Running On All Cylinders
By Chris Hobson
The common perception of Japanese efficiency has its roots in many facets of the nation’s past. One of these aspects is its history of whaling. Since Japan’s mountainous topography made it hard for inhabitants to cultivate livestock, around 12,000 B.C., they turned to whales for sustenance. Although the modern practice of whaling has drawn ire due to the brutality of poachers worldwide, in ancient times, the Japanese held the animal in such esteem that it became tradition to show respect by using every part of it to produce meat, clothing and fuel.
Over the millennia, this custom of leaving nothing to waste made its way into Japanese auto manufacturing. The first proponents of cutting inefficiencies in this process were the heads of the Toyota Corporation in the 1930s. These leaders sought to improve upon the revolutionary yet rigid production methods pioneered by Henry Ford by adding value to their product and eliminating inefficiencies.
The Lean Approach
Dubbed “lean production” in the 1980s, Toyota’s approach to work “demands a commitment to a set of principles that allow people and organizations to become and remain efficient.” The business strategy has only recently been applied to medicine, with great success in many cases. The net effect of integrating the strategy into the field of radiology is to provide customers — both referring physicians and patients — with a higher level of value through continuous improvement.
Waste can take many forms, a few of which include using out-of-date protocols requiring patients to wait due to inefficient scheduling, underutilizing equipment, and storing more supplies in inventory than is necessary. The practice of radiology is a very complex process, notes Lucy W. Glenn, MD, chief of the department of radiology at the Virginia Mason Medical Center in Seattle, which makes it a good fit for the lean process. “Any time you’re dealing with a complex process, you need a tool to simplify operations and look at them in a standardized fashion,” she says.
Virginia Mason was among the first health systems in the U.S. to implement lean, a transition that began with a simple conversation on a plane flight. “A member of our executive team happened to be sitting on an airplane next to a lean consultant,” says Glenn. “Lean hadn’t been attempted in health care, but the consultant explained to him how the approach could apply to medicine. By the end of the flight, the Virginia Mason representative agreed with him.” And the rest is history.