The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Using The Toyota Production System's "LEAN" Process to Reengineer Respiratory Care Services in a 300+ Bed Medical Center

Lawrence B Cole, BS, RRT,  Robert Hase, MS RRT-NPS, Denise Franks, RRT, Joe Streiff RRT, Jeff Suenaga RRT.  Virgina Mason Medical Center , Seattle , Washington

Background:  Virgina Mason Medical Center , a 300+ bed teaching hospital in Seattle , adopted the Toyota Production System (TPS) Methodology which incorporates "Lean" thinking and processes, a management approach that strives to provide customers with exactly what they want through the elimination of waste.  Waste is defined by TPS as any use of resources that does not add value for the customer, or is above the theoretical minimum.  Specifically, Lean identifies waste in seven specific categories: waste of overproduction, time on hand (waiting), transportation, processing, excess inventory, movement, and defect production.  As a key element of Lean, the Rapid Process Improvement Workshop (RPIW) consists of a simple, rigorous, and thorough five-day process-reengineering to accelerate improvement, eliminate waste, and produce dramatic reductions in cost and time associated with process flow time.  RPIW projects strive to achieve at least a 55% reduction in waste through appropriate alignment of tasks with available skill sets, while striving to retain added-value within a reengineered process. In 2002 our Department evaluated its services within the context of an RPIW. 

Process Change: A multi-disciplinary RPIW team was organized to evaluate the Respiratory Care Department, consisting of two Respiratory Care Practitioners (RCPs), an RT Assistant, two RNs (one from ICU & one from one of the floor units), the Department Medical Director, and an Administrative Director; in addition, the team consulted with experts from other departments as needed.  The RPIW process looked specifically at where the RCP adds value to patient care; in addition, skill sets were defined for the various services provided by the Respiratory Care Department.   The recommendation arising from the RPIW group moved the Respiratory Care Department's role away from a task-specific discipline and redefined the Respiratory Care Practitioner as an intensivist and consultant.  Specific changes implemented following the RPIW include all routine medication aerosolization, low-flow oxygen systems, hyperinflation therapy, and bedside monitoring to fall within the scope of care provided by Registered Nurses and nurse-extenders.  The RCP's role refocused on intensive care and consult requests; and departmental processes were reengineered so that essentially all respiratory care became protocol-based.  Most routine low-tech tasks were virtually eliminated or transferred to other labor groups by the end of the RPIW process.

Results: The changes resulted in a reduction of staff from a pre-RPIW level of 25.6 FTEs to the current staffing level of approximately 18 FTEs.  The hospital has a "no lay-off" policy, and the reduction in staff occurred via a combination of staff transfer to other departments as available, as well as through staff attrition over time.  We found no evidence that the changes adversely impacted patient outcomes or RCP job-satisfaction.  Further, using averaged labor costs, we calculate that our facility saves $500,000 annually in labor expense.

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