Picture of health: Denver Health uses 5S to deliver quality, safety, efficiency.

CONCERNS CONTINUE TO GROW WITH REGARD TO American health care in terms of quality, safety, and cost. The public demands that health care institutions address these issues, but there are no simple solutions. As health care leaders consider approaches that would help solve these problems, it seems prudent to examine other industries that have addressed similar problems and use the approaches and tools that have allowed them to achieve success.

Denver Health, a large academic "safety net" institution, provides health care to 25 percent of all Denver residents. It has adopted lean principles and tools to promote efficiency, quality, and safety. Through the application of 5S, middle management orchestrated projects tailored to individual offices and nursing stations to the entire laboratory and financial services departments.

Outcomes included space reclaimed to the extent that changes implemented in just two areas were equivalent to $312,000 of capital costs, improvements in efficiency in terms of both turnaround time in the laboratory department and time to locate equipment in respiratory therapy, and the facilitation of better patient care overall.

Denver Health (DH) operates on a budget of $442 million and employs 4,300 people, including 160 physicians. It is an academic institution with a formal affiliation with the University of Colorado School of Medicine. DH trains 2,400 health professional students each year, including 230 interns and residents. DH's components include an acute care hospital with a level I trauma center, the 911 emergency medical response for both Denver and a neighboring city, eight neighborhood community health centers, 11 school-based clinics, the public health department, a correctional care service, an HMO, and a call center that includes a regional poison and drug center. This integrated system serves approximately 140,000 patients and provided $278 million in care to the uninsured in 2005--an amount representing 42 percent of its total charges.

This burden of unsponsored care and the drive to maintain excellence in quality and safety spurred our search for robust approaches to address the issues of cost, efficiency, quality, and safety.

Two years ago, with a grant from the Agency for Healthcare Research and Quality, we searched for the appropriate change agent and assembled a comprehensive plan punctuated by lean essentials in a health system.

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