Identified problems within DGH 3
Overaching Goals 5
Every one of us has experienced what being in a hospital is like. You can go there when you are sick, need care, when there is an emergency or just because you visit a friend or a relative of yours. However, not everyone’s experience of a hospital visit is a pleasant one and there are multiple factors that can make a visit to the visit unpleasant. But why is that the case? Hospitals can sometimes actually worsen a patient’s condition, because a hospital is a place with a lot of uncertainty, errors and where patients can catch infections. Hospitals are also very costly for patients who for the most part can’t keep up with the rising costs of health care, which on the other side leads to losses for health care providers because of lesser people visiting hospitals and the low profit margin. But why do so many hospitals and institutions within the health-care system lack efficiency and ultimately profitability?
Just like making cars or making airplanes, health care is made up of a series of processes that are required to both deliver health care and handle the administrative aspects, such as billing patients and insurance companies for services. And just like making cars or airplanes or any other product or service, delivering health care that meets or exceeds the customer's requirements necessitates the coordination of people (MD's, nurses, therapists, medical assistants), equipment, MRI's, instruments, and supplies (medications, dressings, syringes, etc.). It is estimated that at least 30% of the cost of care in the U.S. is waste. Waste in the form of defective care (medical errors) or inappropriate care, like unnecessary surgery, or inefficient care, because there is too much time required for staff due to inefficient processes. In recent years, not just manufacturers of cars were looking at the Toyota Production System to make their delivery systems more efficient, but also hospitals and other institutions within the healthcare system were trying to build a better delivery system by bringing TPS to the healthcare industry.
In the “Deaconess-Glover Hospital” case study from the Harvard Business Review, Steven J. Spear and John Kenagy talk about the problems of a Massachusetts-based hospital, called Deaconess-Glover Hospital (DGH), that faced a $2.7 million loss in the previous 12 months. DGH is a 41-bed community hospital and part of a larger hospital network which is called the CareGroup. The CareGroup, with a 1,500-bed system made a loss of nearly $100 million in the same period. The case describes how John Carter, a vascular surgeon, had been trying to find an appropriate location within the hospital network to test out the TPS. Within his approach he tried to understand the current condition of DGH, as well as material and information flows. He observed the day shift medication administration, the work of a nurse, and discovered areas for TPS-style improvement. The main area for TPS-style improvement that Carter identified is within the medication administration at DGH.
Identified problems within DGH
Carter found sever issues within the delivery system of DGH’s medication administration. If we look at the TPS rules, we can clearly see that in the case of DGH and its medication administration, the first rule of TPS was not followed. The first rule of TPS states that: “All work shall be highly specified as to content, sequence, timing, and outcome”1. From Carter’s observations and conversations we know that a lot of the things that are done on a daily basis within the medication administration are not highly specified, such as how nurses should be assigned to patients, how nurses should exchange patient information, as well as how nurses should record patient information. A lot of the information exchange relied heavily on verbal communication which can lead to errors and waste. It