Color-coded wristbands are becoming a standard hospital best practice. The challenge is getting all hospitals to use wristbands in the same way. I wrote last summer about such an effort in Arizona.
Now comes a report from The People’s Defender that a similar effort is taking place in Ohio.
Adams County Regional Medical Center is joining other hospitals, nursing homes, ambulatory facilities and emergency medical services across the state in standardizing wristbands used to identify certain patient conditions, such as allergies or the risk for falls, as recommended by the Ohio Patient Safety Institute (OPSI)…
According to a survey of Ohio hospitals, home health agencies, nursing homes and ambulatory surgical centers conducted in November 2006 by an OPSI-created task force, health care providers have been using 19 different colors with 28 different meanings.
Band Color Communicates: white/clear - patient identification; red - allergy; yellow - fall risk; and green - blood product.
ACRMC plans to implement the new statewide standard on March 10, following health information system updates and detailed staff training.
The state-mandated wristband color for DNR (Do Not Resuscitate) is currently undergoing review, with a recommendation from OPSI pending.
The statewide wristband standardization is endorsed by the Ohio Patient Safety Institute, Ohio Hospital Association, Ohio State Medical Association, Ohio Osteopathic Association and Ohio Board of Nursing, Ohio Academy of Nursing Homes and Association of Ohio Philanthropic Homes, Housing and Services for the Aging.
One question: Is there some way of developing a national standard?
3.28.2008
Understanding Customers Predicts the Future of the Auto Industry
When people, myself included, sing the praises of Toyota, we tend to focus on how its lean approach has enabled the company to streamline its processes.
In everything from auto assembly to marketing to logistics, Toyota has found ways to eliminate waste and focus with laser-like intensity on providing value for its customers.
But we tend to spend too little time on the fact that a successful lean strategy first involves understanding your customers. You can’t create value for them unless you have a solid grasp of what value means to them. To do that, you need to know who they are and what they care about.
And is that is perhaps where Toyota excels the most.
This thought was reinforced during the recent Automotive News World Congress as I listened to a presentation by Mark Templin, group vice president and general manager for Lexus. Templin spent more time than any other speaker discussing customers (which has generally been the case almost every time I have heard a conference speaker from Toyota).
The automaker invests considerable time and effort in learning about its customers, both by speaking with them and by researching demographic trends. Templin used this knowledge to lay out a clear and compelling picture of the trends Toyota believes will shape American auto sales in the future.
One trend Templin discussed is what he called the “new urbanization” – people moving back into major cities, and the creation of “new” downtown, mixed-use areas in suburbs. As a result, he said, vehicles are “morphing into multifunctional tools.” On the daily commute (which averages 50 minutes), he explained, “some people use the time to make calls, have their email read or dictate messages… Others use built-in DVD players as entertainment hubs for children… Commuters… want features that increase comfort and safety, save time and keep them in touch with their work, home and family. And those living in urban areas must deal with smaller parking areas as well as narrow and crowded streets. As a result, many residents will want personal use vehicles and new transportation options, like shared-use car programs.”
Templin also talked about the changing age demographics of car buyers. While more than half of Toyota’s customers have been, and will continue to be, Baby Boomers, generations X and Y – a total of 124 million people born between 1965 and 1994 – are becoming more important. They already represent more than one-third of the driving population.
The skepticism these buyers have for traditional advertising and marketing requires changes – launching vehicles by going to the consumers in their communities, at NASCAR events for Toyota truck buyers, Hot Import Nights for Scion buyers, and a race track test drive for Lexus buyers. It also means making it far easier for buyers to research cars online, offering 24/7 service centers and shorter sales negotiations. Some Lexus dealers are picking up and delivering cars from their customers’ homes or offices for servicing.
Toyota doesn’t have a monopoly on understanding customers. They just seem to be better at it than everyone else.
In everything from auto assembly to marketing to logistics, Toyota has found ways to eliminate waste and focus with laser-like intensity on providing value for its customers.
But we tend to spend too little time on the fact that a successful lean strategy first involves understanding your customers. You can’t create value for them unless you have a solid grasp of what value means to them. To do that, you need to know who they are and what they care about.
And is that is perhaps where Toyota excels the most.
This thought was reinforced during the recent Automotive News World Congress as I listened to a presentation by Mark Templin, group vice president and general manager for Lexus. Templin spent more time than any other speaker discussing customers (which has generally been the case almost every time I have heard a conference speaker from Toyota).
The automaker invests considerable time and effort in learning about its customers, both by speaking with them and by researching demographic trends. Templin used this knowledge to lay out a clear and compelling picture of the trends Toyota believes will shape American auto sales in the future.
One trend Templin discussed is what he called the “new urbanization” – people moving back into major cities, and the creation of “new” downtown, mixed-use areas in suburbs. As a result, he said, vehicles are “morphing into multifunctional tools.” On the daily commute (which averages 50 minutes), he explained, “some people use the time to make calls, have their email read or dictate messages… Others use built-in DVD players as entertainment hubs for children… Commuters… want features that increase comfort and safety, save time and keep them in touch with their work, home and family. And those living in urban areas must deal with smaller parking areas as well as narrow and crowded streets. As a result, many residents will want personal use vehicles and new transportation options, like shared-use car programs.”
Templin also talked about the changing age demographics of car buyers. While more than half of Toyota’s customers have been, and will continue to be, Baby Boomers, generations X and Y – a total of 124 million people born between 1965 and 1994 – are becoming more important. They already represent more than one-third of the driving population.
The skepticism these buyers have for traditional advertising and marketing requires changes – launching vehicles by going to the consumers in their communities, at NASCAR events for Toyota truck buyers, Hot Import Nights for Scion buyers, and a race track test drive for Lexus buyers. It also means making it far easier for buyers to research cars online, offering 24/7 service centers and shorter sales negotiations. Some Lexus dealers are picking up and delivering cars from their customers’ homes or offices for servicing.
