A prescription for better hospitals
When officials at the VA Medical Center in Providence needed to improve patient care, they called in the engineers. The University of Rhode Island team arrived with a clear prime directive: examine dozens of systems and find ways to run them faster, better and more cost effectively. Do the job well, and the hospital becomes a model for the nationwide network of more than 800 Veterans Administration medical facilities.
Led by industrial and systems engineering Professor Valerie Maier-Speredelozzi, the University team is tackling the challenge by taking the concept of lean manufacturing from its birthplace on the automobile factory floor to a hospital that serves more than 32,000 patients annually.
“The principles of lean that were developed by Toyota were targeted at eliminating waste,” Maier-Speredelozzi says. “These same principles can be applied to health care. There’s a great deal of waste that can be eliminated to improve the system and save money.”
Waste takes many forms. At a supply closet on the sixth floor, the professor and her students eliminated wasted time by grouping supplies by medical incident and color-coding their labels. They eliminated wasted money by implementing better inventory control of perishable items like saline by studying past usage and setting appropriate levels that trigger restocking. And they eliminated wasted personnel energy by implementing easier-to-stock shelving with pullout shelves and wheels.
The three-year-old University project goes far beyond the humble supply closet. Industrial and systems engineering graduate students Keerthi Madala and Karen Roman have led many of the hospital’s 1,100 staff in workshops teaching lean techniques and how to apply them from the hospital pharmacy to the operating room. Time and time again, they work with staff on seemingly small problems that, when combined, cause a seismic cultural shift.
“The supply closet definitely got us thinking about how lean can be applied to health care,” VA nurse Amanda Vares says. “For projects in the future we do want to use those lean strategies because time is money and time is patient lives.”
Semi-annual surveys conducted by Madala show that staff increasingly share Vares’ opinions. They no longer view lean as a “flavor of the month” with little long-term potential. Indeed, the supply closet redesign left such a major impact that nurses presented it at a regional nursing conference.
Robert Harris, the hospital’s systems redesign coordinator, says the cultural shift would have been unattainable without the University team bringing “innovative ideas to get things done.”
Harris’ department has been at the forefront of delivering lean for the first time to the Providence facility that includes 73 patient beds, 32 specialty clinics, three operating rooms and three community-based outpatient clinics. Three years ago, he secured a Systems Improvement Capability grant from VA headquarters and brought in the University as a partner to spearhead individual projects.
“We hope that when we make many small improvements, those together add up to a number of improvements, which result in a large improvement,” Harris says.
The Providence project comes as part of a broader effort by the VA – a national network serving more than 6 million patients annually – to improve care and save taxpayer money. VA officials report that systems redesign has already shortened wait times for appointments, slashed the length of hospital stays and reduced costs.
There remains plenty to do. Military conflicts in Iraq and Afghanistan are flooding the system with as many as 10,000 new patients every month. In Rhode Island alone, there are an estimated 71,200 veterans, many of whom may turn to the Providence VA Medical Center for care. The sheer number of patients will compel industrial and systems engineers to keep innovating.
“The field of health care certainly has room for improvement so there’s a lot more to do,” Maier-Speredelozzi says. “We have many more research ideas that we have yet to address.”