Prof. Dr. Ömer Faruk Bilgen, M.D., Specialist of Orthopedics and Traumatology
Ümit Zileli: You’ve already heard about our show, Have Your Say with Ümit Zileli (Ümit Zileli ile Söz Sizde). This is a show that hosts various people having anything to say in any kind of subject. From economy to culture, healthcare, entertainment or politics, the subject may be about anything. Right now, I have two professors of medicine over here and we will talk about a subject you’ve probably never heard much about up to this day. We will talk about a system called lean approach in the healthcare industry, which is being applied in the hospitals right now. By the time we’re done, we will have addressed the issues surrounding the definition of this approach, the hospitals applying it, the healthcare system, the wastes, and the devastating results caused by these wastes. Without further ado, let me introduce you our guests. On one side, Prof. Dr. Ömer Faruk Bilgen, M.D., Specialist of Orthopedics and Traumatology. On the other side Prof. Dr. Aysun Yılmalar, M.D. Specialist of Anesthesia and Intensive Care. Welcome, both of you. You’re working in Bursa, operating a hospital. Medicabil Hospital… Do you mostly specialize in this field?
Prof. Dr. Ömer Faruk Bilgen, M.D.: Our hospital mostly focuses on the cases orthopedy. We have been active for 5 years. To some extent, we have become a center of reference in the region. Because we can recognize this by looking at the characteristics of the medical conditions of our visiting patients. They are either extremely difficult cases, or they have been worked on, unsuccessfully, by other institutions in the past.
Ümit Zileli: Do you mean revision? Prof. Dr. Ömer Faruk Bilgen, M.D.: Yes, to some degree, our hospital has achieved that qualification. By the way, our hospital has another specialty. Our intensive care unit is particularly strong. In terms of not only bed capacity but also qualifications of the staff members, it is substantial. And, it is overseen by Prof. Dr. Aysun, M.D.
Ümit Zileli: To be honest, 5 years is not a long period, but becoming a center of reference is obviously important.
Prof. Dr. Ömer Faruk Bilgen, M.D.: Not much, indeed. The fact that it focuses on the orthopedics makes this possible. Lately, the field of orthopedics has gained popularity. Especially for 15-20 years and in the last 10 years, when you look at the United States (we are looking them because they lead the world in every aspect), the orthopedics and plastic surgery has become one of the most-wanted branches of medicine. Therefore, we can argue that there has been a shift towards that in our country too. Because, at the end of the day these are paths followed by the developed countries.
Ümit Zileli: Is there anything in the orthopedics that we cannot do well, doctor?
Prof. Dr. Ömer Faruk Bilgen, M.D.: No.
Ümit Zileli: Well, you are certain on that end, which is alright. But there are not so many things easier than fracturing a human bone. And then there is the field of traumatology.
Prof. Dr. Ömer Faruk Bilgen, M.D.: Orthopedics consists of 7 branches of specialty, each of which is actively available in our institution. Namely, spinal surgeries, tumors, arthroplasty, which is my main area of interest, sports medicine, children orthopedics, and hand surgeries; all are available in our institution.
Ümit Zileli: Do not underestimate orthopedics. Doctor, we’ve mentioned the intensive care, but your field of specialty, anesthesia is a frightening subject for many people. I know certain things about your field, as a person who have underwent many surgeries. Yet, there have been amazing developments in your field, don’t you think? Prof. Dr. Aysun Yılmalar, M.D.: Well, when you consider the advancements since the time I was an assistant, I can certainly say from my experience that there have been significant developments.
Ümit Zileli: Anesthesia represents almost the most important part of a surgery, doesn’t it?
Prof. Dr. Ömer Faruk Bilgen, M.D.: You know, I’m going to say this. Until you described it as the most important part, I’ve always assumed that I was the only one to believe that argument. I have always preached Doctor Aysun that “Anesthesia is very important, Anesthesia is such and such…” Now, for the first time I’ve heard the same from another person. It is indeed very important.
Ümit Zileli: Congratulations to me, then. Right now, how are we doing in healthcare? We used to talk about it all the time. But when you look at the period after the full day law was passed, there have been amazing developments, and dramatic declines. Some professors have withdrawn their seats. The number of surgeries performed at Cerrapaşa Hospital have now fallen to 20’s, despite being used to between 200 and 220. I believe there is a stunning amount of waste going on in the healthcare system, would you agree to that?
