Applying Toyota model to health care

Everyday Innovators has a guest blogger this week, Douglas S. Brown, president of Community Hospitals and chief administrative officer of UMass Memorial Health Care. This blog post appeared as an opinion piece in the Telegram & Gazette on Sunday, December 11, 2016. You can find it here.

brown-dougMy sister-in-law is a master of family logistics. At large family events, she thrives on designing systems that optimize family flow and efficiency. Holiday dinners are a sight to behold, as she creates harmony out of dysfunction. As I have reflected on her mastery, I have discovered strong connections to my day job. Her approach might even portend a solution to our nation’s health care woes.

Last month, I led a group of 15 trustees from my hospital system to visit a health care system in Wisconsin, called ThedaCare. Few in Massachusetts know of ThedaCare. Nor would many in the Commonwealth think of traveling to Wisconsin to learn about improving health care delivery. But ThedaCare is unique. They think like my sister-in-law. Where she designs dinner menus to reduce the number of pans to wash, they design hospital storage closets to reduce needless searching for supplies.

The ThedaCare story began over a decade ago. Leaders asked themselves an interesting question: What if we applied to our healthcare system the very same engineering principles that Toyota used to transform the automobile industry? It was a crazy idea at the time. After all, medicine is an art as well as a science, involving judgment and nuance and emotion. Manufacturing principles could not possibly serve as a model for the delivery of health care services. Or could they?

The method employed by ThedaCare, commonly known as Lean, is about two fundamental principles: respect for people and continuous improvement.

While seemingly simple, these principles have profound implications for how an organization is managed. Respect for people turns the traditional top-down management style on its head. It recognizes that the best ideas come not from senior leaders, but from those on the front line. That is where value is created in an organization. The job of leaders is to develop systems and tools to unleash those ideas. And then get out of the way.

Continuous improvement brings scientific thinking to daily work. It views problems not as things to hide, but as opportunities to celebrate. You cannot fix a problem if you don’t know about it. The approach encourages a deep understanding of the root causes of a problem before rushing to a solution. And it gives frontline caregivers the tools and training to continuously improve their work. They do so largely by eliminating waste – things like unnecessary waiting, redundant tests, and inefficient flow of staff.

The result? Thedacare has become one of the highest quality and lowest cost health systems in the country.

At UMass Memorial, our Lean journey began in earnest about four years ago when Dr. Eric Dickson became CEO. Improvement is in Dickson’s DNA and he has been our relentless champion since taking the helm. It has not always been easy. Leaders must learn a new way to lead, including getting out of their corporate offices to go to the front line where value is created. Frontline caregivers, who are already overburdened, must understand that continuous improvement and elimination of waste may add to their burdens in the short run, but will pay huge dividends down the road.

It has been a tough slog. But we may have reached a tipping point.

We identify ten “true north metrics” to help us know whether we are winning or losing in our journey toward improvement. These are things like the quality of care in our hospitals, the number of patients waiting to get a bed and our financial results, among other well established indicators of success. This past year, for the first time since our journey began, we improved in all ten.

One such metric is the number of frontline ideas we implement. Our goal was to implement one idea for each of our 12,000 employees. We implemented over 15,000, greatly exceeding our goal. Most of them are small – a new sign in a confusing hallway to help guide patients, a vending machine in a waiting area, a care package for homeless patients. Some are large, like installing noise canceling equipment on inpatient floors so that our patients can rest more peacefully. But all of them empower frontline staff and improve the care we deliver. We celebrate this work through “innovation celebrations,” where our highest performing teams are invited to share their creative approaches with staff throughout the organization to promote a culture of learning and continuous improvement. We also set aside $1 million every year for employee teams to apply to fund the bigger ideas.

The quality of our care has measurably improved at all four of our hospitals throughout Central Massachusetts – UMass Memorial Medical Center, UMass Memorial Marlborough Hospital, UMass Memorial Health Alliance Hospital in Leominster, and UMass Memorial Clinton Hospital.

The same is true for the overall experience of our patients, another metric we follow. This is determined through standardized surveys, which ask patients a series of questions about their experience in the hospital. The results are then publicly reported by Medicare. While we still have room for improvement, in the most important question we track – whether a patient would recommend the hospital – our scores improved at each of our four facilities.

We significantly improved patient flow through our hospitals. Our employee engagement scores have increased. And our financial results, the least important measure to us, were among the best in our history. But perhaps most telling of all – organizations across the country are now asking to visit us.

Are we perfect? Far from it. We continue to have significant opportunities for improvement. And we always will. Lean is not about a quest to be the best in order to hang a banner. Better – not best – is what we are after. A little better each day than the day before. That is what we believe will deliver continuously great value to our patients.

Over the coming months, our country will engage once again in a heated debate about the future of health care. Whether to repeal Obamacare, and what to replace it with, will dominate our national conversation. Through all the noise, I will take solace in the knowledge that the holy grail of improvement is not as likely to come from the acts of Congress as it is from observations similar to my sister-in-law’s at a large holiday gathering.



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