When 99.9% efficiency is not good enough: TWI increases productivity and minimizes errors

In healthcare, the only acceptable error rate is basically zero. Some may call it utopia, but nevertheless, it is the goal of the Virginia Mason Medical Center in Seattle. Here, Laboratory Supervisor Cheryllynn Waymack, whom P360.dk met at the TWI Conference 2014 in Copenhagen, has taken on the task of reducing the errors to zero percent in the laboratory department.

Written by Bo Skovfoged, Senior Consultant, LEAD
Published in: P360

Date: 27.06.2014

With a combination of TWI (Training Within Industry), Lean and Leader Standard Work, Waymack has trained the staff, enabled them to train their colleagues and introduced standardized processes to address some of the biggest challenges at the Seattle hospital.

"In the United States, 98,000 people die because of healthcare errors every year. It is the country's fifth largest cause of death and costs 29 billion USD a year. It's expensive and we hurt each other. For us, 99.9 percent is not good enough. It means that 1 out of 300, for example, experiences errors during surgery. Imagine waiting outside the surgery and being told that no recent mistakes have been made. Are you number 299 or number 300?" says Cheryllynn Waymack.

The hospital was introduced to Lean by Boeing from the same city in 2000 and started introducing the method in 2002. The goal was to reduce the number of errors in, for instance, laboratory tests in the hospital's four clinical laboratories. A minimization of the error rate by just a few percent means a lot for the hospital, which in 2013 processed 1.9 million tests.

Although a sharp reduction in throughput time and reduced error rate is something that many manufacturing companies will envy, it is still not good enough in terms of human health.

"Through different phases we managed to reduce 44% of the throughput time, while achieving 95% success with the samples. 44% is fantastic for the patients. 95% is amazing, except for the 5% who experienced errors in the results. To achieve 100% we had to think more about people in the processes, create common goals, clear expectations and roles, build trust and trustworthy processes," says Cheryllynn Waymack.

It was here that TWI, Training Within Industry, entered the picture for Virginia Mason.

"It's about getting the work standards in place first. We learned the hard way that you cannot add TWI to defective standards - it only accelerates the spread of the defects. Instead, it's in the gap between information and communication that the difference lies. By involving the employees, showing respect for the individual as well as respecting and learning from their reaction to new methods, progress can be seen," she says.

Two steps forward - and one step back

Virginia Mason learned their lesson the hard way and had to rethink their strategy. On the other side of the process, Waymack recommends that you be prepared to show patience.

"There are obstacles to getting started and understanding the methods. You have to be ready to open up and let go of the prestige when working. In the work with TWI in combination with Lean and Leader Standard Work, we have also learned that it is usually two steps forward and one step back and that you must respect and use people in the best possible way," she says, referring to another project where TWI was introduced as a training method.

"Before we started using TWI as a method, 83.5% of the employees took proper care of their hand hygiene. This is an important area in the healthcare system, as the hands are a huge source of contagion. After TWI, 98% take proper care of their hand hygiene, and today, it is said that one can recognize a Virginia Mason employee on their hand hygiene. However, the five people in our department cannot singe-handedly teach 6000 employees to wash their hands. A manager has to teach it to their middle managers who then teach it to others," she concludes.

And what about the error rate in the laboratories? Well, it hit 0% in May 2013.