Prof. Dr. Ömer Faruk Bilgen, M.D.: Yes.
Ümit Zileli: What about you, professor?
Prof. Dr. Aysun Yılmalar, M.D.: Yes, I am of the same opinion.
Ümit Zileli: It is not just about the money; it is going on every level. Wasted time and materials and waiting periods of the patients broke my soul. I asked myself “What would have happened were it not for these?” When I asked you about this lean approach shortly before, I very much liked what I learned from you. Because, the lean approach is a movement towards removing all the waste in hospitals, including the aspects of personnel, material and time, isn’t it? Alright, what is the basic definition of the lean approach?
Prof. Dr. Aysun Yılmalar, M.D.: I used to believe, before adopting the lean approach in the healthcare industry, that the healthcare professionals – not only physicians but all healthcare workers – should complete their daily tasks within the frame of a standardization. This is not just about me, though; the Ministry of Health is now enforcing mandatory quality standards for all hospitals. These are the things that we should always observe in our hospitals. We are being audited every year on these matters. We have been found successful in each year, and take pride in the fact that our score have never been lower than 96-97. Right now, we are focusing on removing the non-value adding procedures from our business processes, which may be an activity that does not offer extra help to the patient, or an unnecessary motion by a staff member, or an unnecessary material. As defined by the lean approach, the term waste refers to any activity that does not provide additional value to the process. Identifying those activities is a part of this approach. Obviously, all healthcare professionals need to pass a training to be able to work like this. It is certainly easier than done, because they need to learn certain methods to change how our brains work, perform their duties, understand and adopt the principles of the lean approach, and adjust accordingly.
Ümit Zileli: This is a rather new concept, right?
Prof. Dr. Aysun Yılmalar, M.D.: I would say so. But, it isn’t a new concept in the industry. It is a philosophy tracing back to Japan. Later, it came over to the West, and they tried to customize it for the healthcare industry. Because they saw the potential. We’re always giving examples from the US, they use the best type of practice. In our time, we visited there frequently. Surely, their system was working like a well-oiled machine. But even they had to come up with a concept by thinking like an industrial engineer to deal with the delays affecting both patients and their relatives by adopting the lean approach. They wrote so many books on this subject and many popular hospitals decided to give it a try. They have done so much work on this concept.
Ümit Zileli: At the end, it creates an amazing financial opportunity, too.
Prof. Dr. Ömer Faruk Bilgen, M.D.: Which reflects on the costs. Any kind of regulation reduces the cost in the healthcare industry.
Ümit Zileli: Are the patients satisfied with this, though?
Prof. Dr. Aysun Yılmalar, M.D.: The patients are satisfied as well. If there is anything that the patients despise is to be kept waiting. They want to be served within the proper optimum time. Had I been a patient, I would have wanted the same thing. This approach allows us to take care of that.
Ümit Zileli: Let’s look at this under topics. What does one need to do this?
Prof. Dr. Ömer Faruk Bilgen, M.D.: To add to what Doctor Aysun have said, we are doing so many things, scientifically, to ensure the safety and satisfaction of our healthcare system workers, healthcare professionals, patients, and their relatives. This approach is a form of doing all these things in light of the new developments, in accordance with the scientific facts, by means of incorporating them in our practices, in the humblest manner. This should be our focus. So, as Doctor has mentioned in the beginning, training is the most important aspect. This logic should be adopted by everyone from top to bottom. Which, as we usually say during our conversations, starts with dreaming. One should first dream about doing something, like, “I am going to do this.”
Ümit Zileli: This is not just for the healthcare industry; it should be observed in every aspect of life. You know how the saying goes, “dreaming it is %50 of completing it.”
Prof. Dr. Ömer Faruk Bilgen, M.D.: It starts by dreaming and envisioning the outcomes; at the end of the day, this is our job. You start an operation by knowing what you’ll get. Ultimately, your goals are clear, so one should start by dreaming first and finalizing properly, which begins with training.
Prof. Dr. Aysun Yılmalar, M.D.: All feedback given by the patients or their relatives, which may be a suggestion or complaint, is an opportunity for continuous development for the hospital. Each of them should be carefully examined. You never know, you might learn about something you’ve missed before.
Ümit Zileli: You’re right, you never know. There certainly things that falls off your radar since you have an intense schedule. That applies to us, as well. Sometimes my writing sounds good to me, but my editors warns me about a word or sentence structure. That’s when I notice my mistake. It’s the same thing.
