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文章来自APICS e-NEWS Vol. 5 | No. 12 | June 21, 2005
先进的技术和方法是普遍适用的，文中的Lean在医疗保健业的应用说明了这一点。
医生的“天书”，人所垢病由来已久，俺大约在半年前也亲身领教了一次。那次药房按单给了俺几味药后，突然告诉俺医生写错了一条，叫俺再找医生重写。俺见惯不惊，就拿回去找他重写了再拿药。看来医疗这个行业的问题不是一点点，空间太大了以至到吓人的地步。
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Health Care in Need of "Lean ER"
Did you know that 493 people died yesterday—and will die today and every day—due to medical errors? This estimate is from a 1994 Journal of the American Medical Association article by Dr. Lucian L. Leape, a pioneer in patient safety and quality. The news media is quick to cover motor vehicle accidents, yet the number of deaths from adverse reactions to prescription drugs is greater than the number of auto accident deaths. Subsequent studies have both reduced and increased the number of estimated deaths, but the point is they are not trivial and they are extremely costly. What is being done to address this situation?
Lean principles and methods, which have been successfully used in manufacturing, offer hope and benchmarks for adoption by the health care industry. Since most process wastes are estimated to be between 70 and 95 percent of the total cost of any process, hospitals should focus on identifying and eliminating these wastes to gain a competitive edge. Health care wastes fall within the traditional lean categories of defects, transportation, overproduction, delays, processing, movement, and inventory.
For example, the Shadyside Laboratory of the University of Pittsburgh Medical Center has applied the lean tools of value stream mapping, 5S, and continuous flow to create cells to process tissue samples. The current-state value stream map showed a typical batch and queue process with lots of process wastes in it. Processes were located in several parts of the lab, adding to the lead time.
Working with a cross-functional team, laboratory personnel were able to create a cell where the work moves counterclockwise through the processes of embedding, cutting, heating, staining, and automation. These changes resulted in a reduction in turnaround from one to two days to same day, a reduction in inventories by 50 to 60 percent, and the elimination of almost all the expensive rush orders. But more importantly, the quality improvement enabled the lab to discover and remedy mistakes immediately, thereby not passing errors on to the next process step.
Materials management and purchasing are areas in a hospital that most closely resemble those operations in a manufacturing environment. A large teaching hospital found the principles of inventory control, inventory management, and lean could be applied directly to its operations.
The hospital had done a good job of controlling the inventory in its storeroom since shipments from vendors and suppliers were received daily. By analyzing the inventory, picking, stocking, and delivering processes, current- and intermediate-state value stream maps for the medical-surgical intensive care unit floor were developed. The hospital is in the process of implementing the changes needed for the intermediate state, which when finished will have merged three delivery processes into a single process with a kanban card inventory system. This improvement will free up staff members to let them be more customer focused and give them time to make multiple deliveries each day to the required floors.
The list of hospitals implementing lean and significantly reducing errors is growing. Given what is at stake—493 lives each day—the number of hospitals becoming lean can’t grow fast enough.
Thomas G. Dzialo, CPIM, CIRM, president, Sixth Floor Consulting Group, and Christine A. Eckert, lean program director, Sixth Floor Consulting Group, can be reached at (860) 233-7411 or via e-mail at tdzialo@sixthfloorconsulting.com or ceckert@sixthfloorconsulting.com.
Additional Resource
For more information, attend Dzialo's presentation, "Lean Health Care: It’s a Matter of Life and Death," at the 2005 APICS International Conference and Exposition, October 16-18, in New Orleans. To register visit http://www.apics.org/education/conference/register.html. | 
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