Toyota's management practices may improve the quality of hospital care

Researchers have long surmised that management techniques successful in manufacturing and technology sectors may improve health care quality. However, there has been very little evidence about how these practices are disseminated in hospitals and whether they are associated with better performance.

A new study led by Oregon Health & Science University (OHSU) health economist K. John McConnell, Ph.D., reveals manufacturing management practices, including Toyota's "Lean" methodologies, may be beneficial in helping hospitals achieve "high-quality health care outcomes." The findings are published online in JAMA Internal Medicine.

"Although a lot of effort has been focused on the use of evidence-based medicine to improve the quality of clinical practice with some important successes, our study results suggest implementing organizational strategies and management practices that enable and incentivize high-quality health care may also be beneficial," said McConnell, an Associate Professor of Emergency Medicine at OHSU, and Director of OHSU's Center for Health Systems Effectiveness.

To conduct this research, McConnell and colleagues focused on cardiac units across the country. They adapted an approach used to measure management practices in manufacturing to collect similar data on 597 cardiac units with interventional cardiac catheterization laboratories and a minimum of 25 annual heart attack discharges annually—making it one of the largest studies ever conducted on management in

The units' nurse managers were surveyed via phone in 2010 and performance scores were calculated based on open-ended questions about whether the unit is a poor, average or high performer in 18 practices. The practices were broken down into four categories: standardizing care/Lean operations, tracking key performance indicators, setting targets and incentivizing employees. The nurse managers' responses were scored on a scale from 1 to 5, with 5 being the highest.

The researchers then assessed the relationship of management practices with "process of care measures," such as staff communication, patient handoffs and discharges, as well as 30-day readmission and 30-day mortality rates for heart attack patients.

The scientists found wide differences in management practices across hospitals. Fewer than 20 percent of hospitals scored a "4" or "5" (best practice) on more than nine of the 18 practice measures. Higher management practice scores were associated with lower 30-day mortality rates and better performance on process of care measures. Higher scores were not associated with lower 30-day readmission rates.

"Many of these manufacturing practices are relatively moderate in scope and do not require substantial capital investment. Our results suggest future directions for hospital and quality of care," said McConnell.

More information: The study "Management Practices and the Quality of Care in Cardiac Units" was supported by grant 1R01HS018466 from the Agency for Healthcare Research and Quality.

add to favorites email to friend print save as pdf

Related Stories

Support players needed to improve primary care delivery

Jan 25, 2013

(HealthDay)—Practice facilitators and care managers can play important roles in improving delivery of primary care, according to a study published in the January/February issue of the Annals of Family Me ...

Researchers question key quality measure for asthma

Oct 04, 2011

Researchers studying the first national quality measure for hospitalized children have found that no matter how strictly a health care institution followed the criteria, it had no actual impact on patient outcomes.

Recommended for you

Older adults are at risk of financial abuse

13 minutes ago

Nearly one in every twenty elderly American adults is being financially exploited – often by their own family members. This burgeoning public health crisis especially affects poor and black people. It merits the scrutiny ...

Medical internet could transform health care

24 minutes ago

The medical Internet is not yet here, but the widespread availability of electronic medical records and enhanced data-storage capabilities are pushing it closer to reality. As now envisioned, this new cyberspace ...

Better care for transgender youth

1 hour ago

A fact sheet on ways to improve the wellbeing of transgender youth in New Zealand has been developed at the University of Auckland.

Experts highlight big gaps in healthy food policies

1 hour ago

Healthy food policies to promote childhood health and reduce obesity are lacking, according to a report highlighting the policy priorities assessed by an expert panel of more than 50 New Zealand public health professionals, ...

User comments