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The Children’s Hospital of Eastern Ontario has cut wait times, saved jobs and improved patient care by deploying a “lean management” system based on a model developed by the Toyota Motor Company.
The system is known as CHEOworks and it’s the hospital’s response to a new provincial funding model that has squeezed its budget and made business-as-usual impossible. CHEO’s core funding has been frozen or cut in four of the past five years, even as wage costs, technology demands and patient volumes have increased.
To do more with less, CHEO has launched a hospital-wide improvement program designed to capitalize on the analytical skills and diagnostic expertise of its entire staff.
“That’s what people in health care do: They solve problems,” said CHEO CEO Alex Munter. “This is really getting them to use that same diagnostic thinking to analyze the workflow and what’s happening on our units — and to make improvements.”
The program shares elements with Toyota’s management system, which propelled the Japanese automaker to the top of its industry through an emphasis on customer value and waste elimination.
During the past decade, the same philosophy has been applied in dozens of North American hospitals searching for the Holy Grail of health care management: measures that cuts costs while improving patient care.
At CHEO, administrators asked doctors, nurses, orderlies and aides to reimagine the hospital by thinking about its value from a patient’s perspective. It meant that staff put common problems under the microscope, and considered new ways to improve wait times and patient safety, reduce the length of hospital stays and improve communication with families.
During the past year, CHEO introduced 618 improvements, both large and small, based on the recommendations of staff. The initiatives cut 40,000 days of wait time for patients, improved safety, led to higher patient satisfaction numbers (77.4 per cent to 79.3 per cent) — and saved money.
Among the initiatives that have demonstrated measurable success:
Suggestions came from frontline staff members such as Ann Felix, a health care aide who has worked at CHEO for 20 years. Her recommendation — that the hospital deploy reusable devices to measure oxygen saturation — has saved $50,000 in the past six months.
“I was just looking at ways to save money,” she said.
Other ideas involved years of study. Members of the pediatric intensive care unit, for instance, knew that too many young patients were pulling out their breathing tubes — a potentially dangerous medical situation. So they studied the problem and found that an average of six such incidents happened every year. The incidents most often occurred during the nightshift (91.7 per cent) and involved children less than one year of age (66.6 per cent).
The team launched an awareness campaign, but it didn’t have the desired effect, so they worked on improving the patient care process. Doctors and nurses had to discuss the risk faced by each intubated patient during daily rounds, and respiratory therapists had to document that they checked the tubes every four hours.
The number of incidents has dropped to one or two a year.
Munter said CHEOworks has allowed the hospital’s frontline staff to take charge of improving patient care within the confines of a balanced budget. “CHEOworks helps us manage the reality of a very difficulty funding environment for hospitals,” he said.
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The system is known as CHEOworks and it’s the hospital’s response to a new provincial funding model that has squeezed its budget and made business-as-usual impossible. CHEO’s core funding has been frozen or cut in four of the past five years, even as wage costs, technology demands and patient volumes have increased.
To do more with less, CHEO has launched a hospital-wide improvement program designed to capitalize on the analytical skills and diagnostic expertise of its entire staff.
“That’s what people in health care do: They solve problems,” said CHEO CEO Alex Munter. “This is really getting them to use that same diagnostic thinking to analyze the workflow and what’s happening on our units — and to make improvements.”
The program shares elements with Toyota’s management system, which propelled the Japanese automaker to the top of its industry through an emphasis on customer value and waste elimination.
During the past decade, the same philosophy has been applied in dozens of North American hospitals searching for the Holy Grail of health care management: measures that cuts costs while improving patient care.
At CHEO, administrators asked doctors, nurses, orderlies and aides to reimagine the hospital by thinking about its value from a patient’s perspective. It meant that staff put common problems under the microscope, and considered new ways to improve wait times and patient safety, reduce the length of hospital stays and improve communication with families.
During the past year, CHEO introduced 618 improvements, both large and small, based on the recommendations of staff. The initiatives cut 40,000 days of wait time for patients, improved safety, led to higher patient satisfaction numbers (77.4 per cent to 79.3 per cent) — and saved money.
Among the initiatives that have demonstrated measurable success:
- neurosurgeons and plastic surgeons combined their separate clinics so that young patients with malformed skulls could meet both specialists at once to develop a joint treatment plan; the system has cut treatment wait times in half;
- the process that governs medical imaging was changed to give in-patients a higher priority, which reduced the amount of time they spent waiting for tests; the changes have helped cut the average length of a hospital stay — and add the equivalent of three full-time beds to the medical unit;
- the Regional Genetics Program cut its wait times in half — it’s now four to six months — by holding group counselling sessions for patients with similar issues and by equipping family doctors with the tools to manage common conditions; and
- managers mined hospital data to remake the daily laundry schedule: The changes saved more than $165,000.
Suggestions came from frontline staff members such as Ann Felix, a health care aide who has worked at CHEO for 20 years. Her recommendation — that the hospital deploy reusable devices to measure oxygen saturation — has saved $50,000 in the past six months.
“I was just looking at ways to save money,” she said.
Other ideas involved years of study. Members of the pediatric intensive care unit, for instance, knew that too many young patients were pulling out their breathing tubes — a potentially dangerous medical situation. So they studied the problem and found that an average of six such incidents happened every year. The incidents most often occurred during the nightshift (91.7 per cent) and involved children less than one year of age (66.6 per cent).
The team launched an awareness campaign, but it didn’t have the desired effect, so they worked on improving the patient care process. Doctors and nurses had to discuss the risk faced by each intubated patient during daily rounds, and respiratory therapists had to document that they checked the tubes every four hours.
The number of incidents has dropped to one or two a year.
Munter said CHEOworks has allowed the hospital’s frontline staff to take charge of improving patient care within the confines of a balanced budget. “CHEOworks helps us manage the reality of a very difficulty funding environment for hospitals,” he said.
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