Toyota doesn’t have a monopoly on understanding customers. They just seem to be better at it than everyone else.
3.26.2008
Using Technology to Eliminate Waste
While lean advocates are sometimes suspicious of technology, I am a believer in the idea that IT can be an enabler of lean. IT, of course, does not by itself improve processes, and it is almost always better to work on the processes first. But technology is necessary to any business, and IT – properly used – can be a part of a lean strategy.
One person who understands this is Dr. John Halamka, chief information officer of the CareGroup Health System as well as CIO and dean for technology at Harvard Medical School. He writes an excellent blog, “Life as a Healthcare CIO.”
In a recent posting, Dr. Halamka talked about progress in the year since his organization went live with electronic prescriptions, in an effort through a statewide health information exchange collaboration of payers and providers.
To his credit, he notes that his group did much more than simply adopt new technology when implementing the initiative.
We had to redefine workflows, cleanup old prescription data and refine the our existing applications to adapt to the new features of e-Prescribing (eligibility checking, formulary enforcement, medication history display and prescription routing).
More to the point, he describes some results after one year.
1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We've reduced this to 80/day and we'll further reduce this to 30/day by next month when all residents go live with e-Prescribing.
2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.
3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.
4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing,rxs travel quickly to pharmacies verses up to 2 days for the rx to be called to the pharmacy.
5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for "communication errors."
Here we see elimination of wasted time, elimination of opportunities for errors, improvement in quality (accuracy), and improved customer (patient) satisfaction. And that is in addition to better use of staff resources. These are all the kinds of results that ought to come from a lean initiative.
This should serve as a model for other organizations, both in healthcare and in other industries.
One person who understands this is Dr. John Halamka, chief information officer of the CareGroup Health System as well as CIO and dean for technology at Harvard Medical School. He writes an excellent blog, “Life as a Healthcare CIO.”
In a recent posting, Dr. Halamka talked about progress in the year since his organization went live with electronic prescriptions, in an effort through a statewide health information exchange collaboration of payers and providers.
To his credit, he notes that his group did much more than simply adopt new technology when implementing the initiative.
We had to redefine workflows, cleanup old prescription data and refine the our existing applications to adapt to the new features of e-Prescribing (eligibility checking, formulary enforcement, medication history display and prescription routing).
More to the point, he describes some results after one year.
1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We've reduced this to 80/day and we'll further reduce this to 30/day by next month when all residents go live with e-Prescribing.
2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.
3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.
4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing,rxs travel quickly to pharmacies verses up to 2 days for the rx to be called to the pharmacy.
5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for "communication errors."
Here we see elimination of wasted time, elimination of opportunities for errors, improvement in quality (accuracy), and improved customer (patient) satisfaction. And that is in addition to better use of staff resources. These are all the kinds of results that ought to come from a lean initiative.
This should serve as a model for other organizations, both in healthcare and in other industries.
3.24.2008
Lean and Schbert’s Unfinished Symphony
A friend forwarded this to me. I thought all you lean devotees would enjoy it.
-----------------------------
A company chairman was given a ticket for a performance of Schubert's Unfinished Symphony. Since he was unable to go, he passed the invitation to the company's Quality Assurance Manager.
The next morning, the chairman asked him how he enjoyed it and, instead of a few plausible observations, he was handed a memorandum:
1. For a considerable period, the oboe players had nothing to do. Their number should be reduced, and their work spread over the whole orchestra, thus avoiding peaks of inactivity.
2. All twelve violins were playing identical notes. This seems unnecessary duplicative, and the staff of this section should be drastically cut. If a large volume of sound is really required, this could be obtained through the use of an amplifier.
3. Much effort was involved in playing the demi-semiquavers. This seems an excessive refinement, and it is recommended that all notes should be rounded up to the nearest semiquaver. If this were done, it would be possible to use trainees instead of craftsmen.
4. No useful purpose is served by repeating with horns the passage that has already been handled by the strings. If all such redundant passages were eliminated, the concert could be reduced from two hours to twenty minutes.
In light of the above, one can only conclude that had Schubert given proper attention to these matters, he probably would have had the time to finish his symphony.
-----------------------------
A company chairman was given a ticket for a performance of Schubert's Unfinished Symphony. Since he was unable to go, he passed the invitation to the company's Quality Assurance Manager.
The next morning, the chairman asked him how he enjoyed it and, instead of a few plausible observations, he was handed a memorandum:
1. For a considerable period, the oboe players had nothing to do. Their number should be reduced, and their work spread over the whole orchestra, thus avoiding peaks of inactivity.
2. All twelve violins were playing identical notes. This seems unnecessary duplicative, and the staff of this section should be drastically cut. If a large volume of sound is really required, this could be obtained through the use of an amplifier.
3. Much effort was involved in playing the demi-semiquavers. This seems an excessive refinement, and it is recommended that all notes should be rounded up to the nearest semiquaver. If this were done, it would be possible to use trainees instead of craftsmen.
4. No useful purpose is served by repeating with horns the passage that has already been handled by the strings. If all such redundant passages were eliminated, the concert could be reduced from two hours to twenty minutes.
In light of the above, one can only conclude that had Schubert given proper attention to these matters, he probably would have had the time to finish his symphony.
3.21.2008
Quality Assurance: Another Challenge for Boeing’s 787 Dreamliner
The problems and delays plaguing development and construction of Boeing’s 787 Dreamliner continue. The latest, as reported by Jon Ostrower on Flightblogger, have to do with problems in processes for quality assurance.
The milestone known as “power-on” of the first aircraft, scheduled for as early as mid-April, may be pushed back to June.
According to program sources, the slow pace of work in recent months can largely be attributed to what are known as rejection tags. Those tags occur when a discrepancy exists between the design and the product. For example, during the normal manufacturing process, holes are drilled to install fasteners. Occasionally, those holes have to be drilled a second time if there is an issue with the first hole. As a result, the hole is considered to be “non-conforming” requiring a larger diameter fastener and must be checked through a quality certification process.