Prof. Dr. Aysun Yılmalar, M.D.: For half a day we oversee the workshops that I’ve just mentioned earlier. In these workshops the concept of a lean hospital as well the developments in the field are thought on a theoretical scale. There are some tools for problem solving techniques included in the lean approach. Tools that ease problem solving… Doctor Ömer suggested organizing trainings about tools such as brainstorming, seven wastes, root cause analysis, and Kaizen exercises. We need to educate our healthcare professional on methods of identifying and solving problems, identifying tools and ensuring continuous improvement on certain areas.
Prof. Dr. Ömer Faruk Bilgen, M.D.: Additionally, Kaizen exercises, “5 S” exercises are all quality-focused examples. To ensure anything to have a certain quality, I have to define the time limit to complete that task. It is about reducing the time spent during that period.
Ümit Zileli: But, in majority of cases it is said to be unnecessary. I’ll leave it to you. Prof. Dr. Ömer Faruk Bilgen, M.D.: When we are working with the lean approach and trying identify opportunities, we usually look around. We are doing this. But, how can we do this by spending less energy, time, and generating fewer waste? Let’s give an example. One day, the operation table in the operation room was covered with a hundred tools. We’ve only used ten of them. We have to get them sterilized once again, though. With this approach, you can prevent labor loss, energy loss, sterilization machine’s deprivation, loss of effort by those carrying the tools, potential risk of injury, etc. at once. 80% of our workload has been eliminated. You can apply this to all areas. For example, frequent opening and closing of an operating room’s door; what happens if you open the door to bring in a single item, and then leave? The risk of infection increases. So, what do we do? We identify which tools and items twe may need to perform the surgery in advance. Because we have already envisioned potential scenarios for the surgery in our minds. We have made plans to solve potential problems. We have defined our supplementary tools and items. I can always use them in case of an escalating situation. So, the door is opened for twenty times instead of a hundred.
Ümit Zileli: A patient can get infected and lose their life as a result. So, hospital sterilization is vital. To what extent this is possible in your hospital?
Prof. Dr. Aysun Yılmalar, M.D.: We have an infection prevention standard. Compliance with this standard is included in the accreditation and quality standards. Stipulated, or to be honest, imposed by the Ministry of Health, which I think is quite necessary. Also, we have JCI, too. They are a US-based non-governmental organization, and they performed an audit in our hospital. We have a certificate for that. The quality standards of JCI and the Ministry of Health contain very important infection prevention standards. We are observing these standards in our hospital.
Ümit Zileli: How long have you been doing this, since founding the hospital?
Prof. Dr. Aysun Yılmalar, M.D.: Yes.
Ümit Zileli: Alright. So, what do you think about how much you make? For 5 five years you must have earned financial success, let alone social capital. Prof. Dr. Ömer Faruk Bilgen, M.D.: We are earning some money, too. But obviously, the most important thing is the patients’ health. I’ll
give you an example. I am interested in arthroplasty. It has been my sole focus of interest for over 25 years. It is one the seven branches of orthopedics. Among the primary cases – i.e. cases first operated by me – of hip or knee prosthesis surgeries, only in one case of knee surgery have we observed infection, which was not related to the surgery and occurred two years after the operation. My infection rate in hip surgeries has remained at zero for five years.
Ümit Zileli: That is significant.
Prof. Dr. Aysun Yılmalar, M.D.: Of course, it is a crucial standard. So, we should emphasize the quality standards of our country, as well as the infection prevention guidelines recommended by JCI. The first item on the list is washing hands. Because our hands are the dirtiest parts of our body. The first rule is to wash your hands before touching a patient, and wash your hands after touching a patient. Once we solve this, once this rule has been adopted by all healthcare professionals, the risk of infection in a hospital is close to zero. This is a lean approach too. Because in the case of an infection, antibiotic treatment begins. In other words, the costs start increasing. Ümit Zileli: Thinking is very important. Not just only in the healthcare industry but in all aspects of life must we think. I am very grateful to have you here Doctor Ömer. Hopefully, the lean approach becomes a common practice until we meet again. Dear viewers, it is truly a new development, I have just learned about it too. But, as you see after viewing this show and listening our guests, it may be revolutionary in the healthcare industry, if it is successful. I wish we could be a part of this revolution in every area of life. Hopefully, I’ll see you soon on another show with a different group of guests.