Improving Patient Care in Cardiac Surgery Using Toyota Production System Based Methodology

摘要

A new cardiac surgery program was developed in a community hospital setting using the operational excellence (OE) method, which is based on the principles of the Toyota production system. The initial results of the first 409 heart operations, performed over the 28 months between March 1, 2008, and June 30, 2010, are presented.MethodsOperational excellence methodology was taught to the cardiac surgery team. Coaching started 2 months before the opening of the program and continued for 24 months.ResultsOf the 409 cases presented, 253 were isolated coronary artery bypass graft operations. One operative death occurred. According to the database maintained by The Society of Thoracic Surgeons, the risk-adjusted operative mortality rate was 61% lower than the regional rate. Likewise, the risk-adjusted rate of major complications was 57% lower than The Society of Thoracic Surgeons regional rate. Daily solution to determine cause was attempted on 923 distinct perioperative problems by all team members. Using the cost of complications as described by Speir and coworkers, avoiding predicted complications resulted in a savings of at least $884,900 as compared with the regional average.ConclusionsBy the systematic use of a real time, highly formatted problem-solving methodology, processes of care improved daily. Using carefully disciplined teamwork, reliable implementation of evidence-based protocols was realized by empowering the front line to make improvements. Low rates of complications were observed, and a cost savings of $3,497 per each case of isolated coronary artery bypass graft was realized.CTSNet classification:4CARDIOTHORACIC ANESTHESIOLOGYThe Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS member or an individual non-member subscription to the journal.The purpose of this project was to develop a new heart surgery program using methodology based on the Toyota production system (TPS). Current management and work structure in cardiac surgery has achieved the excellent outcomes that patients now experience. The level of defects in care is still unacceptable and much opportunity to improve exists.Methodology to continuously remove defects and improve processes has been provided in healthcare in southwestern Pennsylvania by the Pittsburgh Regional Healthcare Initiative (PRHI). This group arose under the leadership of Paul O'Neill, former Chief Executive Officer of Alcoa Corporation and former Secretary of the United States Treasury. The Alcoa Corporation had been transformed in the 1990s by using TPS principles to become the premier aluminum producer in the world. Mr O'Neill offered PRHI the resources to train healthcare providers and leaders in using these approaches to potentially transform healthcare delivery. The Perfecting Patient Care University of PRHI, established in 2001, continues to introduce healthcare workers to the principles of TPS.It has been recognized through the work of W. Edwards Deming and others that removing defects from complex processes results in less variable outcomes and higher quality [