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Emergency Medicine Physician Responds to Recent Article About Lean Success

Posted on Thu, Oct 29, 2015
Emergency Medicine Physician Responds to Recent Article About Lean Success

A recent article in FierceHealthcare highlighted the successes that Stanford Hospital and Clinics have seen after implementing lean manufacturing principles. However, one of EmCare’s advocates for lean cautions the system, stressing that administrators shouldn’t ease up on the gas pedal just yet.

The health system has seen ED wait times drop by 17 percent despite an increase in patient volume and flat operating costs, according to the article.

“The initial gains such as the ones cited in the article are great, and I wish Stanford continued success in its lean journey.  I just hope the journey doesn't end prematurely when the political waters run deep,” said Joseph Twanmoh MD, MBA, FACEP, FAAEM, Director for Health Systems Innovation for EmCare’s North Division.

Because there is so much waste and inefficiency in healthcare, lean has great potential to improve service delivery, explained Dr. Twanmoh.  The challenge is deploying lean properly and making sustained gains.

“Too often lean is used as the latest tool or fad to cut costs or improve efficiency, without senior leadership being truly committed to the principles of the Toyota Production System. Initial gains tend to be easier, as there is plenty of low-hanging fruit. As one climbs the mountain of waste that exists in healthcare, the problems become harder to solve,” said Dr. Twanmoh.

He explained that as a facility moves forward on its lean initiative, it starts to deal with more entrenched behaviors that require more political capital to solve. For instance, ED boarding and patient flow may be related to OR scheduling, the rounding practices of physicians on the inpatient services, the staffing patterns of nursing, or the availability of housekeeping on second and third shift.

“Will senior management be willing to support lean efforts and change processes to create value from the perspective of the patient? If a system is truly committed to lean, then things such as changing block surgical scheduling, setting standards as to when patients are evaluated on inpatient units, and how nursing units are staffed are all fair game for change – and those aren’t quick fixes,” said Dr. Twanmoh.



Joseph Twanmoh MD, MBA, FACEP, FAAEM, is Director for Health Systems Innovation for EmCare’s North Division and the Senior Vice President of the MS2 Group, Providence, R.I. He is a Lean-certified physician with expertise in change management. Dr. Twanmoh has more than 20 years of leadership and management experience turning around emergency departments, redesigning hospital processes, and improving patient flow. Dr. Twanmoh previously served as a Medical Director and ED Chairman. He is a graduate of Rutgers-Robert Wood Johnson Medical School and received his MBA from the Johns Hopkins University Carey Business School. He is past-president of the Maryland chapter of the American College of Emergency Physicians, serves on the Practice Committee for the American College of Emergency Physicians, and is a fellow of the American College of Emergency Physicians and the American Academy of Emergency Medicine.
 

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