Paging Dr. Lean: Health Care Predictions, Part 2

Thursday, February 13, 2014

Paging Dr. Lean is brought to you by Patricia E. Moody, The Mill Girl at Blue Heron Journal. Submit your Paging Dr. Lean questions to

It has been a long year, and we’ve all had enough pain and suffering to last us through “The Next Health Care Revolution.” But at 17 percent of the U.S. gross domestic product, one-third of which is administrative costs, it’s getting personal, real personal.

Even as the principles of lean manufacturing are applied to health care throughput, paperwork and facility design, progress has been too slow. Dorian Shainen, Shewhart Award-winning quality pioneer at my old home base, Rath and Strong, pounded into us the mantra “Let the data lead you.” There is lots of good data out there. But we could use a little vision, some wisdom and some wild and crazy prognostications to comfort us.

Ken McGuire
Ken McGuire

Despite record profits in health care, what Dr. John Toussaint, founder of the ThedaCare Center for Healthcare Value,  called a lack of transparency in costs and billing continues.

Ken McGuire, Japan Study Mission Pioneer and AME Institute director, said simple problems such as inventory management are crying out for redesign. Manufacturing techniques that we studied more than 30 years ago at Kawasaki, Toyota and Honda have now been proved, and while it is silly to assume that all lean manufacturing methods are immediately transferable into health care — where IT, for example, is ahead of manufacturing — materials costs are just too high to ignore.

McGuire said critical device JIT, for example, is one big opportunity. He cited health care’s “concentration of ‘facility proximity’ to support co-location of production facilities. But within these facilities, there also are fragmented authorities and incredible redundancy across the silos. It’s not uncommon to find multiple stockrooms in different buildings, plus the stash hoarded at floor stations and in unmarked drawers, all in the name of securing life-saving devices and supplies for the patient … a mindset and discipline problem whose root cause is that every item, whether it is a bandage or a catheter, is treated the same way through the same systems.”

McGuire recommends a look back at JIT origins. “We said that JIT was not ‘the right item, in the right quantity, at the right time, and in the right place,’ but real JIT was precisely the right item (perfect), in the exactly the right quantity (plus/minus nothing), at precisely the right time (only when needed) and at exactly the right place (where it is used). The old idea of enough is what filled warehouses — the new JIT way separated the vital few from the trivial many (80/20 rule, A's, B's, and C items, etc).”

He predicted “Lean health care will rediscover this JIT truth by working backward to learn exactly what is the right stocking place and exactly where items are used. The same way one would lay out a stockroom for efficient retrieval, the most frequently used items should be in easy-to-pick locations.”

But we’re talking doctors and surgery and critical care here, right? Don’t high-value items need to be available at exactly the time of use, with special safeguards to protect them being lost or misplaced? Implantable pacemakers, defibrillators, stents, knee and hip replacement joints — all of these devices need to be secured as close to the point of use (surgery) as possible and replaced in time for the next surgical procedure.

Why not locate them in a "vending machine" in the surgical prep area? The items can only be withdrawn with the swipe of an authorized personnel badge that also will contain a patient ID number, another way that health care will eliminate lost items and billing errors.

The vending machine will electronically trigger suppliers for 24-hour replenishment —quantities and variety are a simple calculation of how many procedures will be performed per day factored with the most frequent variations. It’s a simple “use one/replace-one kanban” that will eliminate costly stockrooms.

Dick Morley
Dick Morley

Dick Morley, inventor of the PLC, Prometheus Award winner and backwoods geek, speaks to solutions more than theories. Although his predictions may be hard to swallow, his hit rate stands at 98 percent.

Drugs will be dispensed and controlled like plastic. Your heroin or oxycodone “allowance” will be maintained electronically, like a credit card limit, online to drug stores. Production areas located in Mexico and Afghanistan, for instance, stand one step from the register, controlled by the new drug distribution system that cuts out the middleman and reduces drug-related crimes. The shift decriminalizes the distribution and control system, just as legalizing and taxing alcohol replaced bootleggers and criminal enforcers with government oversight of the supply chain.

In health care, there will be a safety net for everybody, including 911 for critical care.

And, of course, we’ll have 3D printing of body parts.

Patricia Moody
Patricia Moody

Named by Fortune magazine a "Pioneering Woman in Manufacturing," Patricia E. Moody, The Mill Girl at Blue Heron, is a business visionary, author of 14 business books and hundreds of features. A manufacturing and supply management consultant for more than 30 years, her client list includes Fortune 100 companies as well as start-ups. She is the publisher of Blue Heron Journal, where she created the Made In The Americas (sm), the Education for Innovation (sm) and the Paging Dr. Lean (sm) series. Her next book about the future of manufacturing is The Fourth Industrial Revolution. Copyright Patricia E. Moody 2013. With permission.