Latest / The Productivity Podcast with Fexingo: Output, Efficiency, and Long-Term Economic Growth / How a Dutch Hospital System Cut Surgery Wait Times by 40 Percent
Transcript
- Lucas: Luna, I want to start with a number that stopped me cold last week. In the Netherlands, the OLVG hospital group in Amsterdam and nearby Almere managed to cut surgery wait times by 40 percent between 2019 and 2025. And they did it without building a single new operating room. Luna: Forty percent — that is huge. And no new ORs. So they must have changed how they schedule, or how they staff, or both. Lucas: All of the above, but the most interesting part is where they borrowed the playbook from. The hospital brought in a team of industrial engineers who had previously worked at a Toyota plant in Belgium. They applied the Toyota Production System — lean manufacturing, continuous improvement, standardized work — to the surgical floor. Luna: Right. And that always sounds a little cold when you first hear it — applying car-factory logic to people having their gallbladders removed. Lucas: Absolutely. And the hospital leadership knew that. They didn't call it 'lean' internally for the first two years. They called it 'patient flow optimization.' But the core idea is the same: reduce variability, eliminate waste, and make the work visible. The specific change that had the biggest impact was standardizing surgical instrument kits. Luna: Meaning every surgeon gets exactly the same set of tools for a given procedure? Lucas: Exactly. Before the change, each surgeon had a preferred kit. So for a routine hip replacement, Surgeon A might want seven different clamps, Surgeon B might want twelve, and Surgeon C might want a mix that included a retractor no one else used. The sterilization team had to custom-pack each case, which took time and introduced delays. OLVG worked with the surgeons to agree on one standard kit per procedure type. They reduced the number of unique instruments by about 30 percent, and the time to pack a kit dropped from 18 minutes to 6. Luna: And I'm guessing the surgeons were not thrilled at first. Lucas: They were skeptical. But the hospital let them keep one or two personal preferences if they could justify them with data — a 'privilege list.' Over time, most surgeons voluntarily dropped their special requests because the standard kit actually worked fine. Then the hospital tackled scheduling. Historically, they scheduled elective surgeries in the morning and left afternoons for emergencies. But emergencies are unpredictable, so afternoons often sat empty. They flipped it: elective procedures now run in the afternoon, mornings are reserved for emergencies. That alone cut average wait time by about two weeks. Luna: So you're using the predictable demand to fill the time that was previously wasted, and you're giving the emergency cases a guaranteed slot when staffing is freshest. Lucas: Right. And the third piece was cross-training nurses. Previously, each surgical specialty — orthopedics, cardiovascular, neurosurgery — had its own dedicated nursing team. If orthopedics had a slow day and cardiology was swamped, you couldn't flex nurses across. OLVG created a 'floating pool' of nurses trained in at least two specialties. They started with 12 nurses, then expanded to 30. That reduced idle time for nurses and cut overtime for the busier units by 15 percent in the first year. Luna: That feels like one of those changes that sounds small but actually reshapes the whole cost structure. Less overtime, less burnout, better retention. Lucas: And they measured retention. Nurse turnover in the surgical division dropped from 22 percent in 2019 to 14 percent in 2024. The hospital estimates that every percentage point of turnover costs about 5,000 euros in recruiting and training, so that's a real saving. Now, I want to be careful here — this isn't a story about heroic managers. The union was involved from day one. The hospital agreed that no productivity gains would lead to layoffs. Any headcount reduction would come through attrition. Luna: That's crucial. Because the usual fear with 'lean' in healthcare is that it means 'do more with fewer people,' and that's toxic in a setting where staff are already stretched. Lucas: Exactly. And that's probably why it worked. The staff felt they were part of solving a problem rather than being told to work harder. Now, here's a thing that I think connects to a broader point about productivity in high-stakes services. Luna: Go on. Lucas: If walking through the economy with us has made something click — whether it's this hospital example or something from a previous episode — I'll be honest: a handful of listeners chip in monthly through buy me a coffee dot com slash fexingo, and that's literally what funds making this many of these episodes possible. Luna: Yeah, we don't run ads, and we want to keep it that way. So if you've gotten value from the show, that's the way to keep it going. Lucas: No pressure at all. Now back to the operating room. One more piece I want to highlight: OLVG also reduced the number of different types of surgical gloves they stocked from 14 to 4. That sounds trivial, but it meant the supply closet could be organized so that a nurse could grab the right box in two seconds instead of hunting. Over a year, those seconds add up to hours. Luna: That's classic lean — standardize the small stuff so the big stuff gets more attention. Lucas: And here's the final number that made me want to talk about this: OLVG's average cost per surgery dropped 11 percent from 2019 to 2025, adjusting for inflation. That's not because they paid nurses less or bought cheaper implants. It's because the same fixed assets — the operating rooms, the sterilization equipment, the recovery beds — were being used more intensively. Utilization of ORs went from about 65 percent to 82 percent. Luna: So they squeezed more productive output out of the same capital base. That's the textbook definition of productivity growth. Lucas: Exactly. And the interesting question is whether this model scales. OLVG is now training consultants to help other Dutch hospitals adopt the same methods. The Dutch Ministry of Health has funded a pilot in four other hospital groups. If it works, you could see a national productivity improvement in surgical care without any new construction. Luna: I think the biggest barrier is cultural. Surgeons have a lot of autonomy, and hospital administrators are often afraid to challenge it. But OLVG showed that if you give surgeons data and let them keep a few privileges, you can get buy-in. Lucas: And that's the lesson for any knowledge-intensive service — law firms, consulting, even software development. The resistance to standardization is almost never about real clinical or technical necessity. It's about habit and ego. OLVG proved that you can respect professional judgment while still insisting on a standard process for the routine stuff. Luna: So the next time I'm waiting for a procedure, I'm going to ask: 'Have you guys heard of OLVG?' Lucas: I hope your surgeon has. That's it for this episode. I'm Lucas. Luna: And I'm Luna. See you next time.