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What Does Airline Safety have to do with Us? Lots

One of the main tenets of Lean, upon which we’ve built our TEAMwork approach here at St. Luke’s, is that quality should be built into organizational processes.
By Dr. David C. Pate, News and Community
February 7, 2012

I’ve asked St. Luke’s Health System Vice President of Performance Excellence Mike Reno to write about how we are improving our processes in keeping with our Triple Aim goals of better health, better care, and lower cost. His thoughts are presented here. I’ve introduced Mike in a previous post, and you’ll be hearing more from him and other members of our executive team as our journey of transformation continues. 

Lean thinking begins with identifying and driving out waste in every aspect of the work we do each day, so that all of our work adds value and serves the customers’ needs, patient, physician, and each other. Identifying the value-added steps, as defined by our customers, and those that do not add value, which are the waste, in every process is the beginning of the journey toward a Lean operating system.

These principles have been used effectively in manufacturing companies for decades and are being successfully applied to the delivery of health care at many hospitals and systems, including ThedaCare, Virginia Mason, Intermountain Healthcare, University of Nebraska Medical Center, and Kaiser Permanente, just to name a few.

I can think of nowhere that these principles are more critical than in the health care industry. Many may recall the landmark report on medical errors, “To Err Is Human: Building a Safer Health System,” released by the U.S. Institute of Medicine in 1999. The report's finding that as many as 98,000 people die each year due to medical errors was likened to a 747 jet liner falling from the sky every day.

Obviously, people would be outraged if this happened, and very likely, the commercial airline industry would suffer drastically. But it doesn’t happen. Why? The airline industry has implemented a very vigorous process and performance improvement methodology to achieve built-in quality, so much so that the airline industry experiences a failure rate of less than 3.4 defects per million opportunities (DPMO). In other words, the industry’s quality rate is greater than 99.99966 percent.

We in the health care industry share a quality rate on par with the airline industry. Unfortunately, it is the quality rating of airline baggage handling. More precisely, our industry’s quality rate is about 93.3 percent (a 6.7 percent error rate, or 66,807 DPMO), which means you are just as likely to experience a medical error as you are to lose your luggage on your next vacation.

Clearly, there is opportunity for improvement. But in the seven years I have been introducing and leading Lean transformations within health care organizations, I have observed entrenchment. I have learned that people who have not been exposed to a rigorous or prescriptive continuous improvement effort frequently believe that their process is so unusual that Lean improvement principles, which often have been associated with the automobile industry and Toyota in particular, simply do not and cannot apply to them or their area. “I don’t have time to work on process improvement,” “We can’t do that,” and “Our process is different” are explanations I hear frequently when I’m helping people improve their methods. And there are others.

Over time, the explanations have repeated themselves, and so I keep a list. When I have started a new project or gone into a new department, there’s usually a good chance that someone will push back against the opportunities being identified or the changes being suggested and give me a reason it can’t be done, convinced that they are, in fact, unique. And I refer them to my list. I show them that they have just given Reason X.

Here are other reasons I frequently hear:

  1. Our patients/doctors won’t let us do it differently.
  2. Our job changes too rapidly.
  3. There are too many variables to standardize this process.
  4. This isn’t manufacturing.
  5. We aren’t building cars here.
  6. Our volume is too unpredictable.
  7. Our team is too spread out.
  8. Our vendor/supplier won’t get on board.
  9. “That” department won’t get on board.
  10. The computer system(s) won’t let us do that.
  11. The boss won’t go for that.
  12. There are too many unknowns.
  13. Our process is too complicated.
These beliefs become an entry point to dialogue. None of these people, teams, and departments have been alone in this thinking. Many people before them have felt the very same way, and yet have figured out how to make things better by applying proven industrial and manufacturing principles and methodologies. Change management is always easier when people know that others have done what they are about to do. It eases anxiety and can create a healthy competition within an organization: If someone else has done it, then so can we.

The commitment to Lean starts at the very top of St. Luke’s organization with Dr. Pate’s vision of TEAMwork. We are committed to involving all of our physician partners, staff members, patients, and volunteers in helping to redesign our processes to improve quality and outcomes and to reduce waste. As other health systems have learned, we must be able to rely on multiple, complex, standardized processes to accomplish our tasks and provide value and built-in quality to our customers, whether they are patients or co-workers. As we do so, St. Luke’s will begin to have a demonstrable impact on quality, safety, productivity, cost, and the timely delivery of health care services.

Yes, health care is different. We have the most to lose: patient lives. We have a responsibility to deliver the right care to the right patient at the right time, every time. We can and will achieve this by eliminating waste from all of our processes, standardizing those processes, and then executing those processes the same way every time.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.