One foundational tenet of the 787 program, according to program sources working with the aircraft, was the idea of a “super-mechanic” who held all the necessary certifications to self check work to appropriate airworthiness standards.
According to sources across the program, over the past year of assembly the self-certification process has become an impediment to progress rather than an enabler of efficiency.
As a result, the 787 program has begun to shift from a system of self-certifying manufacturing staff to a more traditional system of quality assurance similar to Boeing’s legacy programs. The revised system is first being implemented for out-of-sequence traveled work and is expected to be expanded to the entire final assembly process.
The revised system is a “positive step,” says one person working with the aircraft.
By using its traditional quality assurance system, Boeing is able to better control and group the number of rejection tags to reduce paperwork and solution time. For example, under the original system, four non-conforming holes in the same area of the aircraft were filed as four individual issues rather than just one. The new system would streamline the process by grouping these rejection tags together, cutting paperwork, in this example, by 75%.
Quality assurance is not my area of expertise, so I’m not sure which of these two systems is more “lean” or ought to be better. However, I have to wonder why Boeing, which has long experience in trying to make its processes lean, chose to adopt a new system for this aircraft.
Also, I wonder whether anyone is doing some serious root-cause analysis to figure out why these discrepancies between design and product take place, and what can be done to eliminate them, or at least reduce their frequency.
Meanwhile, Ostrower also reports significant variability regarding how much further work is required after major suppliers of the Dreamliner deliver key sections.
If you walk from one end to another, Dreamliner Two looks like a, “Timeline from nose to tail. The farther you go back, the more work it needs,” says a 787 program staffer. The front of the aircraft, Section 41, the nose section, was delivered from Spirit Aerosystems in Wichita, Kansas 97% complete, according to program sources in Everett.
The center fuselage, say sources in Charleston, which is assembled at Global Aeronautica in Charleston contained significant wiring, flight test equipment, ducting, systems and insulation in the forward Section 43 and the center wing box, but significantly less in Sections 44 and 46 toward the rear of the aircraft.
The aft fuselage, Sections 47 and 48, which is manufactured and assembled by Vought Aircraft Industries, is the largest source of traveled work, according to sources in Everett and Charleston. The aft fuselage, which was delivered in early February, had roughly a dozen jobs remaining before it could be considered structurally complete. It lacked any wiring, ducting, insulation or systems when it departed Charleston for Everett.
First, this problem reinforces the questions raised about Boeing’s strategy of outsourcing so much of the airplane’s development to far-flung suppliers. Second, it highlights the need in any supply chain for close working relationships between partners to avoid major surprises.
The hundreds of Dreamliners that have been ordered will ultimately be built. Unfortunately, it appears that many of Boeing’s customers may be waiting for them longer than anyone had thought, and probably longer than necessary.
The milestone known as “power-on” of the first aircraft, scheduled for as early as mid-April, may be pushed back to June.
According to program sources, the slow pace of work in recent months can largely be attributed to what are known as rejection tags. Those tags occur when a discrepancy exists between the design and the product. For example, during the normal manufacturing process, holes are drilled to install fasteners. Occasionally, those holes have to be drilled a second time if there is an issue with the first hole. As a result, the hole is considered to be “non-conforming” requiring a larger diameter fastener and must be checked through a quality certification process.
One foundational tenet of the 787 program, according to program sources working with the aircraft, was the idea of a “super-mechanic” who held all the necessary certifications to self check work to appropriate airworthiness standards.
According to sources across the program, over the past year of assembly the self-certification process has become an impediment to progress rather than an enabler of efficiency.
As a result, the 787 program has begun to shift from a system of self-certifying manufacturing staff to a more traditional system of quality assurance similar to Boeing’s legacy programs. The revised system is first being implemented for out-of-sequence traveled work and is expected to be expanded to the entire final assembly process.
The revised system is a “positive step,” says one person working with the aircraft.
By using its traditional quality assurance system, Boeing is able to better control and group the number of rejection tags to reduce paperwork and solution time. For example, under the original system, four non-conforming holes in the same area of the aircraft were filed as four individual issues rather than just one. The new system would streamline the process by grouping these rejection tags together, cutting paperwork, in this example, by 75%.
Quality assurance is not my area of expertise, so I’m not sure which of these two systems is more “lean” or ought to be better. However, I have to wonder why Boeing, which has long experience in trying to make its processes lean, chose to adopt a new system for this aircraft.
Also, I wonder whether anyone is doing some serious root-cause analysis to figure out why these discrepancies between design and product take place, and what can be done to eliminate them, or at least reduce their frequency.
Meanwhile, Ostrower also reports significant variability regarding how much further work is required after major suppliers of the Dreamliner deliver key sections.
If you walk from one end to another, Dreamliner Two looks like a, “Timeline from nose to tail. The farther you go back, the more work it needs,” says a 787 program staffer. The front of the aircraft, Section 41, the nose section, was delivered from Spirit Aerosystems in Wichita, Kansas 97% complete, according to program sources in Everett.
The center fuselage, say sources in Charleston, which is assembled at Global Aeronautica in Charleston contained significant wiring, flight test equipment, ducting, systems and insulation in the forward Section 43 and the center wing box, but significantly less in Sections 44 and 46 toward the rear of the aircraft.
The aft fuselage, Sections 47 and 48, which is manufactured and assembled by Vought Aircraft Industries, is the largest source of traveled work, according to sources in Everett and Charleston. The aft fuselage, which was delivered in early February, had roughly a dozen jobs remaining before it could be considered structurally complete. It lacked any wiring, ducting, insulation or systems when it departed Charleston for Everett.
First, this problem reinforces the questions raised about Boeing’s strategy of outsourcing so much of the airplane’s development to far-flung suppliers. Second, it highlights the need in any supply chain for close working relationships between partners to avoid major surprises.
The hundreds of Dreamliners that have been ordered will ultimately be built. Unfortunately, it appears that many of Boeing’s customers may be waiting for them longer than anyone had thought, and probably longer than necessary.
