When the three winners of the 3rd Swiss Lean Healthcare Award 2018 by Avance Management Service received their trophies on stage at the Gottlieb Duttweiler Institute in Rüschlikon the audience was impressed. Lean Management and Lean Innovation in Swiss Hospitals. Even I performed a presentation – about Nudges in Healthcare and Hospitals – the rise of Behavioral Economics to make better choices. For patients, their relatives, referring physicians or employees.
> Presentation (in german)
I felt this wave of being impressed too. The nominees, the presentations, the discussions. For the first time since I am writing about the WOW hospitals I asked the one nominee for permission to write about a truly unique innovation in hospital healthcare, Swiss Made. Just keep reading.
The Award: Out of more than 15 projects
Inselspital (University Hospital of Bern)
«Process optimization for outpatient areas» – University Clinic for Neurology
The other two Nominees
University Hospital Basel
Case: Provision of disinfectants – hospital pharmacy
Institute of Pathology, University of Bern
Case: Optimization of laboratory processes
A closer look: The lean laboratory
Dr. med. Heather Dawson, staff pathologist of the Clinical Pathology at the University of Bern showed a firework of applied lean healthcare – results after the reorganization and rebuild of the laboratory in brief:
> Travel-distance of a sample through the lab; from 561 meters down to 56 meters
> Laboratory area reduced by 25 percent
> «TAT» of biopsies; from 53 hours down to 40 hours
> Preparation of a frozen section; from 110 hours down to 59 hours
> New: off-duty weeks for the medical staff and overtime of the laboratory personnel and secretariat reduced
> Free resources to be redirected into important projects; for instance the mobile frozen section car to provide diagnosis on site
The story of the «new frozen section roll-out», the «Schnellschnittauto» invented in Bern, Switzerland
So they had these free resources after the lean implementation. And now what?
In healthcare, lots of innovation, lean processes, behavior changes are needed. There is pressure and there is the tendency to rush.
This team of the Institute of Pathology made it with focused problem identification and the «exchange & conclusion» model.
How did it get to the quick-cut car?
«In discussions with potential external customers the possibility of routine frozen section investigations became the topic. For economic reasons, it would not make sense to build a high-quality facility for frozen section in the respective hospitals.
Alternative options – such as a courier delivering the frozen material to the institute – are not practical due to the long waiting times. So the Schnellschnittauto was the solution for a mobile laboratory, which can be used selectively and as needed and maintained by appropriate professionals.
An frozen section is an intraoperative microscopic examination of the tissue. Here, certain questions can be answered, which influence the further surgical procedure. For example, this is often the assessment of the completeness of the removal of a tumor or the extent of a tumor. Based on the frozen section diagnosis, the further course of the operation can be decided.
In contrast to the conventional workup of the tissue, frozen section material is frozen with a special device within about a minute, cut very thinly (about 3-4 microns), mounted on a slide, and stained. These processes usually take about 10 minutes. In addition, it is possible to «scrape» cells from the preparation and to produce a cytological preparation within about 5 minutes.
Since you have to work in a relatively small space, the frozen section car is set up according to Lean principles. It is generally the same equipment and devices as in the conventional frozen section laboratory. In addition, the car is equipped with a laptop with access to the patient information system of the Institute of Pathology.
The frozen section car is used by external customers who need an frozen section either regularly or when needed. Since an frozen section is required in certain surgeries, patients are mobilized by the respective customer in such a way that these interventions are carried out in a fixed manner during the morning with the frozen section on site. Mission staff: a lab technician and a specialist in pathology.
> Hospitals without an own pathology institute; operations with the Schnellschnittauto, connected to an intra-operative pathological assessment.
The Institute of Pathology was able to win new customers through the Schnellschnittauto who wanted to use this offer. Through this project, the University of Bern wins visibility through the external interest.
> Congresses; for example in Germany – Bamberger Morphologietage January 2018 (morphology days) – the presentation was booked out in a few days
> Congress website (in german)
> The Schnellschnittauto in action, pictures 475 till 478 (courtesy Charlotte Moser)
There are 100 ways to bring out healthcare innovation as a convincing product. Undoubtedly, the Schnellschnittauto of Bern is one of them. The result of a team process, a masterpiece of applied Lean Management and of course a lighthouse for internal and external inspiration, increase in awareness as well as image profit and for sure a platform for collaborative knowledge gain.
Way to go, well done, WOW. My compliments to this smart Institute of Pathology in Bern.