Working to improve quality

When Joan Ching decided to take a position at Virginia Mason Hospital and Medical Center in Seattle, people told her that it would be a bad career move.
The organization was known for using the Toyota Production System. Her colleagues assumed that applying a manufacturing process to healthcare would lead to people becoming "automatons that must follow standardized work." But she found exactly the opposite to be true.
"By standardizing routines, it frees up the mind to use creativity for things that are specific to that patient," said Ching, now the administrative director for hospital quality and safety.
Virginia Mason has been using lean processing in all parts of its system since it created a strategic plan in the early 2000s. But the provider is somewhat of an anomaly in the healthcare industry.
According to the Global State of Quality Report, recently released by the American Society for Quality, there are considerable differences in the use of quality practices between service-based industries - particularly healthcare - and manufacturing.
But with healthcare moving toward pay-for-performance, it is likely that more organizations are going to be looking to groups like Virginia Mason to figure out how to streamline, cut costs and prove their value to payers.
The report's authors said that quality measures can be used throughout an organization to help establish goals, create predictive analytics and base performance compensation. The ASQ survey found that manufacturing is more likely to use quality practices in areas like management, service, training and generally throughout the entire value chain than are healthcare organizations.
Joe Fortuna, chair of ASQ's healthcare division, said manufacturing lends itself to lean quality practices.
"At GM, a car's quality is defined in defects per hour of labor put into it and they are all fairly easily measureable," Fortuna said. "Those kinds of things can be devised for healthcare but we don't have a culture that normally accepts that kind of evaluation.
Doctors don't generally want to know how many errors they made or how many infections they had."
In healthcare, numbers like hospital readmission rates, death rates and improvements in measures like body mass index, cholesterol and blood pressure levels can all be used to gauge quality.
The underlying issue, he said, is that there must be a sweeping change in the culture of healthcare. Instead of looking to what has always been done, he said it's time to look outside of the healthcare industry to improve quality.
Virginia Mason changed its culture when they realized quality efforts they had tried weren't working, said Chris Backous, marketing director of the Virginia Mason Institute, a nonprofit corporation established by the hospital to provide education and training in its production processes.
Instead of justifying what they were doing, they scrutinized practices, used the Toyota process for analysis and reworked anything that wasn't adding value.
Ching said Virginia Mason uses multidisciplinary teams and lean tools to improve patient care in numerous ways. For instance, when they found that there are more than 100 steps involved in the medication use cycle - from the time medication is delivered to the loading dock to the bedside, they implemented barcode scanning and a handful of other improvements from pharmacists to nurses and patient care technicians to improve the process, she said.
"Fifteen percent of a nurse's workday is administering meds," she said. "If this is not efficient, it takes away from other activities they can do."
They also created "Falls University" and standardized the process for toileting patients to try and reduce the occurrence of patient falls.
"I have been at organizations where we spent most of our time figuring out what the work is and how we were going to do it," Ching said. "When you have a codified method, you don't waste time trying to organize around a problem, you just pick out tools or a worksheet and begin to look and sketch the process."