3.19.2008
Jet Fighter Program Keeps Crashing and Burning
This falls into the category of “yeah, right.” Or maybe “did he really say that?”
A new report from the Government Accountability Office says the cost of buying and operating a new fleet of jet fighters is nearing $1 trillion because of price increases and inefficiencies in the program.
The plane in question is the F-35 Lightning II, also known as the Joint Strike Fighter. The plane is for several military services, with different models going to the Air Force, Navy and Marines. Lockheed Martin is the prime contractor.
According to a story from the Associated Press,
Operating costs, projected at $346 billion just a few years ago, have been driven upward by changes in repair plans, revised costs for depot maintenance, higher fuel costs and increased fuel consumption.
The GAO's auditors said they expect development and procurement costs "to increase substantially and schedule pressures to worsen based on performance to date..."
Auditors criticized both the military and the contractor for pressing into the jet's development's phase before key technologies were mature, started manufacturing test aircraft before designs were stable, and moved to production before flight tests showed the aircraft was ready.
"We do not know the basis for the GAO estimates and until we receive and analyze their data we will be unable to comment on them," Lockheed spokesman John Smith said in an e-mailed statement.
It is the next part of the story that raises my level of skepticism:
Smith, however, said the company has been careful stewards of U.S. tax dollars by trimming costs wherever possible.
"We continue to apply the same kind of oversight, budget alignment and lean thinking to the program," he said.
Lean thinking? Really? I have to believe that if there were a truly a lean mindset on the part of all the people involved in this project, the problem wouldn’t be so bad. For example, in a truly lean process that had all steps in proper order, manufacturing of test aircraft would not begin before designs were stable, and production would not begin before the aircraft was ready.
Am I overreacting? What do you think?
A new report from the Government Accountability Office says the cost of buying and operating a new fleet of jet fighters is nearing $1 trillion because of price increases and inefficiencies in the program.
The plane in question is the F-35 Lightning II, also known as the Joint Strike Fighter. The plane is for several military services, with different models going to the Air Force, Navy and Marines. Lockheed Martin is the prime contractor.
According to a story from the Associated Press,
Operating costs, projected at $346 billion just a few years ago, have been driven upward by changes in repair plans, revised costs for depot maintenance, higher fuel costs and increased fuel consumption.
The GAO's auditors said they expect development and procurement costs "to increase substantially and schedule pressures to worsen based on performance to date..."
Auditors criticized both the military and the contractor for pressing into the jet's development's phase before key technologies were mature, started manufacturing test aircraft before designs were stable, and moved to production before flight tests showed the aircraft was ready.
"We do not know the basis for the GAO estimates and until we receive and analyze their data we will be unable to comment on them," Lockheed spokesman John Smith said in an e-mailed statement.
It is the next part of the story that raises my level of skepticism:
Smith, however, said the company has been careful stewards of U.S. tax dollars by trimming costs wherever possible.
"We continue to apply the same kind of oversight, budget alignment and lean thinking to the program," he said.
Lean thinking? Really? I have to believe that if there were a truly a lean mindset on the part of all the people involved in this project, the problem wouldn’t be so bad. For example, in a truly lean process that had all steps in proper order, manufacturing of test aircraft would not begin before designs were stable, and production would not begin before the aircraft was ready.
Am I overreacting? What do you think?
3.17.2008
The Quaid Infants: Blame the Processes
Last night, the CBS program “60 Minutes” did a nice job discussing process failures that led to the near-death last November of the newborn twins of actor Dennis Quaid and his wife Kimberly.
While the Quaid story is not new, many of the early news reports last fall focused on the fact that nurses gave the babies the wrong drug. However, the ”60 Minutes” report, presented by Steve Kroft, made it clear that this was not simply a case of human error, but the result of problems in the processes.
Much of the report focused on Baxter Healthcare, which makes the blood-thinner Heparin. The babies were supposed to receive a pediatric version of the drug, called Hep-Lock, but instead received the adult medicine Heparin – which is 1,000 times stronger. And they received it twice.
The babies survived, and apparently with no long-term damage, but only because doctors and nurses struggled for several days after the errors were discovered to fight the massive bleeding that was starting to occur.
The two different medicines were distributed in vials of identical size with near-identical, hard-to-read labels. Baxter has since redesigned one of the labels, but initially did not recall the old vials.
“60 Minutes” also pointed out that there are other medications where similar packaging causes confusion. In regard to Heparin, the report included a comment from Diane Cousins, vice president of U.S. Pharmacopeia, a non-profit public health group that maintains one of the largest databases on medication errors.
"What we see with Heparin is that it is almost always in the list of top ten drugs that are reported for medication errors, and almost always in the top ten that are harmful."
And in fact, there have been similar incidents elsewhere in the country where infants died.
Has anyone here ever heard of visual controls?
The Quaids are suing Baxter, but not the hospital.
"You haven't sued the hospital even though they're - all sorts of reports have been done and the hospital has acknowledged serious mistakes," Kroft asks Dennis Quaid.
"I'd like to see Cedar Sinai take the lead in doing something to change what's going on in what I consider to, in the end, a broken healthcare system in patient medical care," the actor says.
Quaid calls it a conspiracy of silence, where doctors protect nurses, nurses protect hospitals, insurance companies protect drug manufacturers. Almost no one, he says, is aggressively trying to find ways to eliminate medical mistakes. So the Quaids are in the final stages of launching a foundation they hope will help remedy a situation that almost destroyed their lives.
At least some hospitals are moving beyond that conspiracy of silence to improve their processes. Let’s hope more do so.
While the Quaid story is not new, many of the early news reports last fall focused on the fact that nurses gave the babies the wrong drug. However, the ”60 Minutes” report, presented by Steve Kroft, made it clear that this was not simply a case of human error, but the result of problems in the processes.
