Case Study: Perfecting Patient Care
“I recommend we take the Lean production approach and apply process redesign to our nursing home,” said Jamie. “This approach will help us reduce costs, improve employee satisfaction, and attract more residents.”“Thanks, Jamie,” said Reilly, the system vice president for finance. “I appreciate your enthusiasm, but my experience has been that cost cutting always involves reducing the quality of care or increasing the pressure on employees. Our strategic vision is not consistent with either of those directions.”“Reilly, I’m going to have to disagree,” interjected Logan, the chief operating officer. “My reading of the management literature on the Toyota Production System in healthcare confirms that Jamie is onto something. Waste pervades this place. We are doing things that resi-dents don’t want, and we are doing them inefficiently and unsafely. Eliminating wasted time and wasted materials will make life better for everyone. By teaching our managers how to help workers create safe, efficient work processes, we can transform this facility from a very good nursing home to a superb nursing home that makes lots of money. Lee and colleagues (2009) demonstrated that nursing homes are not efficient, and Graban (2012) showed that the approach that Jamie is recommending has worked in hospitals.”
Discussion questions
• Why is inefficiency common in healthcare? Doesn’t competition force organizations to be efficient?
• What evidence do we have that process redesign can improve efficiency? Isn’t process redesign just another name for making employees work harder? Is there evidence that employees will accept the redesign?
• Plenty of evidence indicates that problems with the quality of care harm patients, but won’t improving quality cost more? How could better quality not cost more?