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Taking the Toyota approach to brain surgery
08 December 2011
Japanese vehicle manufacturer, Toyota, is well-known for developing the principles of so-called "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 cut 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 Company'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 healthcare systems. Their research demonstrates that within the Danish public healthcare system, "lean" can work very effectively for some parts of healthcare provision, such as surgical wards but not necessarily for others. Lean could thus help address the problem of not only financial constraints on public health services but also help hospitals cope with the problem of a lack of doctors, nurses and healthcare professionals in general.
The researchers point out that until recently, lean projects in healthcare have focused only on peripheral activities to improve patient flow through wards and reduction of 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 ten operating rooms. Surgery was split into two streams: one following normal procedures, the other running "lean" for elective operations. Ultimately, the programme 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 set up that would carry out only elective and routine surgical procedures and would be staffed by only senior employees 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, Edwards and colleagues report: "What was previously done in three operating rooms can now be done in two and the teams are finished within their shift," the researchers explain. This has had a significant effect on employee morale as well as increasing patient turnover by a third and eliminating waiting times for the routine procedures carried out in the turbo rooms.
The researchers point out that for the remaining operating theatres at the hospital that were not made lean, there has been no change other than that there are fewer, efficient senior staff available. Staff morale in the non-lean rooms may be somewhat compromised, which highlights the need to investigate further the benefits for patients of a lean approach to surgery and to consider the overall impact on a hospital should lean be implemented in only certain areas. Lean works in healthcares but mixing lean and normal mode surgery in the same ward is not recommended, the team adds.