Much of the report focused on Baxter Healthcare, which makes the blood-thinner Heparin. The babies were supposed to receive a pediatric version of the drug, called Hep-Lock, but instead received the adult medicine Heparin – which is 1,000 times stronger. And they received it twice.
The babies survived, and apparently with no long-term damage, but only because doctors and nurses struggled for several days after the errors were discovered to fight the massive bleeding that was starting to occur.
The two different medicines were distributed in vials of identical size with near-identical, hard-to-read labels. Baxter has since redesigned one of the labels, but initially did not recall the old vials.
“60 Minutes” also pointed out that there are other medications where similar packaging causes confusion. In regard to Heparin, the report included a comment from Diane Cousins, vice president of U.S. Pharmacopeia, a non-profit public health group that maintains one of the largest databases on medication errors.
"What we see with Heparin is that it is almost always in the list of top ten drugs that are reported for medication errors, and almost always in the top ten that are harmful."
And in fact, there have been similar incidents elsewhere in the country where infants died.
Has anyone here ever heard of visual controls?
(One of our recently published books, The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota Based Methods by Naida Grunden, includes case studies of medication errors.)
It can be argued that the hospital in this case, Cedars-Sinai in Los Angeles, bears some responsible as well for processes that lack the kind of mistake-proofing that might have prevented the error. The hospital has admitted that the mistakes were avoidable.The Quaids are suing Baxter, but not the hospital.
"You haven't sued the hospital even though they're - all sorts of reports have been done and the hospital has acknowledged serious mistakes," Kroft asks Dennis Quaid.
"I'd like to see Cedar Sinai take the lead in doing something to change what's going on in what I consider to, in the end, a broken healthcare system in patient medical care," the actor says.
Quaid calls it a conspiracy of silence, where doctors protect nurses, nurses protect hospitals, insurance companies protect drug manufacturers. Almost no one, he says, is aggressively trying to find ways to eliminate medical mistakes. So the Quaids are in the final stages of launching a foundation they hope will help remedy a situation that almost destroyed their lives.
At least some hospitals are moving beyond that conspiracy of silence to improve their processes. Let’s hope more do so.
3.14.2008
What Drives Change? Follow the Money
Insurance companies pay huge amounts for healthcare. Some of them are beginning to realize it makes sense for them to pay to improve healthcare processes.
Blue Shield of California Foundation announced recently that it will spend nearly $6 million for a statewide initiative to target hospital-acquired infections.
$5.75 million, will be used to expand the foundation’s groundbreaking program to dramatically reduce the number of hospital-acquired infections (HAIs). After seeing remarkable success in its nine-hospital pilot project, BSCF will use the grant to expand its innovative California Healthcare-Associated Infection Prevention Initiative (CHAIPI) to at least 100 hospitals.
“Hospital acquired infections put lives at risk and increase consumer costs. We want to dramatically reduce those risks by ensuring hospitals have access to innovative new technologies that help pinpoint and stop the spread of infections,” said Crystal Hayling, president and CEO of BSCF. “Given the results we saw in our test program, we expect the broad expansion of this effort to mean 4,000 fewer patients will contract an HAI in the next year, which translates into 30,000 fewer patient days in the hospital, $60 million in avoided costs to patients and hospitals, and nearly $15 million in bottom-line hospital savings.”
In California, an estimated 150,000 patients suffer from HAIs annually, 9,000 of which result in death. Through CHAIPI, participating hospitals will receive support for new technology and collaborative learning opportunities about best practices. While only not-for-profit hospitals can receive funding, this grant is unique because for-profit hospitals are invited to participate in the collaborative learning sessions and will have the opportunity to purchase the technology at a reduced price.
I don’t know how much of the effort will focus on technology vs. best practices. I hope best practices gets more.
Blue Shield of California Foundation announced recently that it will spend nearly $6 million for a statewide initiative to target hospital-acquired infections.
$5.75 million, will be used to expand the foundation’s groundbreaking program to dramatically reduce the number of hospital-acquired infections (HAIs). After seeing remarkable success in its nine-hospital pilot project, BSCF will use the grant to expand its innovative California Healthcare-Associated Infection Prevention Initiative (CHAIPI) to at least 100 hospitals.
“Hospital acquired infections put lives at risk and increase consumer costs. We want to dramatically reduce those risks by ensuring hospitals have access to innovative new technologies that help pinpoint and stop the spread of infections,” said Crystal Hayling, president and CEO of BSCF. “Given the results we saw in our test program, we expect the broad expansion of this effort to mean 4,000 fewer patients will contract an HAI in the next year, which translates into 30,000 fewer patient days in the hospital, $60 million in avoided costs to patients and hospitals, and nearly $15 million in bottom-line hospital savings.”
In California, an estimated 150,000 patients suffer from HAIs annually, 9,000 of which result in death. Through CHAIPI, participating hospitals will receive support for new technology and collaborative learning opportunities about best practices. While only not-for-profit hospitals can receive funding, this grant is unique because for-profit hospitals are invited to participate in the collaborative learning sessions and will have the opportunity to purchase the technology at a reduced price.
I don’t know how much of the effort will focus on technology vs. best practices. I hope best practices gets more.
3.12.2008
Lean Approaches Make Deere a Global Success
At a time when outsourcing to countries with cheaper labor is all the rage, and when many people believe we are or soon will be in a recession, it is nice to hear about a company that is expanding an existing facility in the U.S.
Deere & Company, a well-known name in heavy equipment, announced last week that it will invest an additional $90 million in its facility in Waterloo, Iowa, which makes large tractors.
Deere is a company with a history of embracing lean strategies. We once sold a video about lean supply chain at John Deere.
Perhaps the best evidence of this is what Deere expects to achieve with its new investment. According to the company news release,
Although the investment will not add floor space to current Deere facilities, it will increase the company's Waterloo capacity to build large, high-horsepower tractors by about 25 percent. The improvements will be substantially completed by early 2010, the company said. The investment will include additional machine tooling, new manufacturing technology, and improved work processes as well as replacement of the current paint system.
