LEAN-living Denver Health a model for integrated care
By Tillie Fong 
| July 17, 2009 | 7:01 AM
Who knew that methods to improve efficiency and reduce costs in car manufacturing could be applied to health care?
Patricia Gabow, chief executive officer for Denver Health, did in June 2005.
“Patty believed that the American health care system was not sustainable unless it was radically changed,’ said Phil Goodman, senior LEAN facilitator for Denver Health. “So we launched a redesign.”
One change was implementing LEAN methods, based on the Toyota Production System, in which workers identify the most efficient and cost-effective ways to do their jobs. The goal is to eliminate eight types of waste: time, inventory, transportation, motion, process, production, defects and human talent.
When Denver Health adopted LEAN, it was one of two in the country to do so (the other was a private health care provider in Wisconsin). Now, more than 100 hospitals use LEAN.
“When we take waste out from the process, quality improves,” Goodman said.
Since LEAN was implemented, Denver’s public health care system has saved more than $24 million, with no reduction in patient services or layoffs.
“The new slogan is: LEAN at Denver Health is saving money, saving jobs and saving lives,” Goodman said.
It was one of the reasons why Mayor John Hickenlooper hailed Denver Health as “one of the most innovative and successful big-city hospitals” in his State of the City speech July 14.
Hickenlooper also noted that Denver Health is “perhaps the only fully integrated big-city health system in America” and suggested that “as the Obama administration searches for answers to our national health care challenges, you can be sure that many will be found in Denver.”
Denver’s integrated system is unique. Integration means that the city hospital, public health department, eight family health centers, 12 school clinics, ambulance services, detox facility (Denver CARES), and specialized services such as the Rocky Mountain Poison and Drug Center are all managed by one entity: Denver Health.
“We’re coordinating and not duplicating services,” said Stephanie Thomas, chief operating director for Denver Health.
One advantage of full integration is that there is only one medical record system. So, if someone being treated at a community clinic needs to see a specialist at Denver Health Medical Center, the hospital physician can easily access the patient’s medical records.
“As the patient moves through the system, we don’t duplicate tests and we better manage medication,” Thomas said.
The records system is online and has been since the 1990s. X-rays and other images also are scanned into the system.
Another advantage of integration is that, because of services such as NurseLine, a 24-hour hotline to reach a nurse for medical advice, patients are given care that is appropriate for their situation and, therefore, more cost-effective.
Thomas said that if all the people picked up by Denver CARES were taken to Denver Health Medical Center for treatment, it would cost the hospital an estimated $20 million a year.
“In the end, it’s really good for the patient,” she said. “The system works to keep them out of the hospital, and they get care at the right time and place.”
Integration also allows Denver Health to provide more services to more people.
“What’s great about that is that we get to leverage a lot of care,” Thomas said. “We get a lot of bang for each buck that the city gives us.”
Denver Health gets only 6 percent of its revenue from the city, with the rest coming from Medicaid, private insurance, Medicare and federal grants. It provides health care for about 25 percent of the city’s population, and one out of every three Denver children is treated by a Denver Health doctor.
Thomas said that while Denver Health can serve as a model for the rest of the country, it would be difficult for other cities to duplicate.
For one, Denver launched its integrated system in 1947, when Florence Sabin became the manager of what was then the Department of Health and Charities. She was the one who decided to “combine public health with the personal” in city services, according to Thomas.
“The groundwork was laid by Sabin,” Thomas said. “A lot of it was to modernize and build, and add components to an existing structure.”
As new services were offered — the Rocky Mountain Poison and Drug Center in the 50s, community health centers in the 60s, and NurseLine four years ago — they were folded into Denver Health’s overall mission.
But Thomas noted that in other large cities, the city hospital, public health department and community clinics have all been established independently.
“It’s the politics,” she said. “They have their own CEOs and boards, and they don’t want to be subsumed into a larger organization. We believe this is the way to go, but it would be very difficult to replicate.”
Denver Health, Florence Sabin, john hickenlooper, LEAN, Phil Goodman, Stephanie Thomas, Toyota Production System
