Saturday, February 24, 2007

The First Lean Hospital

It is extremely encouraging that lean manufacturing principles are beginning to take hold as an improvement approach in our healthcare industry. Our current healthcare system could certainly benefit from the elimination of waste and improvement of services.

I recently read, with great interest, about an experiment to transfer the manufacturing lessons in productivity to a hospital environment (600 beds) with some success. Here are a few excerpts that I found interesting:

“It is not at all certain whether hospitals as they are now managed exist for patients or for doctors.”

“It has been an aim of our hospital to cut away from all of these practices and to put the interest of the patient first. Therefore, it is what is known as a “closed” hospital. All of the physicians and all of the nurses are employed by the year and they can have no practice outside the hospital. They are paid salaries that amount to at least as much as they would ordinarily earn in successful private practice. They have, none of them, any financial interest whatsoever in any patient.”

“In the ordinary hospital the nurses must make useless steps. More of their time is spent in walking than in caring for the patient. This hospital is designed to save steps. Each floor is complete in itself, and just as in the factories we have tried to eliminate the necessity for waste motion, so we have tried to eliminate waste motion in the hospital.”

This account details some additional topics like nurse to patient ratios, hospital design, and admissions. The most interesting part is who led this lean hospital transformation and when this experiment took place. Anyone care to guess?

This account was taken from the book I just finished reading titled “My Life and Work” by Henry Ford in 1922 referencing his experiment at Ford Hospital (previously Detroit General Hospital) in 1919. So I would guess that might establish Ford Hospital as the first attempt at a “Lean” hospital.


Mark Graban said...

Wow. Just wow. That's amazing. I can't wait to share that with the hospital folks I work with.

The most amazing thing, to me, is the idea of doctors being on salary to the hospital.

Many of the dysfunctions we have today seem to be driven by conflicting objectives and independent contractor physicians who don't work for the hospitals. I need to learn more of the history about how that system developed.

Thanks, Mike.

Mike Wroblewski said...

You are right, Mark. It is amazing.

rollei said...

no this is the wrong track. employed physicians means healthcare systems held hostage by providers who think they should be CEO/CFO and in charge of reimbursement. please bring some hospital QI staff to the table to discuss before you are headed down the wrong path