Think about that: a 25 percent increase in capacity with no new floor space. Fantastic!
Deere is by no means just a U.S. manufacturer; it is a global company. In fact, the day after announcing the Waterloo expansion, Deere announced a new joint venture in China to build construction equipment there. (Deere already builds agricultural equipment in China.)
Deere has positioned itself well, with complex, expensive products in high demand globally. But it also has been able to expand with growing demand in an efficient way because of lean strategies.
Deere & Company, a well-known name in heavy equipment, announced last week that it will invest an additional $90 million in its facility in Waterloo, Iowa, which makes large tractors.
Deere is a company with a history of embracing lean strategies. We once sold a video about lean supply chain at John Deere.
Perhaps the best evidence of this is what Deere expects to achieve with its new investment. According to the company news release,
Although the investment will not add floor space to current Deere facilities, it will increase the company's Waterloo capacity to build large, high-horsepower tractors by about 25 percent. The improvements will be substantially completed by early 2010, the company said. The investment will include additional machine tooling, new manufacturing technology, and improved work processes as well as replacement of the current paint system.
Think about that: a 25 percent increase in capacity with no new floor space. Fantastic!
Deere is by no means just a U.S. manufacturer; it is a global company. In fact, the day after announcing the Waterloo expansion, Deere announced a new joint venture in China to build construction equipment there. (Deere already builds agricultural equipment in China.)
Deere has positioned itself well, with complex, expensive products in high demand globally. But it also has been able to expand with growing demand in an efficient way because of lean strategies.
3.10.2008
Coping with Supply Chain Complexity
Supply chains are more complex, consumers are demanding more, and costs are increasing. Can lean help?
I believe so, but first let me explain why I raise this question. Supply chain complexity is the focus of an article in a recent edition of GMA Forum, published by the Grocery Manufacturers Association. The article, by two top executives of Archstone Consulting, describes a survey the consulting firm conducted of leading CPG (consumer packaged goods) companies.
Their findings:
Overall, CPG companies are struggling with rising complexity and the traditional solutions to the problem aren’t getting the job done. The industry is bailing water and the boat is filling up faster.
■ Most respondents cite growing supply chain complexity as one of the most challenging issues they face.
■ All respondents cite their lack of understanding of the costs of complexity as a key gap.
■ Almost all respondents see customer demands, not consumer needs, as the key driver of increased complexity.
■ Most of the respondents demonstrate a pattern of trying many different things to mitigate the negative impacts of complexity and without much success. (Key learning: A shotgun blast won’t tame this tiger!)
■ In general, respondents estimate that rising supply chain complexity costs their businesses between five percent and 10 percent-plus on their bottom line. Given the overall growth of CPG at roughly three percent per year, and average margins for the industry, this is a potentially losing proposition.
Complexity, in this case, refers to the never-ending increase in the number of different products companies develop and sell. Also, “customer demands” refers to a Wal-Mart or other large company “requesting” the manufacturer to develop something new.
The article does note improvements in supply chain operations:
In its most recent logistics study, the GMA reported that order-to-delivery cycle times have dropped from an average of 7.8 days in 1999 to 3.6 days in 2004, with the goal to reach 3.1 days in 2007.
But costs – as a result of complexity – remain a problem. What can be done? The authors say:
We see the emergence of a new kind of supply chain; an innovation-driven supply chain capable of capitalizing on market opportunities to provide consumers with unprecedented levels of personalized customization and choice.
I don’t disagree. But the authors fail to discuss HOW these new innovation-driven supply chains are going to handle all this complexity. What is needed here is a strong focus on the processes of a supply chain, with an application of lean strategies and methods to make sure those processes remain focused on value with as little waste as possible.
(Kanban for the Supply Chain: Fundamental Practices for Manufacturing Management by Stephen Cimorelli is one of many books we publish in this area, with more on the way.)
How is your company coping with supply chain complexity? Post your comments below.
I believe so, but first let me explain why I raise this question. Supply chain complexity is the focus of an article in a recent edition of GMA Forum, published by the Grocery Manufacturers Association. The article, by two top executives of Archstone Consulting, describes a survey the consulting firm conducted of leading CPG (consumer packaged goods) companies.
Their findings:
Overall, CPG companies are struggling with rising complexity and the traditional solutions to the problem aren’t getting the job done. The industry is bailing water and the boat is filling up faster.
■ Most respondents cite growing supply chain complexity as one of the most challenging issues they face.
■ All respondents cite their lack of understanding of the costs of complexity as a key gap.
■ Almost all respondents see customer demands, not consumer needs, as the key driver of increased complexity.
■ Most of the respondents demonstrate a pattern of trying many different things to mitigate the negative impacts of complexity and without much success. (Key learning: A shotgun blast won’t tame this tiger!)
■ In general, respondents estimate that rising supply chain complexity costs their businesses between five percent and 10 percent-plus on their bottom line. Given the overall growth of CPG at roughly three percent per year, and average margins for the industry, this is a potentially losing proposition.
Complexity, in this case, refers to the never-ending increase in the number of different products companies develop and sell. Also, “customer demands” refers to a Wal-Mart or other large company “requesting” the manufacturer to develop something new.
The article does note improvements in supply chain operations:
In its most recent logistics study, the GMA reported that order-to-delivery cycle times have dropped from an average of 7.8 days in 1999 to 3.6 days in 2004, with the goal to reach 3.1 days in 2007.
But costs – as a result of complexity – remain a problem. What can be done? The authors say:
We see the emergence of a new kind of supply chain; an innovation-driven supply chain capable of capitalizing on market opportunities to provide consumers with unprecedented levels of personalized customization and choice.
I don’t disagree. But the authors fail to discuss HOW these new innovation-driven supply chains are going to handle all this complexity. What is needed here is a strong focus on the processes of a supply chain, with an application of lean strategies and methods to make sure those processes remain focused on value with as little waste as possible.
