San Francisco General Hospital Following Toyota Way to Efficiency Discussion This is for CTA 7. and I’ll upload another one soon.https://www.nbcbayarea.com

San Francisco General Hospital Following Toyota Way to Efficiency Discussion This is for CTA 7. and I’ll upload another one soon.https://www.nbcbayarea.com/news/local/Body-Found-at-SF-General-Is-Missing-Woman-Lynne-Spalding-227095731.html http://www.sfgate.com/health/article/S-F-General-following-Toyota-Way-to-efficiency-4879925.php
S.F. General following ‘Toyota Way’ to efficiency
By Victoria Colliver Updated 8:02 pm, Thursday, October 10, 2013
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Dr. Ron Labuguen (right), an S.F. General Hospital continuous­improvement team leader, records observations.
At San Francisco General Hospital, clinicians, executives and other staff members are peppering their
conversations with Japanese words like kaizen, which means continuous improvement, and muda, for waste.
The dialogue is not part of a language program, but rather an effort to infuse Japanese automaker Toyota’s management
philosophy and practices into the way the hospital delivers medicine to its patients. “The Toyota Way,” as it is called, is the
company’s systematic approach to producing cars and trucks efficiently, with the primary goal of pleasing the customer.
“A lot of people think, ‘What does making cars have to do with taking care of patients?’ ” said Iman Nazeeri­Simmons, the
hospital’s chief quality officer.
tation
A lot, as it turns out.
San Francisco General is among a growing number of hospitals in the U.S. taking Toyota’s management principles to heart.
Behind the effort is a need to compete as greater scrutiny is being placed on costs and hospital reimbursements are shrinking.
Health law’s impact
For public hospitals like San Francisco General, which is also the city’s designated trauma center, the federal Affordable Care
Act may further tighten financial constraints as the government reduces payments earmarked for some uninsured patients.
As these patients become insured, they will also have greater options in the hospital they choose to go to. And their choice may
not be their nearest safety-net hospital. That realization is putting these hospitals, including S.F. General, in the unusual
position of having to attract and retain “paying customers” to survive.
“They’re going to have to make themselves more attractive if they’re going to compete for those patients who no longer have to
go there because they have to,” said Dr. Mark Smith, chief executive officer of the California HealthCare Foundation,
an Oakland philanthropy that has invested more than $2 million over the past five years to help hospitals adopt Toyota’s
techniques.
The foundation’s grants have gone to a number of county health systems – San Francisco, San Mateo, Alameda, Contra Costa,
Los Angeles – to help them re-engineer how they operate. That could mean everything from how supplies are organized to how
many steps a nurse should take to reach essential equipment in the operating room.
San Mateo Medical Center’s chief executive officer, Dr. Susan Ehrlich, described Toyota’s method as “really focused on the
small things. It’s making a million small changes and making sure everyone is doing those changes and sticking to them over
time.”
Critical analysis
To make the system work, a team of employees is assigned to analyze a particular area targeted for improvement. The group
immerses itself in what is typically a weeklong, hands-on session, called a kaizen, and emerges with a plan to make specific,
often seemingly small changes designed to have a big impact on costs or the patient’s experience.
Hospital administrators, doctors and nurses or any other staff members could find themselves sitting in a waiting room for
hours with a patient or cleaning floors with the housekeeping staff or watching a specific medical procedure. Suggestions can
become approved practice without the usual bureaucracy.
For example, at San Francisco General, a recent kaizen focused on the number of minutes it takes from the moment a patient
is wheeled into the operating room to when the first incision is made. A team spent a week trying to come up with ways to
whittle 10 minutes off the hospital’s average “wheels in” to incision time of 40 minutes.
Ten minutes may not sound like a lot, but those minutes can add up in wasted time and cost when a staff of nurses and
doctors has to wait for a piece of equipment or a patient to be ready for them. Those delays also keep a patient in the operating
room longer than necessary, reducing the number of procedures that could be performed on other patients.
Working on change
Officials at San Francisco General, which started adopting Toyota’s methods in earnest a little more than a year ago, admitted
that it’s tough to get everyone on board and that change is often met with some resistance.
“You generate these small wins – especially if they’re visible – and that’s what changes people’s attitudes real quickly,” said Dr.
Ron Labuguen, medical director of San Francisco General’s Urgent Care Center, the first department to receive the Toyota
Way treatment.
The hospital’s Urgent Care Center has already seen results. In July 2012, the average wait – from arrival to discharge – was 4 to
6 hours. After going through the new process, the average wait time is 2.5 hours.
During the improvement session in urgent care, team members noticed that every time a patient needed a basic X-ray, they
had to leave the center, walk across the street to a different building and then navigate a maze of hallways to the radiology
department. A patient who couldn’t make the 15-minute walk had to wait for a wheelchair escort, which could take hours at
the busy hospital.
They suggested a logical fix: create an on-site X-ray room. “Having the X-ray here has revolutionized the patient experience,”
said Ricardo Ballin, nurse manager in urgent care.
Toyota’s techniques
The move toward applying Toyota’s techniques in hospitals started around 2000 when executives at Seattle’s Virginia
Mason Medical Center became interested in seeing how they could improve the hospital’s quality, safety and patient
satisfaction. They looked at Toyota because several other industries and companies, including Boeing, were using the
carmaker’s established methods.
At first, the idea was resisted, executives leading the charge said.
“When Boeing heard about Toyota, they said that’s fine for a car manufacturer, but we make airplanes,” said Mike Rona,
Virginia Mason’s former president who now runs his own consulting businesses for hospitals converting to the system. “Our
people, when they heard about Boeing, said that’s fine for Boeing, but we have processes that take care of people.”
