In To Fix Health Care, Hospitals Take Tips From Factory Floor, the Wall Street Journal (4/9/04, p. 1) reports that hospitals are applying techniques pioneered by John Deming and used heavily by Japanese manufacturers to improve the quality of health care. Lawyers and law firms and departments can learn from this example.
The article describes several systematic techniques that hospitals are adopting from manufacturing that improve quality and reduce costs:
“The Toyota system emphasizes the smoothest possible flow of work – accomplished by, say, mapping out work processes and eliminating unnecessary steps, and using teamwork to identify and fix problems as soon as they crop up. Hospitals are using the tactics to reduce patient waiting times, slash wheelchair inventories, prepare operating rooms faster and move patients through a hospital stay or doctor visit quickly, seamlessly and error free.”
At least one hospital sent a team of executives to Japan for 2 weeks to learn how manufacturers, especially Toyota, apply such techniques. One application of this approach is that any health care provider can perform the equivalent of hitting the stop button on a factory line to correct a problem. For example, a nurse in an ICU can now call the attending doctor directly to make sure a problem is addressed.
Another application is to map patient processes. One hospital “produced a 25-foot wall map charting a pneumonia patient’s typical office visit. With help from the consultants, they concluded that 17 steps are valuable and 51 aren’t. In the latter category, for instance, patients walk to a separate laboratory to get blood drawn.” Among other benefits, patient waiting time was cut from 30 minutes to 9.
Of course, making these changes is not easy; the article notes that “the conflict between the culture of efficiency and the culture of caring is never far from the surface.”
Medicine and law share some common characteristics: highly trained and fiercely independent professionals, complicated processes, and often difficult to measure outcomes. It is interesting to contemplate what would happen in a large law firm or department if the “Japanese” approach were applied. Would teams of process consultants that hospitals employed find significant savings and opportunities for quality improvements in law practice processes? I think the answer is undoubtedly yes.
In my next blog posting, I will discuss some recent general counsel initiatives to save money that have not worked as expected. Perhaps the time is coming to “think out of the box.” The types of process improvements described here could be a big money saver for general counsels.