Children’s Hospital is going lean

Pilot project started in clinic to reduce patient wait time
The Business Journal of Milwaukee - by Corrinne Hess | download .pdf

Eliminate waste, put customers first and save money.

It’s the basis of a concept the manufacturing industry has used for decades called “lean management.”

Sounds like a simple solution, but with the exception of ThedaCare in Appleton and Froedtert Hospital in Wauwatosa, the idea of going lean is just starting to catch on in Wisconsin’s health care market.

“In general, health care systems are where manufacturing was in the mid- to late-1980s in terms of lean,” said Jerry McCormick, owner of J.D. McCormick & Associates, Brookfield, a consulting firm that deals with lean and Six Sigma systems for business.

Children’s Hospital of Wisconsin, Wauwatosa, is the latest southeast Wisconsin health care system to implement lean practices, which is Toyota Motor Corp.’s quality improvement process aimed at getting rid of wasted activities to improve productivity.

When Children’s Greenway Clinic opened in Greenfield in October 2007, the orthopedic center staff was chosen for a pilot project that applied lean practices.

Simple changes such as putting casts on patients in exam rooms rather than in a separate area of the clinic, stocking carts with necessary supplies and keeping frequently used forms in each exam room have saved the doctors and nurses time on tasks unrelated to patients, said Dr. Channing Tassone, orthopedic surgeon at Children’s Hospital and assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

Children’s Hospital officials say the project is a proven success, with wait times in all areas of the Greenway clinic down 71 percent. Before lean, patients spent an average of 38 minutes during their visit in exam rooms waiting to see a physician. The average is now 11 minutes.

“We’ve gone from chaos to organized chaos,” Tassone said. “We’re able to see more patients, but it feels easier than ramping up the workload should feel.”

Saving time

Comparing 2006 with 2007, when the lean process was implemented, the clinic experienced a 25 percent increase in the number of patients treated with fractures. The clinic reportedly sees an average of 800 to 1,000 patients per month.

The clinic also decreased the use of exam rooms by 25 percent, which freed up exam-room space to be used by another physician to see patients at the clinic, Tassone said.

Children’s Hospital has hired Aneesh Suneja, owner of Menomonee Falls-based FlowOne Lean Consulting LLC, to help the system implement the lean process.

Children’s is beginning to expand lean practices to the hospital’s operating rooms and other programs including the Herma Heart Center, the neurosciences center, emergency room, neonatal intensive care unit and the pediatric intensive care unit.

McCormick, who has spent the past 10 years teaching companies how to reduce waste and improve quality with lean thinking, said health care is lagging other industries in applying lean practices because the industry traditionally has been focused on doctors rather than on patients.

Patients are starting to demand a change in customer service, forcing hospitals to look at various initiatives such as lean, McCormick said, adding it will take another 10 years before the industry fully embraces the lean concept.

Froedtert Hospital in Wauwatosa has been focusing heavily on lean principles for the past few years, said Beth Lanham, director of the hospital’s lean Six Sigma department.

“We use lean principles hospital-wide in every process improvement project we do,” Lanham said. “It’s very helpful in identifying waste and non-value-added time inefficiencies.”

Since implementing lean in 2003, ThedaCare has been recognized by the health care and manufacturing industries as having one of the country’s most successful lean programs in health care.

Early in the process, ThedaCare kept detailed information on the quality and financial improvements that could be attributed to lean as a way to justify the investment, said John Poole, senior vice president-ThedaCare improvement system.

The company saved $27 million in the second through fourth years of using lean principles.

ThedaCare now has an annual budget of $4.5 million and a staff of 40 people keeping operations at the company’s four hospitals and 20 clinics lean, Poole said.

In February, ThedaCare president John Toussaint stepped down to lead the ThedaCare Center for Creating Value in Healthcare, an organization based in the Fox Cities that works with hospitals and health care providers to reduce costs through the use of lean.

In the past two to three years, the health care field has made strides in using lean principles, but still has a way to go before the industry as a whole applies lean standards to the degree manufacturing has.

Higher costs and lower patient tolerance for inefficient systems make streamlining operations imminent and those who have already embraced lean principles say it is only a matter of time before health care catches up.

© 2008 FlowOne Lean ConsultingN53W15958 Creekwood Crossing | Menomonee Falls WI 53051 (412) 612-0500asuneja@flowone.com