With the theme of a “Lean Laboratory Supporting Lean Healthcare,” attendees at Lab Quality Confab this morning in Atlanta, Georgia, heard the remarkable story of Stockholm, Sweden-based St. Göran Hospital’s  Lean journey to improved clinical outcomes and better customer service for its patients. This 250-bed hospital serves 21,000 inpatients and 200,000 outpatients annually.

This story had added intrigue because it is healthcare delivered to the public in Sweden’s single-payer health system, provided by a privately-owned hospital! St. Göran Hospital is owned by Capio, a for-profit company that provides hospital, radiology, laboratory, and other healthcare services in eight European countries. Thus, it demonstrates how private sector Lean-based innovation and execution is advancing patient care in Sweden. In fact, St. Göran Hospital was sold to Capio by the Swedish health system at the beginning of this decade specifically to be a demonstration site to show other healthcare providers in Sweden how private sector initiative could produce innovation that improves the quality of care while lowering the cost of care.

In his presentation at Lab Quality Confab this morning, Tom M. Pettersson, Ph.D., Head of Development, for Capio Diagnostics/Unilabs at St. Görans Hospital, shared how Lean methods are being used to boost performance in each of the clinical departments, which then do inter-disciplinary Lean improvement projects as integrated teams. Step one, earlier this decade, was to make over the laboratory with an exhaustive application of Lean methods and principles. During this phase, process-ordered production was instituted throughout the laboratory, along with targeted automation solutions. At the same time, staffing was reorganized and laboratory staff satisfaction became a regularly measured attribute. The result was a significant contribution to clinical care through shortened turnaround times, improved quality, and significant reductions in errors.

But what captured the audience’s attention was Pettersson’s fascinating explanation of how, at the next phase, laboratory services played a role in improving work processes in the primary care and inpatient care continuums. Again, Lean methods and techniques were used to realign processes to respond to the voice of the customer while improving outcomes. Pettersson spoke at length about how this was accomplished in the Emergency Department (ED), in a project originally launched in 2005.

Lean techniques were used to address five targeted problems in the ED:

1.   We do too few things in parallel-this increases waiting time and reduces value.

2.   The best competences examine too few patients and that too late.

3.   Lack of coordination and routines.

4.   Working hours of doctors not synchronized with patient flows.

5.   There is much distractions and waste (Muda) in doctors’ work

These problems are common to emergency departments in hospitals in this country. What distinguishes the ED at St. Goran’s Hospital from most of their American hospital peers is how the use of Lean methods has improved the performance of its emergency department. Pettersson explained how the following six Lean approaches were utilized to change work flow through the ED, with impressive gains in patient throughput, outcomes, and reduced costs:

1.   Link activities-to recognize problems early.

2.   Activities in parallel-to gain time.

3.   Pull-next step in chain is prepared to receive the patient.

4.   Visualize-everyone sees what must be done.

5.   Takting (takt time) the flow-improve the working environment.

6.   Standardize-that we can see problems to solve (waste to eliminate).

What captured the audience’s attention was the range of solutions that were inspired by use of these Lean methods. For example, like most hospitals, C discharged the vast majority of its patients daily during the late morning and early afternoon-a batch mindset that has been changed. Now the hospital has a continuous flow of patients into and out of wards across the day and the evening. This has helped the emergency department move patients more effectively from presentation to treatment and either discharge or admit.

This is just one example of how Lean-inspired thinking lead to an unorthodox, but highly-effective solution to a problem common in most hospitals across the globe. That’s been the theme in presentations this morning, which included the laboratory profession’s first public look at the “smart room” developed at University of Pittsburgh (UPMC) . There will be more to come on events unfolding at this week’s Lab Quality Confab.

Regards,

Robert Michel
Dark Daily Editor