There is no question that most of healthcare and behavioral healthcare has become big business. This situation escalated after the development of for-profit managed care over the past 20 years or so, and is likely to further increase if healthcare reform continues.
Accountable Healthcare Organizations (ACOs), after all, have been described as “HMOs on steroids." To keep costs in control and thrive financially, the ACOs and the managed care companies will have to have the best business processes, and hopefully the best business ethics, in place.
Coincidentally or not, over the same time period, my wife and I have been buying Toyota cars. These tended to be the middle-level minivans and Solera models, the former for my wife and the convertibles for me. Why did we do that? Their presumed reliability and value proved to be true, at least for us. Toyota has also been a pioneer in the transition to electric cars with the Prius, which our son bought. This addition supports one of my favorite activist causes, global warming, which was the focus of my very first blog for Behavioral Healthcare.
As Toyota was succeeding in the USA, the big American car companies almost went under with questions of quality, poor gas mileage, and lack of excitement. Even our usual distaste for negotiations with car salesmen were not so bad at Toyota. For our last purchase, last October, we even bought the salesman a carton of chicken soup as a thank you. Recently, we were reminded that this car needs its first servicing and “checkup”. Maybe we need to do more of the same at our clinics.
Of course, we were tempted to go elsewhere at times. Why not something fancier? We could afford that. Then, there was the more recent scare of the stuck accelerator in some Toyotas. Even though American cars seem to be catching up, thanks to a governmental bailout, Toyota seems to be recovering nicely on its own, even after the earthquake in Japan slowed production.
This has got me wondering. Can the success of the “Toyota Way” be generalized to our behavioral healthcare systems to make them more cost-effective? If so, what goes into this “Toyota Way?”
At least one psychiatric hospital has explicitly and publicly started to put this “lean methodology” of Toyota into place. This is the well-regarded Sheppard Pratt system in Towson, Maryland. The first focus was to save time and improve quality. This was applied even to such apparently mundane activities as to gather a discharged patient’s belongings when they were to leave the hospital, which was reduced from 2 hours to 2 minutes. And, to think that we psychiatrists have been complaining of the common reduction of medication checks from 60 minutes to 15 minutes!
Most highly trained professionals seem to resist the “Toyota Way”. Doctors often resist quality improvement processes, arguing that their judgment and expertise can’t be reduced to a set of rules. Are they right?
The Toyota Way
To answer that question, let’s review the history of the Toyota process and where it might have gone astray by 2009. First to understand is their production system of very specific rules, but rules that seem paradoxical. The production workers have been viewed as a “community of scientists” and their supervisors as “teachers.”