Tuesday, June 12, 2007

Almost Lean

One of the current approaches to improving hospital operations has been imported from Toyota, the Japanese car company, and is called Lean. As the word implies, Lean aims to remove waste, unintended variation, and complexity.

Long-time friend and retired Land Court Judge Peter Kilborn has been good enough to send me a write-up on the Lean program at Children’s Hospital in Minneapolis. It included a picture of the hospital’s three-person Lean Resource Office, one of whom is Kilborn’s daughter-in-law.

As I read the material, I was curious about the extent to which the Lean program at Children’s included physicians. Physicians play a key role in patient care at all levels and it would seem imperative that they be an integral part of any hospital’s effort to improve performance.

I found little about physicians in the material Kilborn sent, and so I went to the hospital’s web page to look for more. There was material about projects in nursing and one in the lab. The only reference to physicians I found was in a project to standardize the contents of the hospital’s “crash carts” – the supply carts used in responses to emergencies.

My investigation was admittedly limited, but what I found did not surprise me. The wall of professional independence that separates physicians from hospitals continues in too many cases to exclude doctors from efforts to improve patient care processes.

So long as that continues to be so, the ability to improve efficiency and control cost in health care will be severely limited.

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