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.