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

March 19, 2013

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.

Explore further: Supporting front-line hospital staff leads to safer and happier patients

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.

Related Stories

Supporting front-line hospital staff leads to safer and happier patients

June 21, 2012
Hospitals that use supportive management practices across diverse care providers and front-line staff are more likely to deliver quality patient care, according to a new study in Health Services Research.

Support players needed to improve primary care delivery

January 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 Medicine.

No improvement in patient outcomes seen in hospitals with pay-for-performance programs

March 28, 2012
Paying hospitals to improve their quality of care, known as pay-for-performance, has gained wide acceptance in the U.S. and Medicare has spent tens of millions of dollars on bonuses and rewards for hospitals to improve. However, ...

Researchers question key quality measure for asthma

October 4, 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.

Use of in-hospital mortality to assess ICU performance may bias quality measurement

May 21, 2012
In-hospital mortality for ICU patients is often used as a quality measure, but discharge practices may bias results in a way that disadvantages large academic hospitals, according to a recently conducted study.

Will minorities be left out of health care law provision?

April 26, 2011
Hospitals and physician practices that form care-coordinating networks called "Accountable Care Organizations (ACOs)," under provisions of the new health-care law could reap cost-savings and other benefits. However, experts ...

Recommended for you

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

Schoolchildren who use e-cigarettes are more likely to try tobacco

August 17, 2017
Vaping - or the use of e-cigarettes - is widely accepted as a safer option for people who are already smoking.

Federal snack program does not yield expected impacts, researchers find

August 17, 2017
A well-intentioned government regulation designed to offer healthier options in school vending machines has failed to instill better snacking habits in a sample of schools in Appalachian Virginia, according to a study by ...

In a nutshell: Walnuts activate brain region involved in appetite control

August 17, 2017
Packed with nutrients linked to better health, walnuts are also thought to discourage overeating by promoting feelings of fullness. Now, in a new brain imaging study, researchers at Beth Israel Deaconess Medical Center (BIDMC) ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.