Toyota Production System

Transforming Healthcare Organizations for the 21st Century

By Mike Olive and Mike Brown

A transformation to 21st century healthcare system is dramatically
impacting patient safety and quality healthcare.  New federal
legislation will likely influence how healthcare will be managed and
compensated in this new era. By promoting waste reduction, quality,
accountability, pay-for-performance, evidence-based
medicine, modernization/automation, workflow optimization, core
measures, and transparency, the country is embracing the tenets of the
Toyota Production System.

Quality Improvement

Improve Screening for Osteoporosis with a Simple Intervention

By Alicia Appel, MD; Thomas Mackenzie, MD, MSPH, FAC

Osteoporosis is a common disease characterized by low bone mass with
microarchitectural disruption and skeletal fragility, resulting in an
increased risk of fracture. In the United States today, an estimated 10
million individuals have the disease, and almost 34 million more have
low bone mass, placing them at increased risk for osteoporosis. In
2005, osteoporosis-related fractures were responsible for an estimated
$17 billion in costs By 2040, experts predict that these costs may
double or triple due to the aging population (NOF, 2008).

Advancing the Practice of Evidence-Based Medicine with Standardized Order Sets

By Linda R. Peitzman, MD

A growing body of literature makes it clear that providing clinicians
with access to a greater breadth of automated clinical decision support
tools can improve the quality of care and patient safety. By
integrating clinical guidelines, alerts and reminders, order entry, and
drug information into electronic health records and computerized
physician order entry for point-of-care access to evidence-based
best practices, hospitals also benefit from reduced costs due to fewer
medication errors and other adverse events and enhanced productivity
and workflow.

Measuring and Improving Surgical Quality

By Clifford Y. Ko,MD, MS, MSHS, FACS

Over the past decade, the number of quality measurement programs — both
mandatory and voluntary — has grown exponentially as hospitals respond
to public and government demands for greater transparency and
accountability and improved patient care. Many on the front lines of
hospital quality improvement efforts may find it difficult to tell
which measurement programs are having the greatest impact on patient
care. At the end of the day, we all want to know: Is our quality of
care improving?

MedWise: Preventing Medication Waste While Promoting Safe Administration

By Jeffrey Conzelmann, PharmD; Karyl King, PMP; Sharon Sarnicola, RN; and Brenda Wierenga, RN, BSN

Hospitals face a frustrating medication dilemma: should inpatients be
allowed to take their multi-dose medications (e.g., inhalers, topical
creams, eye drops, insulin) home upon discharge? The natural
inclination is for patients to ask, “These are paid for; why can’t I
take them home? What’s the big problem?”

Rapid Response Teams and Continuous Quality Improvement

By Mary Sue Dailey, APN-CNS; Sue Durkin, APN-CNS; Barbara Gulczynski, APN-CNP, APN-CNS; Marge Kearney, APN-CNS; Barbara Loeb, MD; Joanne Pouliot, RN, MS

When the Institute for Healthcare Improvement initiated the
100,000 Lives Campaign in late 2004, Advocate Good Samaritan Hospital
joined the endeavor to promote patient safety by instituting the six
components of the initiative, including development and deployment of a
Rapid Response Team.

Never Events

Rhode Island Hospital Uses Integrated Approach to Prevent Falls

By Steve Elder

Falls have been a patient safety concern for years. Yet there has been
an increased focus on this issue in recent times, as its scope and
resulting costs have come into clearer focus. Pressure has come from
many directions. In July 2000, the Joint Commission issued Sentinel Event Alert 14,
“Fatal Falls: Lessons for the Future,“ and in 2005 made reducing the
risk of patient harm from falls one of its National Patient Safety
Goals.

How a Captive Insurer Uses Data and Incentives to
Advance Patient Safety

By Diane W. Shannon, MD, MPH

The Institute of Medicine report (2000), To Err Is Human,
unveiled a truth about the U.S. healthcare system that was previously
either obscure or unrecognized: we have a “non-system” of care with a
relatively high frequency of errors. The high defect rate leads to the
death of thousands of people each year from preventable errors — more
individuals than die from motor vehicle accidents, breast cancer, or
AIDS (Kohn, 2000).