UIHC learns to be Lean
Andrew Nugent's time as a doctor at the University of Iowa Hospitals and Clinics has taught him transforming a two-hour procedure into one that lasts 30 minutes is a big deal.
The UIHC's X-ray process underwent exactly that transformation as a result of the hospital's implementation of the Lean technique, said Nugent, the UI interim chairman of emergency medicine.
The theory behind the Lean method is simple: Eliminate unnecessary steps and wasted energy, and efficiency will increase.
"It turns out that when you improve the efficiency, it improves the patients' satisfaction and the quality of care," Nugent said with a small laugh.
And that theory includes patient X-rays. Before using Lean, hospital workers called the radiologist and other personnel to discuss the procedure. Now, the time-consuming phone calls have been replaced with an automated electronic process.
The Lean method came to the UIHC about four years ago, when members of the UI Chemotherapy Infusion Suite worked on the first Lean project, said Ami Gaarde, the nurse manager of the Holden Comprehensive Cancer Center.
The idea of Lean — derived from the Japanese — was officially adopted by the Toyota Production System in the 1920s, which applied the theory to manufacturing. Since then, it has been used by organizations and companies in many fields.
While the UIHC has made significant progress under the theory, officials say it requires continuous implementation each day.
The key is to assess which steps are vital to a particular process and which are unnecessary to "make changes that positively affect the patients," Gaarde said.
One such change was a decrease in nurses' walking distance to care for patients at the Holden Center. The distance a nurse walked to attend to one patient's needs — including getting supplies and medications — has plummeted from 900 feet to 90 feet.
And it doesn't stop there.
"We are now looking at the scheduling of patients to continue to be more efficient and increase their access to the care that they need here," Gaarde said.
The theory is also being used at Mercy Medical Center in Cedar Rapids, where the hospital's Lean coordinator, Kathy Berry, said it has helped to better structure systems involving patient registration to pediatric emergencies.
"The first thing we were addressing was how long it took patients to go through the registration process and then be seen by a physician," Berry said, and the hospital has dropped that time from over an hour to 30 minutes.
Before, patients spent around 20 minutes answering registration questions before seeing a physician. Now, patients register with their name and date of birth only. The other questions are taken care of in the exam room with a physican and nurse, eliminating waiting time.
Iowa was the first state in the country to officially instate an Office of Lean Management, according to the UI website.
The Iowa executive branch has used Lean since 2004 and has a full-time Lean facilitator, said Teresa Hay McMahon of the Iowa Office of Lean Enterprise.
At the UIHC, Nugent said, the Lean system has significantly improved their quality of care.
"The thing about Lean is, it never really ends," he said.
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