February 3, 2006

MGH Revere: Learning from Toyota

Every year, the MGH Revere Internal Medicine practice is challenged by the logistics of its flu-shot clinic. Fitting 500 flu-shot appointments into a packed schedule is not an easy task. This year, staff applied process improvement concepts they learned from automobile manufacturer Toyota to meet that challenge. Companies and organizations around the country have been implementing what have become known as "lean principles," developed by Toyota to streamline production, eliminate waste and continuously improve the production process.

Staff at MGH Revere worked with Steven Spear, a senior fellow with the Institute for Healthcare Improvement (IHI), to apply Toyota'ss lean principles to the flu-shot clinic.

"The results of using this model were surprising," says Joan Niles, RN, the unit nurse leader at MGH Revere. "Lengthy waits for patients were eliminated, and the work was easier for staff."
Using the lean principles, MGH Revere staff managed the flu-shot clinic so that they could do the work while learning to improve the process. This model involved several elements. First, the staff scripted how the flu-shot clinic would work, including check-in, inoculation, documentation and checkout. Specifying the process design ahead of time served two purposes. It captured the staff's shared understanding of what would work best, and it defined what was expected ahead of time, making it easier to identify what had gone wrong when a problem arose.

When a problem was identified, staff made sure not to "make due" by working around it. Instead, they compared the actual experience with their expectations, redesigned their work processes based on what they discovered and incorporated changes into each successive flu-shot session.

Staff paid close attention to the myriad of inconveniences that made the flu-shot clinic more difficult than necessary for staff and patients and responded rapidly to fix these inconveniences. More than 20 small changes in process design were made, which allowed them to increase productivity (See chart above).

"We become used to inefficiency to such a degree that we actually accept it as the norm," says Eric Weil, MD, chief of the MGH Revere Internal Medicine Unit. "It is only when these inefficiencies are removed that we realize just how great a burden they've been. The changes we've made by implementing Toyota's manufacturing principles have been subtle. The cumulative impact of all these changes, however, has significantly improved overall efficiency and quality within the practice."

To learn more or to be among the next departments to pilot Toyota's lean principles, contact Sally Iles at (617) 726-8283.