Code Black: tonight looking into America's busiest ER with Lean Manufacturing

Hospital is just like a factory, where Lean Manufacturing could provide huge bottom-live business benefits.

Exodus: tonight a code black at Angels Memorial takes a turn for the worse when a city-wide blackout leaves the hospital without power or back-up generators. As Campbell and Leanne divert high-risk patients to a nearby care center, Elliot and Heather are trapped in an elevator with a woman in labor, and Willis and Dr. Nolan (Kathleen Rose Perkins) try to help a 92-year-old woman who thinks it’s 1942. A code black at Angels Memorial takes a turn for the worse when a city-wide blackout leaves the hospital without power or back-up generators. As Campbell and Leanne divert high-risk patients to a nearby care center, Elliot and Heather are trapped in an elevator with a woman in labor, and Willis and Dr. Nolan (Kathleen Rose Perkins) try to help a 92-year-old woman who thinks it’s 1942.

Code Black, a movie showing the staff of the LA County Hospital emergency room treats patients under difficult circumstances, is a heart-pounding medical drama that takes place in the busiest, most notorious ER in the nation, where the staggering influx of patients can outweigh the limited resources available to the extraordinary doctors and nurses whose job is to treat them all—creating a condition known as Code Black.

For healthcare, lean eliminates non-value-added activities and waste, thus save time and money. Lean Manufacturing increases patient satisfaction and reduce errors by improving processes. Lean and Lean Manufacturing applications in healthcare require an understanding of how the tools and methodologies translate to the people-intensive processes of patient care. Once applied, the possibilities are endless. For example, using Lean Manufacturing, a hospital improved patient satisfaction over 50%, reduced emergency department length of service by 21%, and recovered over $4 million in cost of quality.

Based on the award-winning documentary of the same name, this medical drama follows the staff members in the nation's busiest emergency room as they cope with a staggering influx of patients, which can outweigh their limited resources, resulting in a condition known as code black. Residency Director Dr. Leanne Rorish -- who is known for her success with high-risk procedures in the trauma area -- leads residents Malaya and Angus, among others. Senior nurse Jesse Sallander manages the residents and serves as Leanne's confidant, with doctors Rollie Guthrie, Will Campbell and Heather Pinkney rounding out the group. Together, the doctors and nurses race to save lives in an overwhelmed system. The hospital's Lean Manufacturing projects deliver concrete, measurable value. Here are some examples of Lean Manufacturing projects and their benefits:

1.     Avoid unnecessary expenses. By reconfiguring its layout and work processes, the hospital's sterile processing department averted a proposed $3.5 million expansion, while improving surgical instrument turnaround time and enhancing the work environment.

2.     Reduce overtime. Since it identified and eliminated wasteful practices, the hospital's cytogenetics lab cut overtime from more than 55 hours a week to just 9, producing annual savings of about $93,000 while reducing turnaround time.

3.     Achieve cost savings. With a 38 percent reduction in storage areas, a hospital's campus freed up space to create an exercise room for employees and a dietary counseling room for patient families. The project saved more than half a million dollars, while boosting staff and patient satisfaction.

4.     Shorten wait times. A hospital's radiology department cut MRI wait time by 90 percent - from 25 days to within 2 - by obtaining insurance authorization earlier, streamlining scheduling, and improving coordination between radiology staff and the doctors who sedate children undergoing MRIs. The hospital can now perform more than 112 MRIs a week, up from the previous high of 84, helping to boost revenue. This lean project received an honorary mention award from the International Quality and Productivity Center in the category of "Best Process Improvement Project Under 90 Days."

5.     Speed up patient care. Using Lean Manufacturing processes, the ER decreased the time it takes to locate airway supplies by 63 percent, thanks to a new mobile unit equipped with all needed supplies. By reducing the search time for supplies, staff can more quickly respond to the changing needs of critical patients.

6.     Improve accuracy. Since burn treatments are often weight-based, it's important to accurately weigh patients. To mitigate risk and uncertainty, a Cellular Manufacturing program identified and resolved variables that could lead to inaccuracies in weighing burn patients.

7.     See patients more quickly. Before implementing a Lean Manufacturing program, 56-85 percent of foster care patients were seen within 72 hours of notification. Standard work instructions and information cards boosted the rate to 100 percent. In addition, access time to appointments for the hospital's Services Board clients dropped from nearly 4 days to 1.6 days, which means patients spend 687 less days waiting for appointments.

