U-M hospital takes page from Toyota
Adopting automaker's game plan of cutting pointless tasks could boost care, trim costs.
Sharon Terlep / The Detroit News
The University of Michigan Health System is borrowing the waste-cutting tools of Toyota Motor Corp., applying the Japanese automaker's philosophy to everything from how patients make appointments to the way doctors scrub in.
U-M is one of the first medical centers in the United States to apply to health care the corporate culture known as the "Toyota Way," a strategy based on eliminating pointless work and empowering employees. By using the principles pioneered by the world's second-largest automaker, the Ann Arbor institution hopes to improve patient care and cut administrative and other costs.
"Basically, instead of producing 50 cars with the screw in the wrong place, this strategy is 'we'll fix it now and make sure it never happens again,' " said Dr. John Billi, U-M associate vice president for medical affairs. "We're trying to do exactly that in health care."
The initiative, called the Michigan Quality System, is a centerpiece of U-M's five-year plan to boost patient volume by 3 percent a year at the 865-bed operation and maintain a 3 percent profit margin. The health care system has a $1.2 billion annual budget and sees nearly 44,000 admissions a year.
More hospitals and medical centers are adopting such philosophies, and many are seeing results similar to those at U-M, said Ron Wince, chief executive officer of Arizona-based consulting company Guidon Performance Solutions.
"The approach provides not just process-improvement tools," he said. "It's a complete holistic philosophy for helping every worker improve work every day."
Docs take factory lessons
Waste, when Toyota's principles are applied to health care, essentially means any effort that hampers a patient's overall experience. That could include lengthy waits to see a physician or return visits to the doctor.
The Toyota Production System is the best known automotive application of the widely popularized manufacturing approach known as lean manufacturing, which many credit Henry Ford with developing in the early 1900s.
The concepts behind Toyota's strategy involve zeroing in on waste, finding ways to eliminate it, involving employees in creating a better process and continuing to find ways to improve. U-M is getting help from several experts in the manufacturing field, including a crew from General Motors Corp.
Another of Toyota's key concepts is to eliminate potential errors by producing products one-at-a time, from start to finish, rather than stockpiling. The automaker used American grocery stores as model of efficiency. In a grocery store, shelves are stocked with a minimum amount of goods so products aren't wasted and it's easy to tell when something is running out.
In health care, the one-at-a-time approach could mean taking a patient's call, pulling the patient's records, scheduling a visit and performing the exam that day, rather than creating a backlog of appointments or letting people crowd a waiting room. That way, if something goes wrong, it's easy to target where the problem happened and fix it right away.
Already at U-M, the Toyota approach has produced dramatic results. The hospital's sports medicine department is a prime example.
Patient wait times plunge
Patients used to have to wait weeks for an appointment. That's because doctors wanted to review each case to make sure an orthopedic visit was necessary. Doctors would sometimes take several days to read the files the staff had pulled.
It turned out that virtually every patient was deemed a good candidate for a visit.
Using the Toyota system, doctors' review of patients' records is unnecessary. Instead, the staff has a list of basic criteria and is authorized to determine whether a patient gets seen.
The new wait time: Usually less than 24 hours.
Similar changes are under way in the radiation oncology department. Patients used to go through a three-step process that required three separate visits that sometimes stretched over a week.
Under the new system, patients call for an appointment, receive an evaluation and treatment plan, and can begin radiation as soon as that day.
"I've noticed that they're trying to expedite and do things the same day. It's so nice," said Flint's Midge Robbins, 64, who's received radiation for bone cancer on and off over 23 years at U-M. She called Thursday for an appointment and was treated Friday morning.
"When they scheduled my appointment, the woman seemed totally engulfed in helping me," she said. "It's a good feeling when you're in a situation like this."
Dr. Theodore Lawrence, chairman of U-M's Department of Radiation Oncology, was initially skeptical that an auto-style approach could apply to health care.
"Patients aren't Toyota," he said, describing his initial impression.
"But when you look at what they're doing, there's a remarkable applicability to health care."
