「華人戴明學院」是戴明哲學的學習共同體 ,致力於淵博型智識系統的研究、推廣和運用。 The purpose of this blog is to advance the ideas and ideals of W. Edwards Deming.

2011年3月1日 星期二

一篇醫療業的"應用": Henry Ford applies lean principles to lab work


Last Updated: March 01. 2011 9:27AM

Henry Ford looks to auto industry for lab efficiency:Henry Ford applies lean principles to lab work

Christine Tierney and Melissa Burden / The Detroit News

With hundreds of technicians handling daily more than 31,000 tests of blood and tissue samples in glass tubes, slides and plastic cups, the laboratories of the Henry Ford Health System aren't that different from the car factories conceived by automotive pioneer Henry Ford.

Like auto assembly plants, labs process vast amounts of inputs and materials under intense pressure to keep down costs, minimize delays and limit errors.


In hospital labs, the stakes are even higher. "A single failure can have catastrophic results for a patient," said Richard Zarbo, chairman of pathology and laboratory medicine at the Henry Ford Health System, which includes five hospitals in Metro Detroit.

Over the past six years, Zarbo has adopted some of the best practices from manufacturing industries — particularly from the auto industry — to achieve remarkable gains in efficiency and turnaround times that have drawn national attention. For patients, the improvements mean faster diagnoses and treatment.

While the U.S. health care debate focused a spotlight on the country's soaring medical costs, America's hospitals also are struggling to reduce tens of thousands of patient deaths annually caused by hospital errors.

Zarbo, who joined Henry Ford Health System in 1987 as a surgical pathologist, was exposed early in his career to the ideas of W. Edwards Deming, a quality consultant whose principles had been adopted by Toyota Motor Corp. as it developed the Toyota Production System, also called Toyota Way.

Having risen to head of pathology, Zarbo sensed the inefficiency as he walked through labs and saw "carts and containers piled everywhere with blood and tissue samples to be tested," he wrote in a first-person account in a book coming out in April.

"Every one of the samples in these large coolers came from a patient who was waiting to know his fate and a doctor who was waiting to decide how to treat the patient."

Ralph G. Benitez, a lab supervisor, recalled workers sitting around waiting for large batches of specimens to arrive and be processed. "We no longer see that and that's a great thing," he said. They now come more frequently in small batches.

Deming's philosophy and the Toyota Way both emphasize and rely on employee input to streamline processes so that inefficiencies or problems can be fixed immediately. Henry Ford himself also had astute observations on quality and efficiency.

"You put all those together and we are able to put together something that works in health care, and we call it the Henry Ford Production System," Zarbo said in an interview.

The changes and improvements are often simple — color-coding tissue samples to indicate the priority level, or hanging a white board on a wall where technicians or workers can jot down types of errors and likely causes — without assigning blame.

Dramatic improvements

The improvements have been dramatic at Zarbo's labs — a $565 million operation within the Henry Ford Health System that employs 785 people handling 11.5 million tests a year for 30 clinics.

Between July 2006 and August 2007, the number of misidentified samples — tissues labeled with the wrong patient's name, for instance — declined 62 percent. The hospital said lab errors that harm patients are extremely rare.

"It's a lot more organized," said Jennifer Negron, 27, of Southgate, a lab assistant who registers specimens.

Test results are processed faster, and wasteful procedures have been eliminated. From the first step, taking a sample from a patient, until the doctor receives a diagnosis, the process has been cut to 24 steps from 35.

"The numbers they've been able to achieve are world-class," said Jeffrey Liker, a professor at the University of Michigan and an expert on Toyota.

"They've gotten to such a low level of errors, and the turnaround time — from the time the test is taken to when the results are sent back to the doctor — is almost always within the same day."

The improvements don't reflect one particular change, Liker said. "It's hundreds, maybe thousands of things they've done over five years, and everyone's involved."

In his book coming out in April, "The Toyota Way to Continuous Improvement," Liker has a chapter on Zarbo's work at the Henry Ford Health System.

Now, John Popovich, CEO of Henry Ford Hospital, is seeking ways to drive out waste throughout the hospital system.

Last fall, he and Zarbo attended a two-day workshop in Grand Rapids sponsored by the Toyota Production System Support Center Inc., an Erlanger, Ky.-based company within Toyota.

Initially established to assist suppliers, it now helps other businesses and institutions to apply Toyota Way methods. In addition to hospitals, customers include other manufacturers, food services companies and schools.

'Look for the flow'

St. Joseph's Healthcare Hamilton hospital in Ontario became a client after Ray Tanguay, one of Toyota's highest-ranking North American executives, took his wife to its emergency room on Christmas Eve 2008.

During a two-hour wait, Tanguay watched as doctors selected batches of folders, and the patients corresponding to those folders were put in rooms where they waited to be treated.

"Whenever I go to a place, I always look for the flow. That's what the Toyota production system teaches," Tanguay said. "The flow wasn't that great."

He called the hospital's chief executive, Kevin Smith, and offered to put him in touch with the Toyota Production System Support Center. Smith took his offer.

Three employees from Toyota's auto plant in nearby Cambridge and a Toyota production center specialist spent months working with doctors, nurses and other staff at the hospital.

They knew there was a problem. The province of Ontario was pressing hospitals to speed up treatment and get patients in and out of emergency rooms within four hours. The average wait at St. Joe's was considerably longer. Administrators were mulling installing a new computer system or adding waiting rooms.

In the end, the emergency room set up a control board that would hold the patients' folders, slotted at the time they arrived. Made in a garage using two pieces of plywood, the board helped change how the flow was managed and the work was allocated.

The turnaround time for emergency room patients — from arrival to discharge for those not being admitted to the hospital — was cut in a year to 3.8 hours. It had ranged from six to seven hours for the majority of cases.

Not all aspects lend themselves to the Toyota Production System, Smith said. "What can't be lost as we improve efficiency is that the patients feel they're getting the time they need."

Still, he said, in laboratory, diagnostic and other "high-volume, high-throughput operations," the Toyota Production System can be very beneficial

Detroit News Staff Writer Christina Rogers contributed.