Tom Thomas
Could the principles of efficient manufacturing hold the key to curtailing rising health-care costs at hospitals and medical clinics across the country?
Officials with the Lexington Clinic believe so, which is why the clinic spent the past few years working to achieve accreditation from the Accreditation Association of Ambulatory Health Care (AAAHC), an organization that advocates for the provision of high-quality health care through the development of nationally recognized standards and through its survey and accreditation programs.
This past summer, the Lexington Clinic was awarded the maximum three-year accreditation, becoming the only group of physicians in a Kentucky practice together to hold this accreditation.
The standards set forth by the AAAHC are basically the medical field’s version of techniques drawn from manufacturing and business to facilitate process improvement and efficiency, said Dr. Robert Bratton, chief medical officer at the Lexington Clinic.
“We started this process back in 2009 as a way to address rising health-care costs and improve our service,” Bratton said. “When you talk about clinic care, you need to develop a way of measuring all the various clinical indicators so you can see what you are doing well and what you need to improve on.”
Founded in 1920, the Lexington Clinic offers more than 30 specialties and operates offices in more than 30 locations throughout central and eastern Kentucky. The clinic sees more than 600,000 patients annually and uses more than 200 providers.
In order to receive the accreditation, the Lexington Clinic had to undergo an extensive self-assessment and on-site survey by surveyors appointed by the AAAHC, which included physicians, nurses and administrators who are actively involved with ambulatory health care.
Tom Thomas, senior director of quality at the clinic, came to the Lexington Clinic in 2012, in part to help attain the AAAHC certification. Thomas has a background in helping medical organizations apply the concepts of Six Sigma, a set of techniques that seeks to minimize variability in the manufacturing process.
“The idea is that you can measure anything, including quality,” Thomas said. “If you can identify critical pathways and utilize some of these best practices, you can cut costs and improve quality at the same time.”
Thomas said one example where the clinic was able to make improvements concerned the method by which it distributed samples. Drug samples at the clinic had always been organized alphabetically, but in many instances, two drugs with similar names would be located next to each other, which increased the chance that the wrong one was distributed. One of the best practices recommended in the accreditation process was organizing drugs by type instead of by name.
Another practice identified in the accreditation survey was the disposal of normal waste into trash bags designated for medical waste, which are denoted by their red color. These red bags cost considerably more to dispose of than normal trash bags because they contain potentially dangerous items, such as used syringes, and need to be disposed of in a special — and more costly — manner.
“We found that some people were throwing things like leftover lunch sandwiches away in the red bags, which costs us way more,” Thomas said. “These little things don’t sound like a big deal, but when you identify hundreds of them, they can add up and have a serious effect on your bottom line.”
A key component of the accreditation process was increasing communication among the various departments at the clinic and eliminating the “silo effect,” or the tendency of separate departments to lack communication, particularly in large organizations.
At the Lexington Clinic, this meant that one department may have more stock than it needs of a particular drug while another department may be experiencing a shortage. Rather than simply requesting the surplus from the other department that has too much, the department with the shortage would simply buy more.
Bratton said the clinic was able to address this problem by improving the email system to make employees more aware of what drugs were available outside of their own department. He noted that, in many ways, this was a direct application of “just-in-time” — a pillar of the production philosophy known as “Lean Manufacturing” and popularized by Toyota — that states inventory should be kept to a minimum, because if it is not part of an organization’s current workflow, it does not add value to the product.
“A lot of these drugs are expensive, and if they aren’t used before the expiration date, they have to be thrown out. In the past, that has been a huge source of waste for us,” Bratton said. “As part of this process, we are reorganizing so that we have larger departments and hopefully, more communication.”
Thomas said that while many of the techniques used to improve manufacturing are applicable to the health-care field, he is well aware that there are some major differences.
“The biggest difference, obviously, is that you are dealing with somebody’s life,” Thomas said. “In manufacturing, your biggest concern is your costs.”
Thomas said in the coming months the Lexington Clinic will be assessing its performance in an attempt measure the benefits realized by undergoing the AAAHC certification process. While cost will undoubtedly be one of the parameters measured, so will several others.
“We are dealing with people here, not widgets,” he said. “We realize there is going to be some variation in treatments for some patients, but for a large majority, things will be pretty standard. We’re just trying to close that gap to a reasonable level.”