Showing posts with label quality. Show all posts
Showing posts with label quality. Show all posts

Thursday, October 28, 2010

Efficiency vs. Quality - LEAN goes for efficiency at the expense of quality (and the morale of workers)

Here is an example of the emphasis that LEANSTERs can place on efficiency.  When you are in a healthcare setting, sometimes quality trumps efficiency.  If the  method looks  like it has been LEANed, and is more efficient, but underneath the quality of the process has been sacrificed, then there has been a threat to patient care.


This is a danger of the LEAN intruder in hospitals.  

The article 3/15/2008:
To build a better hospital, Virginia Mason (Medical Center) takes lessons from Toyota plants
"Virginia Mason said overall benefits include an 85 percent reduction in how long patients wait to get lab results back, and lowering inventory costs by $1 million. They've redesigned facilities to make patient and staff work flow more productive. The hospital reduced overtime and temporary labor expenses by $500,000 in one year and increased productivity by 93 percent. While direct cost savings aren't passed on to patients with the new system, less waiting, increased safety and more efficient care are." (Bold added).

LI comments:  
85% reduction in wait for lab results 
$1 million lowering of inventory cost (for today yes, for the year maybe not)
redesigned facilities to make patient and staff work flow more productive (more productive but at what quality level?  LEAN can mean higher productivity at lower quality levels for the patient - this must be accounted for)
reduced overtime and temporary labor expenses by $500,000 in one year
increased productivity by 93% (Huh?)
direct cost savings not passed on, BUT 
less waiting, 
increased safety, 
and more efficient care. (a measurable benefit or a Hawthorne affected opinion?)
The LEANSTERS would always tell you that care is more efficient, however, in a healthcare setting efficiency and quality may not always be equal.  Let's not choose efficiency over quality.


Posted by FirstHillResident at 3/15/08 12:26 p.m.
"Yeah....I left Virginia Mason because of this system. It has completely ruined morale among workers. I was in the accounting office, but when they implemented this system I literally had a guy with a stopwatch standing over me for two days timing my every move, looking for ways I could accomplish more in less time. I can't tell you how demeaning that felt. There's also such a thing as being too lean. This system has actually caused problems at Virginia Mason, most notably the death of an elderly female patient because they had gone so lean that a certain chemical wasn't properly labeled and she was injected with it. Workers there really hate this system, and if patients are ultimately going to get good care, their healthcare providers needs to be happy to be there." (Bold added).

Wednesday, October 13, 2010

NYT Factory Efficiency (LEAN) Comes to the Hospital

What do you see when you read the article from the NYT on LEAN in hospitals?

http://www.nytimes.com/2010/07/11/business/11seattle.html



Here is one paragraph:


"The system (refers to supply system for ICU) is just one example of how Seattle Children’s Hospital says it has improved patient care, and its bottom line, by using practices made famous by Toyota and others. The main goals of the approach, known as kaizen, are to reduce waste and to increase value for customers through continuous small improvements."


Note the following sentences from this paragraph:
1)  "Improved patient care, and its (Seattle Children's Hospital) bottom line."


2)  "Main goals...are to reduce waste and to increase value for customers through continuous small improvements."


What are the main goals of a hospital?


Reducing waste and increasing value for customers?  Does that mean cutting costs and what for customers?  Increasing value?  What does that mean in a health care setting?  "Improved patient care and its bottom line."  Which comes first - the improved patient care or the improved bottom line? 


 Was there any or check in place to catch the fact that the enthusiastic LEANsters in the hospital were convincing Hospital administration to do something that would degrade patient care?


If not, why not?


“It turns out the highest-quality care also is the most cost-effective because we make fewer mistakes and create better outcomes,” says Patrick Hagan, the hospital’s president."


Not true based on Seattle Children's second child death due to drug overdose in a year.  Sad,but a wake up call?