Barnes-Jewish Hospital (St. Louis) and its Lean Results

According to a recent article over on the STL Today website, Barnes-Jewish Hospital in St. Louis has seen dramatic improvements during the past five years with its "patient-centered care" approach. With the hospital's focus on value stream analyses and standardized work, the term "patient-centered care" is quite synonymous with Lean management.

According to Dr. John Lynch (vice president and chief medical officer), streamlining the hospitals preparations for surgery saved about $1 million in 2010. The hospital performs about 40,000 surgeries per year. In addition, standardizing the installation of patients' intravenous lines "lowered the hospital's central line bloodstream infection rate by 40 percent in the last year."

I think Dr. Lynch's reply to the criticism that these techniques might cause rote "cookie-cutter care" is important -- according to Dr. Lynch "we only use standardization when it makes sense." The hospital does not resemble an assembly line: "We're more like a body shop, where every car comes in with its own problems," Lynch says. "We always allow room for individual patient variation. We're not telling the surgeon where to cut."

Although Barnes-Jewish hospital has put such tools as kanban, poke-yoke, and root-cause analysis to great use, the major area for improvement is the reduction of wait time in the emergency department. Solutions here are difficult because of the dramatic increase of patient visits each year. Do any readers of this blog have some suggestions for increasing the efficiency for admitting patients? Should the focus be on decreasing the wait time or adding value to the wait time?


Anna G. said...

in my experience with patient admin CI events i've yet to see a one size fits all solution.

BJC does use the KaizenOptimizer (www.leanoptima.com) to track event success and that doubles as a way for each site to quickly see the success of a siser site.

But overall, from the patient perspective, less wait time is probably the more desirable.

John said...

I agree with Anna. Decreasing the wait time undoubtedly earns the greatest patient satisfaction. But as long as there's a need for a doctor to address a series of highly unknowns at each patient visit, there's very little commonality to the process.

For potential improvements, however, one thought would be to use the 80/20 theory - which would say that 80% of all wait time is in 20% or less of all the things that influence a patient waiting. Sit down and develop what that 20% is and then focus seeing if there's anything that can be done to make it more "patient friendly." I believe some useful ideas would surface.

Anne said...

Have the not so sick pts go to their family doctor, or outpt clinic or express care. if the docs and nurses are not inundated with chronic migraines, drug seekers, young adults with fevers of 102 brought in by squad who did nt take tylenol, etc etc. then ER staff could tend to those that really need emergency care and the satisfaction scores will go higher. and--make sure you give them the bill when they leave--before billing medicaid/insurance. People do not realize the expenses incurred and if they truly did, and had to pay for it--maybe it would stop. docs are paranoid to "miss something" anyone can sue--just another point. sorry--huge oet oeeve of mine

Anne R.