edwards of the Technical University of Denmark in Lyngby and colleagues first reviewed the research literature on lean practices. Lean manufacturing based on the Toyota Production System is founded on the idea of “preserving value with less work.” It is perhaps the natural extension of the Ford Motor Co.’s original production line approach and involves avoiding any expenditure or costs that do not create value for the end customer. From the consumer perspective, this means offering products or services at a price the customer is willing to pay.

The team hoped to discover whether the same values of lean, value, and efficiency might be applied to health care systems. The research demonstrates that within the Danish public health-care system, “lean” can work very effectively for some parts of health care provision, such as surgical wards, but not necessarily for others. Lean could thus help address not only the problem of financial constraints on public-health services, but also help hospitals cope with the lack of doctors, nurses, and health care professionals in general.

The researchers point out that until recently, lean projects in health care have focused only on peripheral activities to improve patient flow through wards and reduce turnover times. Numerous hospitals have implemented lean in these contexts with varying degrees of success. Likewise, administrative procedures have also benefited from a lean approach.

The team has now studied the case of a major hospital outside Copenhagen with 200 employees and 10 operating rooms. Surgery was split into two streams: one following normal procedures, the other running “lean” for elective operations. Ultimately, the program was initiated to create more effective working procedures and ensure a total continuity of care to the benefit of both staff and patients in the light of absenteeism and morale problems at the hospital.

As part of the lean approach, two “turbo” rooms were to be staffed only by senior employees, and were set up to carry out only elective and routine surgical procedures, and have no educational functions. Teamwork was also encouraged with a fixed team in which, for instance, the anaesthetist might assist the surgeon by holding a patient’s arm when required.

The results were overwhelming. “What was previously done in three operating rooms can now be done in two, and the teams are finished within their shift,” says Edwards and colleagues. This has had a significant effect on employee morale. It has increased patient turnover by one-third and eliminated patients having to wait for routine procedures carried out in the turbo rooms.

The researchers point out that for the remaining operating theaters at the hospital that were not made lean, there has been no change other than having fewer, efficient senior staff available. Staff morale in the nonlean rooms may be somewhat compromised, which highlights the need to further investigate the lean approach to surgery and the benefits to its patients, and to consider the overall impact on a hospital should lean be implemented only in certain areas. Lean works in health care, but mixing lean and normal-mode surgery in the same ward is not recommended, the team adds.

Source: International Journal of Technology Management

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