Jenei István

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István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration director of the clinical administration, the developments must find new courses; a mere increase of the resources will not produce adequate results and, as far as the NHS is concerned, capacity problems are due to everyday routines, habits, which no one has ever tried to change (Bennett – Lister, 2006 cited by Parnaby – Towill, 2008). De Koning et al. (2006) also agree that the development of the care provision processes may play a significant part in harnessing the growth of macro-level health care expenditures (Kim et al., 2006), for “…a major source of the growth of health care expenditures is operational inefficiency, and that is not a necessity at all. Health care professionals can influence that (De Koning et al., 2006, p.4.). The macro-level system is the totality of the entities (institutions) constituting the health care system. Initiatives which affect several institutions in the same way will obviously produce change also at macro level. Let us quote an estimate to support that correlation: if the hospitals of the US (some 5-6000) could all implement the developments realised by ThedaCare through the application of Lean – 25% drop in the costs of in-patient care –, the country would save USD 400 billion over 10 years – in inpatient care alone (van Susteren, 2009). 2.2. Actuality of the transformation of health care: micro-level challenges This section demonstrates why it is inevitable to transform health care at the level of service provider institutions. In particular, why it is important to improve the quality and cost-effectiveness of the health service processes in the developed countries (Hungary included). It presents some international researches which highlight these problems. Although they mostly present the health services of the US and the UK, given the nature of the problem, the situation is probably similar also in the other advanced economies. This hypothesis is apparently corroborated by the experiences of research projects carried out in other countries (Laursen et al., 2003; Brodt, 2006; Kollberg et al, 2007). - 33 -
István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration In Autumn 2006, a team of consultants visited Royal Bolton Hospital, which is located in the Manchester region and is part of the British National Health Service. The consultants were invited by the hospital management to survey the hospital processes. This is what they said about their experiences (excerpt): “We have encountered significant frustration, as well as delays, duplications, over-complicated processes and poor communication – many processes seemed useless and full of wastes – many people struggled to remedy them.” (Schenk, 2006, p.4.). Of course, this is but one example from the many hospitals of the world. Nevertheless, as will be shown later on, it is not an exceptional one. The research launched in 1997 in the USA by the Institute of Medicine to survey security and quality levels in their health care institutions (especially hospitals) came to the conclusion that health care struggles with major problems in need of urgent solutions (IOM, 2000): “Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents, braest cancer, or AIDS – three causes that receive fare more public attention. Indeed, more people die annually from medical errors alone than from workplace injuries. And, although errors may be more easily detected in hospitals, the problems extend to every health cares setting, including day-surgery and outpatient clinics, retail pharmacies, nursing homes and home care. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread health problems.” (IOM, 2000, front flap) Other sources suggest that the number of patients who died due to hospital infection is of the same order of magnitude as that of deaths due to false medical decisions. Moreover, for every patient who dies due to medical error or hospital infection, there are 5 to 10 others who suffer infection with less severe consequences. In other words, at the turn of the millennium, in the USA, of 1000 people subjected to hospital care for some reason, 88 were infected, injured or provided wrong therapy, and 6 among them actually died due to that (Spear, 2005). That is, the error rate of the - 34 -
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Jenei István

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