Rona said it doesn’t really matter what any particular company or industry does or produces. “Every organization has
processes to make whatever they make,” he said, adding those processes can always be improved.
Today, numerous hospitals around the nation, including many private hospitals in the Bay Area, are using Toyota’s techniques
in some of their practices.
San Mateo example
At San Mateo Medical Center, which is well on its way to full adoption, administrators have trained 100 staff members to
teach the system to their colleagues, involved 300 employees in 52-week kaizens and made significant changes in nine
departments.
In one improvement session, hospital staff members looked at operating room cancellations. They analyzed the reasons for
those cancellations – ranging from surgical scheduling conflicts to patients not having their pre-op preparation done in time –
and recommended changes that reduced cancellations by 17 percent. That saved the hospital more than $200,000 between
October 2012 and July 2013, CEO Ehrlich said.
Another session targeted the infusion center, where patients receive chemotherapy and other life-saving treatments. The
group focused on reducing time lost getting insurance authorization for these very expensive drugs. Ehrlich said reducing
muda, or waste, in that process saved the hospital $300,000 from February to August of this year.
Believers in Toyota’s method say the key to making the system more than just another management fad is to standardize the
new processes so that everyone does them the same way and works to sustain the changes.
San Francisco General’s quality officer, Nazeeri-Simmons, admits that can be a challenge in a seemingly chaotic atmosphere
of a major trauma center. But, she said, at least 80 percent of the work done at the hospital every day is predictable or routine.
That’s where the changes can be made.
“You just can’t act like everything we do is brand new, every day,” Nazeeri-Simmons said. “When you stabilize the 80 percent,
that gives you flexibility for the chaos.”
Glossary
Toyota’s production system, which focuses on reducing waste and inefficiencies while making customers happier, has been increasingly adopted by hospitals trying to improve medical
quality and increase patient satisfaction. Here are some of the system’s frequently used Japanese terms, many of which do not have a direct English translation:
Gemba: the place where work is performed
Hansei: a period of critical self reflection
Heijunka: a level production schedule that provides balance and smooths day­to­day variation
Jidoka: using both human intelligence and technology to stop a process at the first sign of a potential problem
Kaizen: continuous improvement
Kanban: a visual card or signal used to trigger the fulfillment of need, such as restocking supplies
Muda: anything that consumes resources but provides no value
Poke­yoke: a mistake­proofing device that prevents errors
Source: Rona Consulting Group
Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com Twitter: @vcolliver
© 2017 Hearst Communications, Inc.
CTA 7: Kaizen at San Francisco General Hospital.
Links to short news items and video about SF General’s initiative to adopt Kaizen to improve its operations and the
challenges it still faces along its journey. Staff members at SF General employed Kaizen in areas such as reducing
patients’ average wheels-in to incision time to shaving average wait time in its Urgent Care unit. These improvement
efforts, while commendable, did not eliminate errors completely. Ironically, around the same time Kaizen
implementation at SF General Hospital was reported, another news broke about that SF General lost a female patient
for two weeks, and she was eventually found dead in a hospital stairway.)
News Item 1: S.F. General following ‘Toyota Way’ to efficiency(clicking this link will download the item as a PDF file)
News Item 2 (includes video): Body of Missing Woman Found at San Francisco General Hospital – (Links to an
external site)
Critically analyze the information contained in news article and the video. Then write well-thought out answers to the
questions below:
1. Why are hospitals, such as San Francisco General Hospital, adopting the ‘Toyota Way’?
2. Which of the many Japanese terms (listed in the Glossary provided in News Item 1) could have prevented the lost
patient? Explain the rationale of your choice(s).
Critical Thinking Rubric.
Criteria
Ratings
Pts
5.0 pts
4.0 pts
Identifies and
Summarizes
issue at hand
Identifies not only the basics
of the issue, but recognizes
nuances of the issue
Identifies the main issue and
subsidiary, embedded, or
implicit aspects of the issue
2.0 pts
Does not identify and summarize the
issue, is confused or identifies a
different or inappropriate issue
5.0 pts
Personal and
5.0 pts
4.0 pts
3.0 pts
2.0 pts
Personal and
other salient
perspectives
and positions
5.0 pts
Addresses and
analyzes salient
perspectives from
experience and
information from
outside sources.
4.0 pts
Identifies,
appropriately,
one’s own
position and/or
other salient
perspectives on
the issue
3.0 pts
Address a single source or
view of the argument and
fails to clarify presented
position relative to one’s
own and/or other salient
perspective
2.0 pts
Fails to address even a single
source or view of the
argument and fails to clarify
presented position relative to
one’s own and/or other salient
perspective
5.0 pts
5.0 pts
Quality of
evaluation
and analysis
Observes cause and effect and addresses
existing or potential consequences.
Clearly distinguishes between fact,
opinion, and acknowledges value
judgments
4.0 pts
Examines the evidence and
source of evidence,
questions its accuracy,
precision, relevance, and
completeness
2.0 pts
Merely repeats
information provided,
taking it as truth or denies
evidence without
adequate justification
5.0 pts
Conclusions,
implications,
and
5.0 pts
Objectively
reflects upon
4.0 pts
Identifies and discusses
conclusions,
implications, and
consequences
3.0 pts
Identifies and discusses
conclusions, implications, and
consequences but only
superficially
2.0 pts
Fails to identify
conclusions,
implications, and
consequences of the
issue
consequences
own
5.0 pts
assertions
Total Points: 20.0

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