Deaconess Glover Hospital

Aneesh P.G - 03027

Geordie J Pottas - 03036
Kashinathan K - 03042
Jebin George - 03039
Deepu Varma - 03032
Vinod P - 03079
Dr. John Carter

A vascular surgeon and surgical practice manager with 20 years of

experience
Carter as a patient fell from a tree breaking his second cervical vertebra.
Even though nurses, doctors and administrative staff were all well
committed ,he experienced many uncomfortable close calls.
Worked 5 years within healthcare system and 2 years outside to find a
better way to manage health care.
Worked with TPS experts for more than an year
They had helped him view TPS as more than a collection of specific
production tools. Rather, he had begun to understand TPS as an integrated
approach to designing and improving the work of groups of people engaged
in collaborative effort.

In this case: Testing Toyota Production System (TPS) to healthcare setting

 Deaconess Glover Hospital and CareGroup

A Needham community hospital established in 1909

Run in to losses during 1980s, with capping introduced for each treatments
reimbursement.

In 1994, Deaconess Hospital, a large, Harvard-affiliated teaching and research

institution, purchased Glover (DGH)

In 1996, Deaconess merged its system with that of the Beth Israel
Medical Center, another large, Harvard-affiliated teaching hospital.

The combination, named CareGroup, was a six-hospital network based in

eastern Massachusetts that employed 13,000 people and had a 2,000-person
medical staff.
 Why ?

DGH was a 41-bed community hospital that had lost $2.7 million in the previous
12 months
CareGroup, the 1,500-bed system of which DGH was part, had lost nearly $100
million in the same period
If CareGroup mastered TPS principles, then it might

provide higher-quality care at lower cost relative to its rivals, just as Toyota
had demonstrated sustained and superior quality.
it would become both a showcase and the source of teachers for the rest of
the CareGroup system

DGH - a test site within care group for testing TPS

Within DGH, a model line is required for testing TPS
Gastrointestinal Unit

Carter talked to the Doctor and the staff

Directly observed the work group following patients through a medical
procedure
Carter noted who was doing what and when, trying to record both the physical
activities and the information exchanges taking place among the different
members of the GI staff and the patient minute by minute.
Carter saw that much of the information was situational. Emotional stability
requirement of anesthesia dosage, preparedness for the amount of agitation
Gathered info on the mix of procedures and its frequency. Aim: understand
better the actual needs of the units patients and the demands these needs
placed on the work group
Understanding customer expectations served as a prelude to studying how and
how well the processes within the plant met customers expectations.
Further Studies -South Two Medical/Surgical Inpatient Care
Unit
34 beds, 100 doctors
Studied the activities performed by nurses day shift ,night shift , hand over of
responsibilities
Pharmacy
Activities of Pharmacy technician ,Pharmacist ,Unit Manager
Medication Administration on South Two
the process that delivered pharmaceuticals to patients on a 7-day per-
week, 24-hour-per-day basis
Material and Information Flows: Day Shift
understand the current condition, how the process actually worked
Result:
who was involved in the medication administration process,
what each person was exchanging/communicating with the other,
where these exchanges took place, and
how they were exchanging medications and communicating
information.
Because these information flows contained instructions of what to do, the
diagram suggested - why people did certain activities.
The final element of the diagram indicated the time element - when
 Summary of Steps to Understand Current Condition

Traced specific pathways over which prescriptions and medications traveled,

Documented flows of information and medication among those making

requests and those generating responses

Studied the work of individuals who performed activities on the pathway over
which prescriptions and medications traveled.

Tried to determine the number of distinct pathways over which prescription

requests and medications traveled

Expressed the information diagrammatically

TPS: Summary of Steps to Understand Current Condition

Traced specific pathways over which prescriptions and medications traveled,

Documented flows of information and medication among those making

requests and those generating responses

Studied the work of individuals who performed activities on the pathway over
which prescriptions and medications traveled.

Tried to determine the number of distinct pathways over which prescription

requests and medications traveled

Expressed the information diagrammatically

What has Carter been doing at Deaconess-Glover Hospital and why?

What problems has he discovered following the TPS?
TPS in Toyota
Activities are in sequence and
timed
There is a limited set of steps to
complete an activity
Content of an activity and the
outcome is predefined
Connections between people
(customer-supplier)are simple and
direct
Relatively easy to answer the
questions :
How do you do this work?
How do you know you are doing
this work correctly?
How do you know that the outcome
is free of defects?
What do you do if you have a
problem?
Challenges in DGH
No proper sequence of events
Some activities are not part of
routine activities
Requirements for each patient is
different
Much of the information received
by nurses were situational
Expectation of the outcome is
vague
Interaction between people may
involve multiple steps and multiple
intermediaries
Difficult to answer the TPS
questions
What solutions, according to you, should Carter give to John
Dalton and Julie Bonenfant, the President and VP of the
hospital? Discuss why?

1. Make a STANDARDIZED format for communication between nurses.

2. Specify whom to contact whom for all communication between nurses,
doctors, volunteers, pharmacies and patients.
3. Introduce Nursing Assistants in Executive grade for taking care of all
communication between nurses and pharmacy LESSER COSTS
HIGHER PRODUCTIVITY.
4. Charge Nurses may be assigned as local mentors in accordance with
Rule 4 of TPS
5. Bring in External mentor while introducing TPS.
6. Introduce a Simple Chart at every nursing station, pharmacy, patient
room, doctor and volunteer room for explaining the flow of information,
timing and sequence of jobs to be done.
Exhibit 7: Medication Administration South Two Day
Shift: Flows of Medication and Information
Exhibit 9: Summary of One Hour of Nursing Activity.
Exhibit 11: Who communicates with whom
Thank You