8.     Reduce surgical patient wait time. Although demand for surgeries has increased, the hospital's Operating room (OR) space was limited and room utilization was 64 percent - well below the best practice standard of 80 percent. By implementing a continuous improvement method called kaizen, the perioperative services staff increased emergency surgery time by 137 percent (from 61 hours to 145) and decreased patient wait time by 30 minutes. Process improvement also reduced the number of times a patient was moved from 8 to 3.

9.      Lower appointment cancellations/no-shows. Despite efforts to improve missed appointments, the hospital's rehab department could not lower its cancel/no-show rate below 20 percent, impacting patient outcomes, staff satisfaction and profitability. By developing standard work instructions, new communications and attendance policies for patients, the rate is now 15 percent, resulting in a boost to annual revenue of $104,366. 

In Code Black, the show centers on the fictional Angels Memorial Hospital, where four first-year residents and their colleagues must tend to patients in an understaffed, busy emergency room that lacks sufficient resources. Lean Manufacturing can be used to target waste and defects in any component of health care delivery. For example, the following improvements can be achieved in a hospital:

Reducing readmissions. Helped 30-day readmission rates for heart failure patients to reach an all-time low, down to 17.5 percent from a baseline of 24 percent

Saving blood products. Reduced by more than 50 percent the rate at which units of packed red blood cells had to be discarded, saving $800,000 in the first four years

Ensuring MRI safety. Conducted a proactive risk assessment to identify possible failures associated with a new intraoperative MRI suite, and then implemented several preventive measures

Streamlining medication administration. Reduced total time for Botox administration process from 42 minutes to 24 minutes in an outpatient neurology clinic

Capturing revenue. Realized an additional $50,000 a month for charges related to supplies in procedures in an interventional radiology service

For all the dozens of medical shows that have aired, only a few actually center on the emergency room or emergency doctors and paramedics. So what does this have to do with Lean Manufacturing? Four forces are converging to make the delivery of healthcare in the years to come more difficult than it has ever been:

The aging baby boomers: Over the next 10-15 years, these people will become healthcare consumers in vast numbers. They have always been a demanding and vocal group, and there is no reason to think that this will change.

Scarce financing: The U.S. has been experimenting with various forms of healthcare financing over the last 15 years with HMOs, PPOs, Medicare DRGs, etc. An alphabet soup of concepts, none of which seem to work for more than a few years. But one thing is clear; there are limits to what we can spend on healthcare.

Staffing shortages: While there seems to be no shortage of physicians, the healthcare field is once again suffering shortages of other staff, primarily nurses.

Need to prevent litigation mania: As shown in a recent report by the Institute of Medicine, medical errors in hospitals, to our great surprise, are not uncommon. The medical profession, once protected against malpractice suits, has become one of the prime targets of personal injury lawyers. And although doctors and hospitals can buy insurance to avoid financial ruin, a lawsuit can rapidly destroy the reputation of the institution that was responsible for the mistake, which can be prevented by Poka Yoke (mistake proofing).

The confluence of increased demand, decreased funding, shortages of staff, and increased litigation creates a compelling case for change. Lean Manufacturing might be one of the most compelling strategies to address these issues. n his vivid and thought-provoking filmmaking debut, physician Ryan McGarry gives us unprecedented access to America’s busiest Emergency Department. Amidst real life-and-death situations, McGarry follows a dedicated team of charismatic, young doctors-in-training as they wrestle openly with both their ideals and with the realities of saving lives in a complex and overburdened system. Their training ground and source of inspiration is “C-Booth,” Los Angeles County Hospital’s legendary trauma bay, the birthplace of Emergency Medicine, where “more people have died and more people have been saved than in any other square footage in the United States.” CODE BLACK offers a tense, doctor’s-eye view, right into the heart of the healthcare debate – bringing us face to face with America’s only 24/7 safety net.

Lean Manufacturing is not for the faint-hearted. It is a challenging strategy to master and execute in manufacturing and transactional industries, but even more difficult in the healthcare industry with constraints such as high barriers between the different professional groups, the lack of funds, understaffed and overworked employees, and individualized work procedures that are rarely managed or controlled. However, the rewards are worth it, and its benefits can serve healthcare providers in many ways. Primarily, Lean Manufacturing processes can deliver better care to more people at a lower cost.

See More:

https://www.crcpress.com/Lean-Manufacturing-Business-Bottom-Line-Based/Wang/p/book/9781420086027