In the business world, competition is the rule. If your business is inefficient, you will go out of business. Similarly, if you manufacture a product that is of lower quality than your competitor, you will be forced to close your company. Healthcare consumers are unable to compare prices and have a hard time judging the quality of care. Because of a lack of price comparisons and quality measures, most healthcare systems and hospitasl have failed to improve the efficiency of the quality of that care. Unlike other businesses, they continue to survive. We in healthcare can learn many lessons from high performing businesses. Of course, these solutions will need to be adapted to patient care but nonetheless, the principles of high performing businesses have developed to succeed can and should be applied to healthcare. The number one automobile manufacturing company in the world, is Toyota. For over 75 years, they have been utilizing Toyota production system, TPS, to continuously improve the quality, and reduce the prices of their cars. In the 1990s, when consumer organizations looked at the quality of cars from different manufactures, they conclude the initial quality of Toyota was 20% higher than average. Using a dependability index, they also determined that Toyota dependability was 22% above the average. Consumer Reports noted that an eight year old Toyota was equivalent in reliability to a three year old Ford or Chrysler and a two year old VW. By the way, I have no stock in Toyota and I don't own a Toyota this time. I should point out also that today many car manufactures are now claiming to produce cars that have high quality as Toyota. As based on Consumer Union's analysis, this is true. How did car companies achieve the same quality as Toyota? They adopted TPS, therefore, we can thank Toyota for the overall high quality of all of today's cars. The steady flow of work is emphasized in TPS and when flow is constant, personnel are neither overworked or idle. Does this sounds like your hospital? If you see harried caregivers, this suggests inefficient care and a lack of workflow management. Let's look a little closer. A Toyoda workflow is carefully mapped out. These maps are called value streams. Let's apply a simplified value stream to the treatment of a common infectious disease, bacterial pneumonia. Because actively growing bacteria double every 60 minutes, prompt administration of antibiotics is critical. In fact, Medicare requires that all cases of bacterial pneumonia receive antibiotics within four hours of arrival to the hospital. Here is our value stream, as you can see the expectation is that the patient with potential pneumonia will have a history and physical exam completed within 15 minutes. If the caregiver feels pneumonia is a possible diagnosis, a chest x-ray should then be performed in the following 10 minutes. If the chest x-ray is abnormal, the patient should undergo blood tests, including the determination of an arterial oxygen level. These tests ideally, take no longer than 12 minutes. Based on the tests results, the patient will be either sent home on an oral antibiotic or admitted to the hospital for intravenous antibiotics and close monitoring. The final step in our value stream is expected to occur within 15 minutes. The total time from arrival to the beginning of antibiotics is 52 minutes. By creating this value stream, we create time expectations and then can steadily improve each phase of our process to achieve these times. For those of you who have been in an emergency room for pneumonia, did your care follow this value stream? I suspect the answer is no. Unfortunately, at the present time, only a limited number of hospitals are applying workflow mapping for specific diseases. Perhaps you can ask your hospital about adopting value streams and sharing them with their patients.
