美国议员尝试用工厂经营方式进行管理

When Virginia Mason Medical Center in Seattle started losing money in 1998, its CEO began a search for a new management system that would get the hospital back on track.

1998年，西雅图的维吉尼亚·梅森医疗中心出现亏损，执行长开始寻求使医院扭亏为盈的新经营方式。

After two years of visiting hospitals around the U.S. and talking with many of the smartest minds in the health care industry, he concluded that there wasn't a single medical institution in the entire country that had a system worth emulating. Instead, he turned to a Japanese carmaker for inspiration.

在两年时间里，他遍访全国各地医院，向专家学者求教，最后得出结论，全美国没有一个医疗机构的制度值得效仿。于是他转向了日本的汽车制造业。

Lean management style

Dr. Gary Kaplan, head of Virginia Mason Hospital in 2001, thought he could adapt Toyota’s lean management style - which focuses on eliminating waste in the production process - to improve healthcare.

2001年，维吉尼亚·梅森医院院长加里·卡普兰医生认为，他可以采用日本丰田汽车的精简经营模式，减少浪费，提高医疗效率。

"He turned to the Toyota production system because it was clear to him that taking these principles and tools and adapting them to healthcare could significantly make Virginia Mason a more efficient operation," says efficiency expert Charles Kenney, author of "Transforming Healthcare, Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience."

经营效率专家查尔斯·肯尼写了一本书，叫作《医疗机构转型，维吉尼亚·梅森医院追求完美的就医经验》。

One of the first Toyota concepts Kaplan instituted was value stream mapping, which involved taking a complicated process and breaking it down into individual steps to find ways to make each step more efficient. Virginia Mason hired several Japanese consultants, called senseis, to help them with their first value steam map: a cancer patient’s visit. In his book, Kenney recounts how the senseis instructed the staff to trace the patient’s journey on a map of the hospital, using a piece of blue yarn.

肯尼写道，卡普兰院长首先引进丰田公司的价值流程图，将复杂的生产流程分解成为单个步骤，然后寻求提高每一步的效率。医院聘请了几名日本顾问，他们的任务是协助制定第一份癌症病人门诊流程图。日本顾问指导工作人员用蓝色丝线在医院地图上标出病人行走的路线。

"And at the end of the process, the blue yarn was snaking around this piece of paper - the schematic on the floor - and it was this immensely powerful visual experience for the entire team," says Kenney, "and they realized that what was happening was they were taking these patients, for whom time is absolutely the most precious thing in their lives, and they were wasting huge amounts of it."

肯尼说：“最后，蓝色丝线在医院平面图上绕来绕去，蜿蜒蛇行。这种直观图像一目了然，他们立即意识到他们在大量浪费对病人来说无比珍贵的时间。”

So the team used the lean management approach to refine the process of administering chemotherapy treatments. By sorting out the steps, simplifying and standardizing them, they were able to cut the amount of time it takes a patient to receive treatment by 50 percent. Then, they turned to other departments, finding ways to increase efficiency and improve safety.

于是这个工作小组开始修订、简化病人化疗的程序，并使之标准化，从而为病人节省了百分之50的时间。然后，他们又转向其它科室，找出提高效率和改善安全的措施。

"So the Virginia Mason Production System is now viewed throughout the world by many people as a viable alternative to the current system," Kenney says.

现在，维吉尼亚·梅森医院的制度已经被世界各地许多人士看作是可以替代现行制度。

It has been adopted by dozens of hospitals in the United States, including Barnes Jewish in St. Louis, Missouri.

美国已经有十几家医院采用了这项制度，包括密苏里州圣路易斯市的巴恩斯犹太医院。Kent Rubach is one of the senseis Barnes hired to guide them on what they call their learning journey. The first change he made was to set up a strategy room for hospital staff. Above a long conference table is a complicated diagram which takes up one entire wall of the room. It is made up of hundreds of hand drawn lines that connect dozens of small pink and yellow sticky notes. It’s just like the charts in Toyota’s strategy rooms.

肯特·鲁巴奇是巴恩斯犹太医院聘请的顾问之一。他做的第一件事是为医院人员布置一个策略室。在这个房间里，一张复杂的图表挂占了整面墙。图表上有数百条线，连接着几十个粉色和黄色纸条。

"You would see the exact same thing, for a part going from raw material to the finished good," Rubach says.

But in this case, the value stream map illustrates the process of a patient coming into the hospital with a stomach ache. Each one of the pink notes represents a point in the process where a patient has to wait.

这张价值流程图显示的是一名胃痛病人进入医院后的就诊流程。每一个粉色纸条代表病人必须等候的地方。

"So if we do have wait, we're trying to add value to that wait, and not just have them sitting and doing nothing," says Daryl Williams, head of the Emergency Department at Barnes. "Can we give the patient education? Can we get their labs done ahead of time so when they get to see the doctor all that stuff is back?"

巴恩斯医院急诊室主任达里尔·威廉斯说：“如果我们必须要他们等，就应该增加等的价值，而不是让病人干坐在那里。比如可以利用这点时间让病人了解一些知识，或者提前做相关化验，这样，当医生为他们看病时，化验结果已经出来了。”

According to Williams, under the old system, an acute abdominal pain visit typically took three hours. Today it’s two hours.

威廉斯说，在旧制度下，严重的腹痛病人就医通常需要三小时。现在只需要两小时。

A key principle of the Virginia Mason Production System is to encourage staff members to speak up whenever they see a part of their job that can be done more efficiently or a process that could be improved.

维吉尼亚·梅森制度的核心是鼓励员工在发现可以提高效率或改善流程的方法时，大胆说出来。

An employee who worked in the Intensive Care Unit had an idea to help patients’ families, who often spend day and night in the waiting room while their loved ones are in the ICU.

比如，医院就根据一名加护病房员工的建议，更换了等候室的家具，使不得不整天守候在医院的病人家属可以把椅背放平，躺下休息一会儿。

Linda Henderson, whose fiancé suffered a stroke, has been living in the waiting room for eight days. Before the lean changes, she would have had to sleep in a chair or on an air mattress on the floor. But based on the employee’s suggestion, the hospital replaced the furniture in the waiting room with special chairs that recline into beds.

"I can lay back and I have my blanket and my pillow or my teddy bear for my pillow and then I snooze and go to sleep," says Henderson.

The improvements at Barnes Jewish, Virginia Mason and other hospitals using lean management techniques have been noticed. A recent study of the nation’s hospitals put Virginia Mason in the top one percent in safety and efficiency for two years running.

巴恩斯犹太医院和维吉尼亚梅森医院以及其它医院的改进措施，引起了注意。一项对全国医院的调查，连续两年把维吉尼亚·梅森医院评为安全和效率最好的医院之一。

But lean management is not for everyone. It requires a tremendous investment of time and resources as well as a leadership willing go forward despite resistance from doctors and staff to the idea of operating like a factory. Also, the process never ends. As the Toyota senseis say, they live in the biggest room in the house, the room for improvement.

可是，这种制度并不适用于所有医院。它需要投进大量的时间和资源。同时，领导层还必须排除医生和员工拒绝用工厂式经营方法管理医院的阻力。再者，这是一个永无止境的进程。