Applying the Toyota Production System: using a patient safety alert system to reduce error.
BACKGROUND
In 2002, Virginia Mason Medical Center (VMMC) adapted the Toyota Production System, also known as lean manufacturing. To translate the techniques of zero defects and stopping the line into health care, the Patient Safety Alert (PSA) system requires any employee who encounters a situation that is likely to harm a patient to make an immediate report and to cease any activity that could cause further harm (stopping the line). IMPLEMENTING THE PSA SYSTEM--STOPPING THE LINE: If any VMMC employee's practice or conduct is deemed capable of causing harm to a patient, a PSA can cause that person to be stopped from working until the problem is resolved. A policy statement, senior executive commitment, dedicated resources, a 24-hour hotline, and communication were all key features of implementation.


RESULTS
As of December 2006, 6,112 PSA reports were received: 20% from managers, 8% from physicians, 44% from nurses, and 23% from nonclinical support personnel, for example. The number of reports received per month increased from an average of 3 in 2002 to 285 in 2006. Most reports were processed within 24 hours and were resolved within 2 to 3 weeks.


CONCLUSIONS
Implementing the PSA system has drastically increased the number of safety concerns that are resolved at VMMC, while drastically reducing the time it takes to resolve them. Transparent discussion and feedback have helped promote staff acceptance and participation.
Furman
Cathie
C
Virginia Mason Medical Center, Seattle, USA. Cathie.Furman@vmmc.org
Caplan
Robert
R
D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D007221:Industry; D019300:Medical Errors / Q000517:prevention & control*; D019982:Organizational Case Studies; D016134:Organizational Policy; D011786:Quality Control; D012308:Risk Management; D017751:Safety Management / Q000379:methods*; D017749:Total Quality Management / Q000379:methods*; D014861:Washington