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200,000 Preventable Deaths: It’s Time for Fundamental Change

 News Release: August 9, 2009

200,000 Preventable Deaths: It’s Time for Fundamental Change

Appleton, WI  --  The news reports that an estimated 200,000 people will die from preventable medical mistakes this year is a sad and telling statement on the abundant waste and the thousands of errors in the current health care system, according to one leading healthcare executive.

“It’s time for everyone in healthcare and for public policy makers to admit that we need a fundamentally different way to deliver care to patients in the safest and most effective ways possible. These latest news reports build on other credible national studies that have demonstrated that thousands of people are injured or die in healthcare settings every year as a result of preventable errors,” said Dr. John Toussaint, President of the ThedaCare Center for Healthcare Value and a leading proponent of increasing the quality and reducing the cost of care by eliminating errors and taking waste out of the system using “lean” principles adopted from the Toyota Production System.

Toussaint said most credible studies estimate that “30 to 50 percent of healthcare services do nothing to improve patient care. These are wasted resources.”

Many healthcare leaders “recognize the problem and that’s why we are developing and implementing solutions to fix the problems,” he said. “Lean healthcare eliminates the errors and mistakes that lead to death. It’s not just about preventing mistakes; it’s about preventing injuries and deaths.”

Toussaint said “lean is a defined methodology that works. It’s all about system redesign coupled with a commitment to making daily improvements throughout the system.”

For the past six years, ThedaCare, a community-owned healthcare system in Wisconsin, has used lean methods and tools to redesign the way patients are cared for in the hospital room and the physician clinic. The results have been dramatic:

  • Heart surgery mortality rates decreased from 4 percent in 2001 to 1.4 percent in 2008 and zero percent in 2009
  • Medication reconciliations errors are at zero percent since February 2007, compared to one per patient stay prior to redesign
  • 15 minute turnaround time on most common lab procedures in the clinic

Other healthcare systems across American have produced similar results using lean principles and tools. The staff at Allegheny General Hospital in Pittsburgh eliminated central line infections in a critical care unit in 2006 using lean improvement practices. In 2003, under the traditional approach, 49 patients got infections and 19 died. In 2006, under the lean system (called “Perfecting Patient Care”), only three patients got infections, and zero died.

“Many of us in the healthcare industry agree that now is the time for healthcare reform. Group Health of Puget Sound, ThedaCare, Gunderson Lutheran and 12 other healthcare delivery organizations in the U.S. and Canada have come together to accelerate and spread our learning on delivering better patient value,” Toussaint noted.

The ThedaCare Center for Healthcare Value and the Lean Enterprise Institute (LEI) have formed a partnership to fundamentally improve healthcare delivery by systematically identifying and eliminating waste through lean thinking. The partnership has created a web site of resources at http://www.healthcarevalueleaders.org/ and formed the Healthcare Value Leaders NetworkÔ to share information and best practices.

The Healthcare Value Leaders NetworkÔ members “know we can reduce or eliminate the billions of dollars of healthcare waste through the use of lean principles of quality improvement and focus on delivering greater value to each and every patient we treat,” Toussaint said.

“The biggest internal barrier to change is the culture within healthcare. We moved from a culture of blame to a culture of promptly finding out why mistakes happen and then designing best practice to make sure mistakes are not repeated,” he said.

Beyond culture change, Toussaint said the other barriers to the transformation in care delivery are the backward incentives in the current payment systems, both for government programs and private insurance companies.

“This is what healthcare reform should be all about. The current payment system rewards providers for delivering more and more expensive services, regardless of their quality and outcomes, while penalizing providers who increase quality and reduce costs,” he said.

“Rather than delaying the inevitable, Congress should include strong provisions in its reform plans to reward providers who improve quality, safety and access while reducing costs. Waiting around for ten years to learn the results of Medicare CMS Pilot Study is like rearranging the deck chairs on the Titanic,” he said.

“We have a proven methodology with the results documented by independent third-parties. It’s working in healthcare systems across America. It’s time to get on with the important work at hand. It’s time to make sure we tell our patients that when we take care of them we will not harm them,” said Toussaint.

The principles and tools of lean thinking, applied successfully for decades by manufacturers, dramatically improve quality, cost, safety, morale, and delivery by systematically identifying and eliminating waste. Manufacturers that have diligently and thoroughly applied lean thinking have reaped steady productivity gains with falling defects while improving the customer and employee experience.

“It’s encouraging to see members of the healthcare community implementing lean thinking since healthcare patient pathways are some of the most important value streams in our lives,” said Helen Zak, chief operating officer of LEI. “What the healthcare delivery system now needs is to not only implement lean tools and methods, but to change how the entire system is managed -- so we can create and sustain lean thinking gains in healthcare like some companies in other industries have done so successfully over the past few decades.

“High quality is one of the foundations of lean thinking,” Zak noted. “Doing things right the first time, thus eliminating preventable errors, is the key to lower cost and a better patient and provider experience. There is not a cost tradeoff to produce higher quality; it’s all in the way the work gets done. Workarounds and band-aids, commonplace in the healthcare industry, must be eliminated, and can be eliminated through lean thinking.

“ThedaCare and Virginia Mason are two of the pioneers in applying lean thinking in healthcare,” Zak said. “We at LEI are working hard to educate and encourage more executives to lead their organizations in making the lean leap to transform healthcare delivery.”

About the ThedaCare Center for Healthcare Value

Created in 2008 by ThedaCare president/CEO emeritus John Toussaint, MD, the ThedaCare Center for Healthcare Value is working to close the gap between value creation and marketplace reward. The goal is to create a healthcare marketplace that rewards providers for delivering value measured in terms of optimized quality and cost for patients. The Center’s work focuses on documenting innovative processes that reduce waste and transforming healthcare's current culture into one focused on continuous improvement. Visit www.createhealthcarevalue.com for more information.

For More Information: Jeffrey Remsik, 414-231-3330, jremsik@blmpr.com

About the Lean Enterprise Institute

The Lean Enterprise Institute, Inc. was founded in 1997 by management expert James P. Womack, Ph.D., as a nonprofit research, education, publishing, and conferencing company with a mission to advance lean thinking around the world. We teach courses, hold management seminars, write and publish books and workbooks, and organize public and private conferences. We use the surplus revenues from these activities to conduct research projects and to support other lean initiatives such as the Lean Education Academic Network (www.teachinglean.org ) and the Lean Global Network (www.leanglobal.org ). For more information visit LEI at https://www.lean.org.

For more information, contact Chet Marchwinski at 617-871-2930, cmarchwinski@lean.org