美國議員嘗試用工廠經營方式進行管理

When Virginia Mason Medical Center in Seattle started losing money in 1998, its CEO began a search for a new management system that would get the hospital back on track.

1998年，西雅圖的維吉尼亞·梅森醫療中心出現虧損，執行長開始尋求使醫院扭虧爲盈的新經營方式。

After two years of visiting hospitals around the U.S. and talking with many of the smartest minds in the health care industry, he concluded that there wasn't a single medical institution in the entire country that had a system worth emulating. Instead, he turned to a Japanese carmaker for inspiration.

在兩年時間裏，他遍訪全國各地醫院，向專家學者求教，最後得出結論，全美國沒有一個醫療機構的制度值得效仿。於是他轉向了日本的汽車製造業。

Lean management style

Dr. Gary Kaplan, head of Virginia Mason Hospital in 2001, thought he could adapt Toyota’s lean management style - which focuses on eliminating waste in the production process - to improve healthcare.

2001年，維吉尼亞·梅森醫院院長加里·卡普蘭醫生認爲，他可以採用日本豐田汽車的精簡經營模式，減少浪費，提高醫療效率。

"He turned to the Toyota production system because it was clear to him that taking these principles and tools and adapting them to healthcare could significantly make Virginia Mason a more efficient operation," says efficiency expert Charles Kenney, author of "Transforming Healthcare, Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience."

經營效率專家查爾斯·肯尼寫了一本書，叫作《醫療機構轉型，維吉尼亞·梅森醫院追求完美的就醫經驗》。

One of the first Toyota concepts Kaplan instituted was value stream mapping, which involved taking a complicated process and breaking it down into individual steps to find ways to make each step more efficient. Virginia Mason hired several Japanese consultants, called senseis, to help them with their first value steam map: a cancer patient’s visit. In his book, Kenney recounts how the senseis instructed the staff to trace the patient’s journey on a map of the hospital, using a piece of blue yarn.

肯尼寫道，卡普蘭院長首先引進豐田公司的價值流程圖，將複雜的生產流程分解成爲單個步驟，然後尋求提高每一步的效率。醫院聘請了幾名日本顧問，他們的任務是協助制定第一份癌症病人門診流程圖。日本顧問指導工作人員用藍色絲線在醫院地圖上標出病人行走的路線。

"And at the end of the process, the blue yarn was snaking around this piece of paper - the schematic on the floor - and it was this immensely powerful visual experience for the entire team," says Kenney, "and they realized that what was happening was they were taking these patients, for whom time is absolutely the most precious thing in their lives, and they were wasting huge amounts of it."

肯尼說：“最後，藍色絲線在醫院平面圖上繞來繞去，蜿蜒蛇行。這種直觀圖像一目瞭然，他們立即意識到他們在大量浪費對病人來說無比珍貴的時間。”

So the team used the lean management approach to refine the process of administering chemotherapy treatments. By sorting out the steps, simplifying and standardizing them, they were able to cut the amount of time it takes a patient to receive treatment by 50 percent. Then, they turned to other departments, finding ways to increase efficiency and improve safety.

於是這個工作小組開始修訂、簡化病人化療的程序，並使之標準化，從而爲病人節省了百分之50的時間。然後，他們又轉向其它科室，找出提高效率和改善安全的措施。

"So the Virginia Mason Production System is now viewed throughout the world by many people as a viable alternative to the current system," Kenney says.

現在，維吉尼亞·梅森醫院的制度已經被世界各地許多人士看作是可以替代現行制度。

It has been adopted by dozens of hospitals in the United States, including Barnes Jewish in St. Louis, Missouri.

美國已經有十幾家醫院採用了這項制度，包括密蘇里州聖路易斯市的巴恩斯猶太醫院。Kent Rubach is one of the senseis Barnes hired to guide them on what they call their learning journey. The first change he made was to set up a strategy room for hospital staff. Above a long conference table is a complicated diagram which takes up one entire wall of the room. It is made up of hundreds of hand drawn lines that connect dozens of small pink and yellow sticky notes. It’s just like the charts in Toyota’s strategy rooms.

肯特·魯巴奇是巴恩斯猶太醫院聘請的顧問之一。他做的第一件事是爲醫院人員佈置一個策略室。在這個房間裏，一張複雜的圖表掛佔了整面牆。圖表上有數百條線，連接着幾十個粉色和黃色紙條。

"You would see the exact same thing, for a part going from raw material to the finished good," Rubach says.

But in this case, the value stream map illustrates the process of a patient coming into the hospital with a stomach ache. Each one of the pink notes represents a point in the process where a patient has to wait.

這張價值流程圖顯示的是一名胃痛病人進入醫院後的就診流程。每一個粉色紙條代表病人必須等候的地方。

"So if we do have wait, we're trying to add value to that wait, and not just have them sitting and doing nothing," says Daryl Williams, head of the Emergency Department at Barnes. "Can we give the patient education? Can we get their labs done ahead of time so when they get to see the doctor all that stuff is back?"

巴恩斯醫院急診室主任達里爾·威廉斯說：“如果我們必須要他們等，就應該增加等的價值，而不是讓病人幹坐在那裏。比如可以利用這點時間讓病人瞭解一些知識，或者提前做相關化驗，這樣，當醫生爲他們看病時，化驗結果已經出來了。”

According to Williams, under the old system, an acute abdominal pain visit typically took three hours. Today it’s two hours.

威廉斯說，在舊制度下，嚴重的腹痛病人就醫通常需要三小時。現在只需要兩小時。

A key principle of the Virginia Mason Production System is to encourage staff members to speak up whenever they see a part of their job that can be done more efficiently or a process that could be improved.

維吉尼亞·梅森制度的核心是鼓勵員工在發現可以提高效率或改善流程的方法時，大膽說出來。

An employee who worked in the Intensive Care Unit had an idea to help patients’ families, who often spend day and night in the waiting room while their loved ones are in the ICU.

比如，醫院就根據一名加護病房員工的建議，更換了等候室的傢俱，使不得不整天守候在醫院的病人家屬可以把椅背放平，躺下休息一會兒。

Linda Henderson, whose fiancé suffered a stroke, has been living in the waiting room for eight days. Before the lean changes, she would have had to sleep in a chair or on an air mattress on the floor. But based on the employee’s suggestion, the hospital replaced the furniture in the waiting room with special chairs that recline into beds.

"I can lay back and I have my blanket and my pillow or my teddy bear for my pillow and then I snooze and go to sleep," says Henderson.

The improvements at Barnes Jewish, Virginia Mason and other hospitals using lean management techniques have been noticed. A recent study of the nation’s hospitals put Virginia Mason in the top one percent in safety and efficiency for two years running.

巴恩斯猶太醫院和維吉尼亞梅森醫院以及其它醫院的改進措施，引起了注意。一項對全國醫院的調查，連續兩年把維吉尼亞·梅森醫院評爲安全和效率最好的醫院之一。

But lean management is not for everyone. It requires a tremendous investment of time and resources as well as a leadership willing go forward despite resistance from doctors and staff to the idea of operating like a factory. Also, the process never ends. As the Toyota senseis say, they live in the biggest room in the house, the room for improvement.

可是，這種制度並不適用於所有醫院。它需要投進大量的時間和資源。同時，領導層還必須排除醫生和員工拒絕用工廠式經營方法管理醫院的阻力。再者，這是一個永無止境的進程。