This article is adapted from a commentary published in the Minneapolis Star Tribune on June 18, 2005.

Toyota System Helps Patients, Health Care

by David K. Wessner

Skepticism is useful and important when challenging long held, traditional practices. Change should never be made merely for change’s sake. Park Nicollet Health Services’ use of the Toyota Production System (TPS) in health care has generated praise, as well as some skepticism in the press. Recently, a newspaper reporter, when writing about TPS, referred to patients being on a "health care assembly line."

He has a valid point. Many patients, as well as doctors and nurses, may feel that way in the American health care system. The irony is, however, that lessons learned from the "assembly line" will provide more time for doctors and nurses to treat their patients, not less.

This is not conjecture. It’s happening right now at Park Nicollet, one of only a select few medical providers in the United States pioneering the use of the Toyota Production System, also known as "Lean Production," in health care.

Many of you are familiar with the frustration of long waits for doctors’ appointments. In our Endoscopy clinic at Methodist Hospital, where we examine gastrointestinal tracts, we had a significant number of patients waiting for appointments. In an era of reduced resources and rising costs, our challenge was to find ways to improve patient access to the clinic without remodeling or hiring new staff.

We performed a Rapid Process Improvement Workshop (RPIW) in our Endoscopy clinic. RPIWs are the process used in Lean Production to identify waste, develop standard work and improve safety and efficiency. A team of Park Nicollet employees, including doctors, nurses and technicians, spent a week focusing on improving clinic efficiency. Team members used stopwatches to time each step performed in certain procedures. They drew maps outlining the exact movements of patients, staff and equipment through the clinic. They looked for ways to standardize work, including developing a standard supply cart so that doctors and nurses didn’t have to leave their exam rooms to look for supplies. They devised a series of signals using lights to provide visual cues for staff to bring patients into assessment areas at appropriate times. They staggered the starting times of patient appointments with respective doctors to "level the flow" and avoid having waiting rooms that were either too full or empty.

While this process may seem simple, the results are real and meaningful to patients and staff. We are now able to see twice as many patients each day in our Endoscopy clinic. Despite the larger patient load, doctors and nurses report they spend more time with each patient, or the same amount of time. Not less. We’ve achieved similar results in our Cancer Center, Heart Center, Urgent Care and Wound Clinic.

Some of the benefits of Lean are less obvious to patients, but also significant. In our surgery department, we analyzed variation in instrument preferences and developed a list of standard instruments used in surgeries. Standardizing surgical instruments means fewer opportunities for errors, as well as significant cost savings since we now process 40,000 fewer instruments each month.

We’ve performed 85 RPIWs at Park Nicollet, resulting in a savings of $7.5 million in 2004. As a nonprofit health care provider, these savings are reinvested in our system to improve patient care. We also used the savings to lower fees on average to uninsured patients in 2005. As more savings are realized, we are committed to finding other ways to create better value for our patients and community in terms of improved care and lowered prices.

It’s not surprising that the world’s leading system for identifying waste and improving efficiency was developed by an island nation with few natural resources. Japan has always had to find ways to do more with less. This is also the prospect facing American health care. The first of 78 million baby boomers begin reaching retirement age in 2010. When boomers start experiencing the inevitable infirmities of old age, they will place enormous demands on a health care system already strained by high costs, government cutbacks, and restructured or reduced health benefits for employees.

Lean Production, or the Toyota Production System, has been used successfully for over 40 years in Japan. It’s being used effectively by American manufacturing companies. At Park Nicollet, we’re proving its value to patients. The goals of Lean Production are to eliminate waste, reduce costs, and improve quality and safety. These are certainly worthwhile goals to pursue in American health care.

David K. Wessner is President and CEO of Park Nicollet Health Services.