(Kanban for the Supply Chain: Fundamental Practices for Manufacturing Management by Stephen Cimorelli is one of many books we publish in this area, with more on the way.)
How is your company coping with supply chain complexity? Post your comments below.
3.07.2008
Hospital Improvement Efforts Target Blood Clots
Much of the reporting I’ve seen so far about improving processes has health care has focused either on eliminating time wasted – i.e., improving patient flow – or on reducing or eliminating medical errors and problems, such as incorrect medications, incorrect surgery, infections, and so on.
A recent story in the Philadelphia Inquirer falls into the second category, but it focuses on a problem I hadn’t seen mentioned in previous stories: blood clots.
In 2006, more than 2,000 surgery patients at hospitals in Philadelphia and its Pennsylvania suburbs developed blood clots. That was 14 cases for every 1,000 of those patients, according to an Inquirer analysis of billing records. A decade earlier, the rate was 9 cases per 1,000 surgical patients…
Chester County Hospital is trying to reduce that risk. Last year, it was one of 13 hospitals that participated in a regional effort to lower the incidence of postsurgical venous thromboembolism (VTE) - blood clots that obstruct flow in vessels of either a leg (deep vein thrombosis) or a lung (pulmonary emboli).
The hospitals were part of a broader quality-improvement campaign by the Partnership for Patient Care, a collaborative of local health-care institutions that also worked to reduce patients' falls in the hospitals and confusion when their prescriptions change.
Every year, local hospitals take on one or more of the partnership's initiatives. The choices for 2008: eliminating wrong-site surgery, standardizing the reporting of falls, and preventing bed sores. The collaborative helps hospitals identify and implement so-called best practices - those known to improve patient outcomes…
All the hospital systems in Southeastern Pennsylvania took part in at least one of last year's quality-improvement initiatives, and detailed surveys conducted at the start and end of the six-month programs suggest increased use of the best practices.
A true measure of success - actual data on, say, how many patients develop blood clots after surgery - isn't yet available.
Meanwhile, the day-to-day challenge is making sure that the correct actions are taken with every patient before, during and after surgery.
One example of best practices related to blood clots is to make sure that every surgery patient (or at least those having leg, knee or hip surgery) wears a so-called “compression stocking,” which prevents blood from accumulating in the leg. The relevant lean concept is standard work – making sure something is done exactly the same way every time.
It’s good to know more hospitals are moving in the right direction.
A recent story in the Philadelphia Inquirer falls into the second category, but it focuses on a problem I hadn’t seen mentioned in previous stories: blood clots.
In 2006, more than 2,000 surgery patients at hospitals in Philadelphia and its Pennsylvania suburbs developed blood clots. That was 14 cases for every 1,000 of those patients, according to an Inquirer analysis of billing records. A decade earlier, the rate was 9 cases per 1,000 surgical patients…
Chester County Hospital is trying to reduce that risk. Last year, it was one of 13 hospitals that participated in a regional effort to lower the incidence of postsurgical venous thromboembolism (VTE) - blood clots that obstruct flow in vessels of either a leg (deep vein thrombosis) or a lung (pulmonary emboli).
The hospitals were part of a broader quality-improvement campaign by the Partnership for Patient Care, a collaborative of local health-care institutions that also worked to reduce patients' falls in the hospitals and confusion when their prescriptions change.
Every year, local hospitals take on one or more of the partnership's initiatives. The choices for 2008: eliminating wrong-site surgery, standardizing the reporting of falls, and preventing bed sores. The collaborative helps hospitals identify and implement so-called best practices - those known to improve patient outcomes…
All the hospital systems in Southeastern Pennsylvania took part in at least one of last year's quality-improvement initiatives, and detailed surveys conducted at the start and end of the six-month programs suggest increased use of the best practices.
A true measure of success - actual data on, say, how many patients develop blood clots after surgery - isn't yet available.
Meanwhile, the day-to-day challenge is making sure that the correct actions are taken with every patient before, during and after surgery.
One example of best practices related to blood clots is to make sure that every surgery patient (or at least those having leg, knee or hip surgery) wears a so-called “compression stocking,” which prevents blood from accumulating in the leg. The relevant lean concept is standard work – making sure something is done exactly the same way every time.
It’s good to know more hospitals are moving in the right direction.
3.05.2008
Creating a Lean and Green Building
I don’t write many postings based on news releases about things that haven’t happened yet, but here’s one I couldn’t resist: Plans for construction of a manufacturing facility that is both lean and green.
HelioVolt, which makes solar products such as glass and roofing products as well as photovoltaic cells, has announced plans to renovate a facility in Austin.
The project is being developed by a team of two companies: TAG International, an architecture and land development services firm, and Harvey-Cleary Builders. TAG issued a news release about the project.
According to Dave Bowen, HelioVolt's vice president of manufacturing operations, the TAG/Harvey-Cleary team was selected from a competitive pool of design/build teams due to the flexibility in responding to HelioVolt's innovative processes, as well as TAG's in-depth experience designing specialized manufacturing facilities.
TAG's long standing interest in sustainable design and lean manufacturing expertise enables a beneficial exchange of ideas and concepts between the TAG design team and HelioVolt. In addition to TAG and Harvey-Cleary, the project design team includes EEA Engineering, whose expertise in energy efficient HVAC and electrical design will play an integral role in the project…
TAG will submit the HelioVolt project to the US Green Building Council for LEED Silver Certification. LEED (Leadership in Energy and Environmental Design) is a third-party certification designed for rating new and existing commercial, institutional and high-rise residential buildings. Austin was the first US city to require municipal buildings to seek LEED certification, and many private sector companies are now seeking LEED certification for their facilities.
In designing the HelioVolt facility, TAG will incorporate a variety of green concepts including energy efficient lighting, water usage reduction, the reuse of an existing building, construction waste management, storm water management, and energy efficient HVAC systems using enhanced refrigerant management.
