Early in 2000 the top management of the ABC Hospital looked at their operation and found it was designed around them, not the patient. While looking for a better way to improve quality, safety and patient satisfaction, they turned to the Toyota Production System, with an idea to eliminate waste and defects in production. There are seven wastes, according to the production system. A series of training sessions on the Toyota Production System opened their eyes about the seven types of wastes, such as patients waiting for a doctor or for test results to come back, having more materials and information than is necessary, stockpiling brochures and pamphlets in storage closets. The hospital implemented a Kanban system, a card put near the bottom of a pile of tongue dispensers, gauze strips or brochures, which signals the need to restock. When a nurse or physician sees the card, he or she knows it's time to refill. Supplies don't run out, but they also aren't over-ordered. The hospital created standardized instrument trays for surgeries and procedures, which saved thousands of rupees by no longer setting out extra instruments no one used. Unused but opened instruments have to be thrown away. They displayed flip charts showing the appropriate picture of what the patient can do, and each nurse or physician who comes in the room doesn't have to waste time searching for charts or asking questions. ABC implemented a production plan to hire more staff before a shortage exists based on turnover rates on any given floor. Another adaptation from the Toyota model is a patient safety alert system. At the manufacturing plant, if there's a problem, the whole line is stopped and the problem is fixed immediately. ABC's practice so far had been to identify and fix problems after the mistakes have occurred. They adapted an alert system from the Toyota System which allowed nurses and physicians to signal a problem when it happens and fix it immediately. They had about 10 alerts each day. A series of such measures reduced appointment and telephone delays by having medical assistants handle incoming calls, instead of medically untrained operators. Instead of the doctors waiting until the end of the day to go through a stack of patient records, they now write comments and recommendations immediately after seeing the patient before going to see the next one. The time thus saved increased the time a physician could spend with a patient. Increased cost of medical care is due to clogs in the flow of informationpaper forms, lab results, phone messages, often leading to irritated patients. The hospital reduced overtime and temporary labor expenses by Rs50 lakhs in one year, along with increased safety and more efficient care. 10. What are the wastes identified by the hospital management in their health facility? (15 Marks) 11. How did the hospital management address these wastes using the Toyota way? (15 Marks) 12. What is lean methodology and what are its principles? (15 Marks