INNOVATORS: Wisconsin Hospitals Trim Waste and Improve Care

"There are two things we need to do in medicine," a hospital administrator told Guy Boulton of the Milwaukee Journal Sentinel recently. "We need to learn to see waste. And we need to see risk."

The paper wrote a thoughtful two-part series (here and here) recently documenting how ThedaCare, a four-hospital chain in Wisconsin, has used those two guiding principals not just to save money but to improve patient care. They've re-examined everything from washing sheets to heart surgery. They've saved money—and improved outcomes for patients. They've shortened waits for appointments for CT scans. And they've eliminated hundreds of forms.

One example: an uncomplicated heart bypass surgery, including the doctors' fees, cost $30,400 at a ThedaCare hospital. At some other southeastern Wisconsin hospitals, insurers pay more than double that.

A lot of the improvements can be seen in the general medicine unit at ThedaCare's Appleton Medical Center, where they've introduced a model called "Collaborative Care." The unit serves patients with infections, pneumonia, heart failure, and similar problems. The improvements have cut the amount of time patients typically stay in the hospital by 20 percent.

In this context, "Collaborative" is more than a buzzword. Doctors now make rounds with a pharmacist and a nurse. A care manager (who deals with things like insurance coverage or follow up home care) sometimes joins them. The pharmacist can chime in about the doctor's prescription choices, for instance, reducing the risk of errors or dangerous drug interactions. The collaboration also reduces the number of frantic calls to the doctors' pagers. Nurses are more involved in coordinating care; more routine aspects have been turned over to licenses practical nurses or trained aides.

By focusing on reducing waste, ThedaCare is joining a number of hospitals trying to implement Toyota's proven methods of increasing quality and reducing cost. We wrote about the similar journey of Seattle's Virginia Mason Medical Center last month.

Coincidentally, we were attending a conference about reinventing practice sponsored by the Institute of Healthcare Improvement when this article came out. ThedaCare and its culture of change has caught IHI's attention, too.