Modifying the Toyota Production System for Continuous Performance Improvement in an Academic Children's Hospital

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The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

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Principles of continuous performance improvement

The philosophy of Continuous Performance Improvement (CPI) recognizes that the continuous improvement of an organization's performance is a long-term generational effort. The CPI organization serves its customers first, vigorously supports its people in their work, and with rigor and discipline applies the scientific method to the iterative improvement of its practices. In so doing the organization recognizes the inter-relationship of Quality, Cost, Delivery, Safety, and Engagement.

Continuous performance improvement principles adapted to clinical practice

Many of the process changes are designed and implemented using the RPIW methodology. During the workshop, the team goes to the actual clinical site and watches the actual process. To expose the many forms of waste it is important to follow a series of standard steps when looking at a process. The team maps and quantifies the actual steps involved, the time for each step, and the distance traveled with each step, then determines which steps add value and designs and implements the improved

Continuous performance improvement in the academic teaching setting

As described previously, a culture of CPI with participation of the entire hospital community is required for success. In a teaching hospital, clinical care is provided in a supervised educational process with a team of resident physicians and medical students. The daily teaching rounds have been described as a mobile one-room school house. Early in our journey with CPI, we developed a philosophy of including a resident or residency director in most clinical improvement processes. This approach

Research applications

The past decade has been marked by rapid advances in technology that have transformed the conduct of biomedical research and accelerated the pace of scientific discovery. These advances have been fueled largely by funding from the National Institutes of Health (NIH). Having doubled between 1998 and 2003, the NIH budget has stagnated in recent years. The current economic crisis exigencies threaten the NIH budget, and with it, the pace of scientific discovery. Rather than implementing

Summary

Continuous performance improvement based on the principles of the Toyota Production System can be successfully adapted to improve the quality of medical care and academic processes. Seattle Children's has been evolving along this journey for a number of years. We believe the improved quality, safety, efficiencies, and cost savings examples shown in this article are the tip of the iceberg for clinical, administrative, and academic programs. Since 2005, there have been well over 200 CPI events

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