Have you heard of Lean Healthcare? I am sure many of you have and that quite a
few haven’t. The concept of lean healthcare has been adopted from manufacturers.
The idea of lean manufacturing and lean service are most visibly displayed by
Toyota Motor Corporation. Toyota has so refined and developed the techniques
that organizations around the world are using their ideas to improve their own
organization and are benchmarking against Toyota.
Lean healthcare is basically reducing waste in the delivery of service both directly to
the patient and to internal customers, such as human resource services to
employees. For instance, lean techniques help eliminate duplicated procedures,
such as a nurse taking the blood pressure of a patient and then the doctor doing the
same a few minutes later. It also makes sure that all of the necessary tools and
products are in an examination room when needed. It is beyond the scope of this
article to fully describe lean healthcare; many books have been written about it. In
fact, the American Society of Quality in their online bookstore has several titles,
including Lean-Six Sigma for Healthcare. I would like to define a few techniques
found in lean healthcare to illustrate its value, though.
One of the most commonly used tools is Value Stream Mapping. VSM displays in a
physical graph the process from beginning to end of the delivery of a service or
procedure in order to identify wasted effort or steps that don’t add value to the
results. For instance, in the April 2005 issue of Quality Progress the article Lean Six
Sigma Reduces Medication Errors presents the process by which a team of nurses
and pharmacists in a hospital setting reduced the waiting time and errors in the
delivery of medication from the pharmacy to the patient. By the use of VSM and
other statistical techniques, the error rate was reduced from 0.33% to 0.14% in 5
months and a savings of $550,000 was realized.
Lean healthcare emphasizes tapping employees knowledge to improve processes.
Leaders of an organization empower employees to present ideas for improvement
and then enact promising ones in order to save time, money and improve patient
health and satisfaction. One such technique for empowering employees is the
kaizen. This is a meeting of staff to quickly generate solutions to a process which
has been identified as needing improvement; the team members are representatives
of those actually involved in the process. A kaizen event is marked as a brief,
intense effort to solve such a problem. It may take several hours or a day or two.
The work time lost of the members of the kaizen is more than offset by the
outcomes of the meeting.
Lean healthcare is driven by the identified needs of the patient or customer. For
instance, waiting time is deemed waste. A patient having to wait more than a day or
two to see a doctor for an office appointment is waste. Many in healthcare think
that this is a problem which is almost impossible to solve. It isn’t. Solutions to this
problem have been described in several articles of Family Practice Management, a
publication of the American Academy of Family Physicians. The ideas are easily
adopted to sites which aren’t primary care physician practices.
Lean identifies the best techniques and strategies to deliver quality care and then
makes them standard operating procedure. In fact, it is a good idea to write a
manual of the best processes in order that any employee can reference at any time
and also in order to use it as a training tool for new employees.
I would like to urge you to look deeper into the ideas of lean healthcare. There are
many publications describing it, as the ASQ publication mentioned earlier. The April
2006 issue of Family Practice Management has a great article for lean in the doctor’s
office; it can be found for free online. Your efforts in implementing lean techniques
will be rewarding to both you and your patients.