TABLE 9-3 National and VMMC Trends in Safety Metrics, 2005-2008

Safety Indicator


2005 (%)


2008 (%)


2009* (%)



Ventilator-associated pneumonia

(% per 100 ventilator days)





Central-line infection

(% per 1,000 central-line days)




Surgical site infection

(% per 100 procedures)





*Data through August 2009.

Extrapolating Nationally

Applying the same trends in the reduction of ventilator-associated pneumonia, central-line infections, and surgical site infections, the VMMC production system experience translates into national savings deliverable to patients, payers, and employers estimated at $4.1 billion.


Our experience with the VMMC production system suggests production systems can reduce institutional waste and medical errors while improving patient safety. The resultant cost per RVU, capital, and liability cost savings could yield $7.5 billion for medical provider groups. This, plus attendant margin improvement, provide a stable platform for relentless improvement and further savings. For VMMC, a strategy of cost reduction through improving access and quality is more reliable and sustainable than a strategy of revenue enhancement. The sum of the estimated clinical and patient safety savings on a national scale is more than $44 billion. We estimate this figure from a selected set of chronic care model and patient safety improvement yields.

The VMMC production system is the methodology that drives our improvements, providing a model for national savings. We propose that research and promotion of systematized care design and continuous improvement—which we call a production system—become a vital component of healthcare reform. The operating principles of a production system focus our effort on operational, clinical, and patient safety savings through relentless improvement of care—as opposed to relentless expansion of care. Although we know the “end line” in the expansion of medical costs—failure of the U.S. healthcare system—we do not know where it is in waste

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