When Dr. Fred Cerise, the CEO of Parkland Memorial Hospital, learned that Toyota was moving to Plano, he saw an opportunity.
He'd heard the car manufacturer has a philanthropic arm that helps nonprofits find ways to run more efficiently — for free. Cerise wanted to improve the public hospital's emergency room, one of the busiest in the country. It's a constant challenge to treat 500 to 700 patients each day in a space that holds only 118 beds.
Cerise reached out to Toyota, and the company agreed to help on the condition that the project not be used as part of a layoff plan. That was no problem, Cerise said.
"We know we have more demand than we can meet," Cerise said. "So this wasn't about downsizing the operation. This was about: How can we create more capacity and get more patients through?"
Toyota's team finished its work last month, after eight months of working with Parkland doctors, nurses and other staffers in the ER. Hiring consultants for such a project would have cost hundreds of thousands of dollars, Cerise said.
From the beginning, Toyota didn't want to apply its expertise in assembly-line efficiency to medicine, which could hurt patients. So the Toyota team decided to tackle one segment of the many hours that patients spend in the ER: the "discharge time." That is, the time patients must wait between a doctor's discharge orders and the time they leave the hospital. If those minutes could be cut down, the bed would open up faster for a new patient, reducing wait times.
At first, staffers were skeptical.
"This is really weird — they make cars, we help people," said Stephanie Warnock, a nurse who worked on the project with Toyota. "But it was really cool to see how you can apply the same mechanics to anything. It opened our eyes to things on the floor that we needed to change."
So far, the results have been promising.
In February, when the project started, the average discharge time was 52 minutes. By September, when all the changes were in effect, the discharge time had shrunk to 31 minutes. The team set a goal of 15 minutes, which they believe they will eventually reach.
"Every minute a patient is in a bed and doesn't need to be there takes away from another patient that needs to be in a bed," said Gina Donahue, director of nursing for the hospital's emergency services.
So, how did they do it?
The Toyota team worked alongside Parkland nurses and other front-line staffers to break down the process of discharging a patient. They looked at all the elements — such as paperwork and calling for a social worker or translator if needed — and challenged them to see places for improvement.
"It's all about empowering front-line workers," said Scott Dickson, a senior manager at Toyota Production System Support Center who headed the Parkland project. "It's critical that it's their idea. They're the experts."
One major change the team came up with was using a light system that had come with the brand-new hospital. Each patient has his or her own room, with a light on the ceiling outside. Previously, the ER team didn't use the lights because they involved a time-consuming code and didn't seem useful. The Toyota team got the hospital's information technology department to reconfigure the lights to be more applicable to the ER's needs.
Now, they use the lights to signal immediately to each other what needs to be done in each room. Purple means the room is clean and ready for the next patient. Orange means the patient is out having X-rays taken. Green means a doctor has said the patient is ready to go home. And red means the room needs to be cleaned.
"From a patient privacy perspective it's nice to have your own room, but from a management perspective it's very difficult to see because everything's behind a closed door," Dickson said. Having "quick visibility" is a key part of Toyota's assembly-line production, he said, and it also helped the hospital staff communicate better.
Another change put in place was asking the patient earlier in his or her ER stay whether a social worker would be needed. The Toyota team found that lots of patients' discharge times were longer due to waiting for a social worker to come help a patient who needed assistance with clothing, housing or a ride home. Asking earlier in the process enabled the social workers to be in place to talk to the patient sooner, reducing that time lag.
A third change was setting a uniform standard for all nurses to finish their discharge tasks for a certain patient in that patient's room. Before, the nurses would often take out a patient's IVs and tell him or her to get dressed, then leave the room to work on some documentation or other items.
While the nurse was in the hallway, he or she would often become distracted by ringing phones or other patients or their families, and then that could lengthen the time it would take for the original discharge to occur. Only when that's complete can the room be cleaned and prepared for the next patient.
The hospital has long used the Toyota Production System, a model that helps streamline an organization to make it run as efficiently as possible. But Cerise said having the experts on the system come in with a "different set of eyes" was extremely helpful.
Since moving its headquarters to Plano, Toyota has also helped North Texas Food Bank and Children's Hospital.
"We've been doing this kind of work for 25 years — sharing our knowledge with society," Dickson said. "Honestly, the staff that I worked with on this project was very, very interested and engaged and they truly want to make things better."
