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Should Hospitals Eliminate Waiting Rooms?

To hear Dr. Robert Mecklenburg tell it, the conversation was the first time in his career as a physician that he’d felt ashamed.

It happened over 10 years ago when he and a group of his fellow doctors took a trip to Japan to learn about the world famous Toyota production system.

At the time, their hospital, Virginia Mason Medical Center in Seattle, was losing money for the first time in its history. They knew drastic action was in order. But what?

They had heard good things about how Toyota had gotten rid of waste and improved efficiency along its assembly lines. And they wondered if some of those business principles might work in American health care.

So off they went to Japan to learn what lessons they might bring back home to Seattle and apply in their hospital system.

Late one night while on that first trip, Mecklenburg and some of his colleagues were in a conference room at one of the factories when they were approached by a Sensei. In Japan, that’s a master teacher. In this case a master teacher of the Toyota production system.

The Sensei wanted to know what the “pathway” was for patients to get health care at Virginia Mason. So Mecklenburg began to draw a diagram on a piece of paper.

The Sensei wanted to know what the box was that Mecklenburg had drawn on one part of the page. He replied, “Well, that’s the waiting room.”

Looking a bit puzzled, the Sensei then wanted to know, through an interpreter: “What is the patient waiting for?” Mecklenburg said, “The doctor.” After more conversation, the Sensei asked, “How long is the patient waiting?” Mecklenburg replied, “Oh, 45 minutes or so.”

Then the Sensei wanted to know if this was a scheduled appointment. “By this time I was starting to feel bad,” Mecklenburg recalls.

Then the Sensei asked “You have waiting rooms where patients wait for scheduled appointments for 45 minutes to see the doctor. These measure 25 by 30 feet and you have least 40 of these?”

Mecklenburg nodded his head to say yes.

Then the interpreter turned back to him and said “Sensei wishes to know aren’t you ashamed?”

“This is a moment I’ll never forget,” Mecklenburg says today. “I was ashamed.”

“I had not realized that all this cost of waits and delays and these rooms with the Internet access and the fish tanks and the coffee machines, and the cubes of office staff keeping people waiting and trying to get them in for new appointments were all unnecessary costs which are ultimately paid by that patient.”

For Dr. Mecklenburg, this was a great big “Ah-Ha” moment that set the stage for Virginia Mason’s 11-year quest to get rid of waste, improve the quality of care and put the patient first.

Over the past decade as Virginia Mason has re-designed its medical clinics, waiting rooms are being eliminated and there’s no more 45-minute wait time to see the physician.

And they’ve pared down the three- to four-week backlog of patients waiting for care by taking calls as they come in instead of letting them back up at the end of the day.

Today at the Kirkland Clinic in suburban Seattle, there are same-day appointments and no waiting rooms. When the patients arrive, they go straight to reception, where they’re directed to an exam room.

At Kirkland, doctors and nurses work collaboratively as a team using Medical assistants to manage the “flow” of the delivery of care.

But there’s still a long way to go.

Dr. Gary Kaplan, CEO of Virginia Mason Health System, was also on that first trip to Japan. He gets a big smile on his face now when he describes how hostile the local press was at the time. Health care and cars? Crazy. And the push back from the hospital’s doctors was even worse.

Virginia Mason was a top-down organization where everything was organized around the doctors. And they were used to doing things THEIR way.

Kaplan says back then, some of the doctors were saying they’d change their ways “over my dead body.”

But Kaplan and Mecklenburg were determined to give some of the Toyota ideas a try. They began to transform the entire health care system into one where teamwork was the rule, where doctors and nurses worked together to take care of patients.

An all-out war against waste was declared — a war that continues today. To what effect? Watch our full broadcast story on the medical center’s production-line philosophy below:

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We continue our health cost coverage with a week-long exploration of why the U.S. system is so expensive and some possible solutions to fixing it. Full lineup:

Monday: Why are U.S. health care costs more than two-and-a-half times more than most other developed countries? We talk with Mark Pearson, head of Division on Health Policy at the Organization for Economic Co-operation and Development, about some of the cost-containment strategies that have worked elsewhere in the world.

Tuesday: What steps can you take to make your next hospital stay safer and cheaper? Hari Sreenivasan talks with Elizabeth Bailey, author of “The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized.”

Wednesday: We illustrate what the U.S. could buy with the $750 billion wasted in American health care each year, and, in a separate post, our partners at Kaiser Health News examine the “Top 7 Drivers of U.S. Health Care Costs.”

Thursday: In a “Reporter’s Notebook,” Betty Ann Bowser examines Virginia Mason’s decision to eliminate a staple of the American hospital: the waiting room.

Friday: What inefficiencies have you seen in the U.S. health care system? We share some of the first-person accounts submitted by NewsHour viewers.

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