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Here is a sample patient care problem in the emergency department (ED). Pat McNeill, RN, patient representative at St. James Healthcare in Butte, MT, compares routine problem solving with problem solving according to the principles of the Toyota Production System.
• Problem: A pregnant patient needs a Doppler ultrasound for assessment. The ED nurse tries to locate this equipment at several locations, but the batteries are dead or the device is malfunctioning. The nurse has to call the obstetrics floor to get working equipment. This causes delays in treatment.
• Routine problem solving: Working equipment is located. The nurse complains to the supervisor about the problem. The problem is put on the agenda for the next staff meeting. There are too many items on the agenda, so the item is delayed for another month until the next meeting is held. The problem is ignored until the next time it occurs.
• Toyota Production System problem solving: Working equipment is located. A root-cause analysis is done to identify what caused the problem. The findings are shared with staff. Staff formulate a plan to correct the problem. The plan specifies what needs to occur and who is responsible to test the results. After changes are made, the problem is solved or revisions are made.