This post was created in partnership with Toyota. All opinions expressed in the post are my own and not those of Toyota.
I recently was able to take part in reviewing a film created by Oscar-nominated director Kief Davidson. It documented the experience at a busy eye clinic at Harbor-UCLA hospital. Inefficiencies in their processes were leaving their patients waiting for months for appointments, and subsequently going blind in the process.
Basically, Toyota stepped in and reviewed their processes. Why Toyota, of all companies? Why would a car company step into a hospital and shake things up?
I personally didn’t realize this, but Toyota has something called the Toyota Production System (TPS). It was first developed in the 1940’s and is an integrated social-technical system that utilizes small, continuous improvements to facilitate high quality work. They have been sharing this system with other industries, manufacturers, community organizations, and non-profits because they believe that when good ideas are shared, great things can happen.
Basically, they found something that works and they want people of all industries that can reap the benefits to do so.
So, TPS + a busy eye clinic at Harbor-UCLA hospital = the elimination of a backlog of hundreds, HUNDREDS, of patients. That’s pretty incredible if you ask me.
Check out this video that demonstrates their success.
Doesn’t that make you pumped? I immediately was trying to think of things that could be improved on in my unit and came up with a bunch of practical questions.
Here are my questions and the answers from Susan Black (Chief Improvement Officer) and Dr. Pradeep Prasad (Chief of Ophthalmology) at The UCLA Medical Center about this process.
- Did you see any push back from physicians, patients, or any other member of the health care team before, during, or after the process change?
Change is always difficult especially for physicians and nurses who have grown accustomed to a certain operational flow for years (and sometimes decades). The operational changes we made with Toyota are predicated on identifying high yield solutions, testing the results of those solutions and adjusting based on the test data. As a result, initially, every member of our patient-care team experienced significant changes in their work-flow. Some changes worked, others did not and, initially, the constant change was overwhelming and frustrating for some. We have now reached a more steady-state in our operations and minor changes continue to be made but not on the same scale as the initial interventions. Education was key to keep morale up and everyone dedicated to our end goal: to provide better care for our patients. Toyota did a great job of educating all members of our clinic team (clerks, nurses, physicians, administrators, etc) regarding the TPS philosophy and how it could help us achieve our goals. This big-picture approach helped us move forward when we felt like we were getting stuck in the weeds of operational changes.
2. Were there any changes that you would have liked to implement but were unable to do so? (Due to cost, professional disagreements, etc.)
Overall we were able to implement most of our desired changes since they had more to do with work-flow than capital investment. Part of the challenge, especially in a county-based safety-net hospital setting, is the limitation in terms of financial resources. Could we be even more efficient with a re-designed workspace? Yes. Could IT improvements help with our efficiency? Yes. However these changes take time and money. They are part of our long-term plan and the hospital administration has expressed a commitment to help us realize these goals in the long-term. With that said, it’s been remarkable how much we were able to achieve with almost no capital investment.
3. Was staff of any/all levels involved in the identification of inefficiencies, or did Toyota come in and observe and report their findings?
Yes, literally everyone working in the clinic was involved in identifying areas of improvement. This wasn’t a Toyota consultation. This was a Toyota skills transfer. They educated us on the TPS strategy, guided regarding its implementation, and have now largely left it up to us to continue to improve. This is far more valuable to us as an organization than simply prescribing a fix for our problems.
4. Did your staffing levels change because the efficiency was so drastically changed?
Our clinic volume was already above and beyond our capacity with our old operational flow. Now our clinical activity better matches our workforce capacity.
5. Has there been another follow-up since the creation of the video to see if all changes stuck? If so, how is the unit doing now? What was their average patient throughput pre-intervention and what is it today?
We continue to find ways to improve. A major change for our hospital was the implementation of an electronic medical record system about 1 year ago. This change forced us to rethink some of our workflow and admittedly we took some steps back before moving forward. However, had we not already gone through the Toyota training, the implementation of the electronic health record might have paralyzed us. Instead, patient care did not suffer, and in fact, is much better now than it was a year ago.
This made me think. what other areas of the hospital can this be applied to? What inefficiencies do I see that could be easily corrected and save my time, the health care team’s time, and streamline processes? Change occurs so quickly in health care that you barely have time to react. You are barely keeping your head above water as an end-user.
What would Toyota say if they saw your unit? What changes would they implement? Would it not only save time, but lives? What do you think about this?
Coming up this Saturday on the Nurse Eye Roll blog: a post about the recent ruling in California and a nurse’s viewpoint on assisted suicide. Stay tuned!