TAG's design utilizes building materials with high recycled content and low VOC emissions, as well as regionally available materials. HelioVolt will encourage employees to use alternative transportation methods by providing access to public transportation, and offering bicycle storage and changing rooms at the new facility.
I’ve said before that strategies for lean and for sustainability fit well together. It’s nice to see some companies pursuing them jointly.
HelioVolt, which makes solar products such as glass and roofing products as well as photovoltaic cells, has announced plans to renovate a facility in Austin.
The project is being developed by a team of two companies: TAG International, an architecture and land development services firm, and Harvey-Cleary Builders. TAG issued a news release about the project.
According to Dave Bowen, HelioVolt's vice president of manufacturing operations, the TAG/Harvey-Cleary team was selected from a competitive pool of design/build teams due to the flexibility in responding to HelioVolt's innovative processes, as well as TAG's in-depth experience designing specialized manufacturing facilities.
TAG's long standing interest in sustainable design and lean manufacturing expertise enables a beneficial exchange of ideas and concepts between the TAG design team and HelioVolt. In addition to TAG and Harvey-Cleary, the project design team includes EEA Engineering, whose expertise in energy efficient HVAC and electrical design will play an integral role in the project…
TAG will submit the HelioVolt project to the US Green Building Council for LEED Silver Certification. LEED (Leadership in Energy and Environmental Design) is a third-party certification designed for rating new and existing commercial, institutional and high-rise residential buildings. Austin was the first US city to require municipal buildings to seek LEED certification, and many private sector companies are now seeking LEED certification for their facilities.
In designing the HelioVolt facility, TAG will incorporate a variety of green concepts including energy efficient lighting, water usage reduction, the reuse of an existing building, construction waste management, storm water management, and energy efficient HVAC systems using enhanced refrigerant management.
TAG's design utilizes building materials with high recycled content and low VOC emissions, as well as regionally available materials. HelioVolt will encourage employees to use alternative transportation methods by providing access to public transportation, and offering bicycle storage and changing rooms at the new facility.
I’ve said before that strategies for lean and for sustainability fit well together. It’s nice to see some companies pursuing them jointly.
3.03.2008
Joseph Juran – A Leader in Quality
In the world of continuous improvement, you may be most familiar with names like Shigeo Shingo, Taiichi Ohno and Edward Deming.
But let me take a moment to pay tribute to another important figure, Joseph Juran, who died Thursday at the age of 103.
Among other books, Juran, a Romanian immigrant, wrote the Quality Control Handbook, first published way back in 1951 and now entering its sixth edition. According to the obituary in The New York Times,
Mr. Juran’s work in quality management led to the development of the widely practiced business methodologies referred to as Six Sigma and lean manufacturing. He founded the Juran Institute, a training and consulting firm in Southbury, Conn.
He created the Pareto principle, also known as the 80-20 rule, which states that 80 percent of consequences stem from 20 percent of causes. Today managers use the Pareto principle, named for an Italian economist, to help them separate what Mr. Juran called the “vital few” resources from the “useful many.”
Whether Juran deserves as much credit as the Times gives him can be debated, but he certainly was an important figure in the improvement world. The Times also notes that
In a Public Broadcasting System documentary about Mr. Juran called “An Immigrant’s Gift,” Peter Drucker, the late author and management consultant, said Mr. Juran’s influence on the nation’s industrial economy could not be overstated.
But what most impresses me was Juran’s attitude.
Recently, Mr. Juran was working on an updated edition to another of his books. David Juran (his grandson) and Joseph De Feo, the Juran Institute’s chief executive, said they planned to finish the book.
“His belief was that you always have a project to keep your mind going,” Mr. De Feo said. “He always had something to do…”
Mr. Juran remained actively involved with the institute even after his official retirement in 1994. A celebration of the institute’s 25th anniversary also served as his 100th birthday party, with a cake decorated to resemble a stack of books he had written.
“He never really made a distinction between work and leisure. He enjoyed his work so much that any time he had he spent working,” David Juran said. “To him there was no such concept as retirement or a day off.”
There are many fine thinkers and writers working in continuous improvement today. Let’s hope one legacy of Joseph Juran is that he inspires even more people.
But let me take a moment to pay tribute to another important figure, Joseph Juran, who died Thursday at the age of 103.
Among other books, Juran, a Romanian immigrant, wrote the Quality Control Handbook, first published way back in 1951 and now entering its sixth edition. According to the obituary in The New York Times,
Mr. Juran’s work in quality management led to the development of the widely practiced business methodologies referred to as Six Sigma and lean manufacturing. He founded the Juran Institute, a training and consulting firm in Southbury, Conn.
He created the Pareto principle, also known as the 80-20 rule, which states that 80 percent of consequences stem from 20 percent of causes. Today managers use the Pareto principle, named for an Italian economist, to help them separate what Mr. Juran called the “vital few” resources from the “useful many.”
Whether Juran deserves as much credit as the Times gives him can be debated, but he certainly was an important figure in the improvement world. The Times also notes that
In a Public Broadcasting System documentary about Mr. Juran called “An Immigrant’s Gift,” Peter Drucker, the late author and management consultant, said Mr. Juran’s influence on the nation’s industrial economy could not be overstated.
But what most impresses me was Juran’s attitude.
Recently, Mr. Juran was working on an updated edition to another of his books. David Juran (his grandson) and Joseph De Feo, the Juran Institute’s chief executive, said they planned to finish the book.
“His belief was that you always have a project to keep your mind going,” Mr. De Feo said. “He always had something to do…”
Mr. Juran remained actively involved with the institute even after his official retirement in 1994. A celebration of the institute’s 25th anniversary also served as his 100th birthday party, with a cake decorated to resemble a stack of books he had written.
“He never really made a distinction between work and leisure. He enjoyed his work so much that any time he had he spent working,” David Juran said. “To him there was no such concept as retirement or a day off.”
There are many fine thinkers and writers working in continuous improvement today. Let’s hope one legacy of Joseph Juran is that he inspires even more people.
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