"Lean" principles apply to health care
Bizjournals.com
Donna Daniel
From the Puget Sound Business Journal
Each year, innovations offer hope in improving health care: breakthroughs in disease prevention, new technologies for early detection of neurological conditions, innovations in cellular medicine and dramatic advances in gene therapy.
Yet, it may be a time-tested manufacturing practice that promises the most compelling change in patient care today. Leading health-care organizations across the country are beginning to implement a manufacturing principle called "lean" in their organizations in order to eliminate waste, streamline processes and cut costs.
Sure, it has decades of success in the automotive industry ... but health care? It may help to understand the essence of lean before dismissing it altogether.
Lean is an integrated set of industrial principles that emerged in the post-World War II Japanese automotive industry and gained traction in the United States in the 1970s. It eliminates waste by taking out unnecessary processes and redirecting human effort toward value-added business operations. This reduces production time, decreases costs and improves customer satisfaction.
Experts agree that our health-care system is fraught with inefficiencies and redundancies that have an effect on patient care. When an individual spends more time in the waiting room than with a doctor, for example, this suggests some inefficiency is taking place. When a medication error occurs or medication isn't administered in time, this can be attributed to some breakdown, bottleneck or miscommunication in the process. These problems, in turn, increase costs and decrease the quality of medical care and health insurance for employers and workers.
So, how does lean apply to health care -- where practitioners aren't factory workers and patients aren't widgets? Both manufacturing and health care have a work flow -- a succession of steps and an established process -- that requires interaction with humans. As different as they are, both industries require this interaction to produce an output or outcome; it could be an automobile or a healthier patient.
Most people in health care will tell you that, like manufacturing, health care must cut costs and streamline operations to improve quality of care. This understanding has led a number of health-care organizations to adopt the methodology. Virginia Mason Medical Center in Seattle has applied it. Children's Hospital and Regional Medical Center, also in Seattle, has adopted it.
The organizations listed above that have applied lean should not intimidate the smaller, budget-strapped medical practice. There are books on the subject. Simple research on the Internet yields an abundance of information and case studies. The Institutes for Healthcare Improvement (IHI) promotes the adoption of the methodology and offers information on its Web site (www.ihi.org). The Lean Enterprise Institute (www.lean.org), a nonprofit organization that promotes the principles of lean thinking, might offer assistance. Health-care quality improvement organizations (QIOs) -- there is one in every state -- may offer free services too.
Regardless of the path to lean you choose to pursue, it will require some investment of time. As with any culture change, you should expect challenges. In order to ensure that your lean program has a chance to succeed, consider these elements:
Lean is a "top-down" endeavor. In order to succeed, you must have full management support to engage in the lean concepts.
Be patient with the process: It can take years to yield results.
Be prepared to address skepticism. It may be effective to benchmark the processes prior to implementation and then measure them at an appropriate time afterward. Share results and improvements with management and employees.
Consider hiring a consultant from the manufacturing industry or schedule a visit to a lean enterprise or factory for guidance and perspective.
Conduct "value stream mapping" or another mapping tool/technique to identify, analyze and lay out the effective and wasteful processes used presently within your organization.
From this "present" snapshot of your organization, create a map of the "future state" of your organization.
Eliminate or consolidate those steps that do not bring value to the process, creating a work flow that is more efficient.
Making the shift to a lean enterprise, whether it's in a hospital, a physician practice or a nursing home, isn't easy. Like any culture shift, it will require commitment and time. There may be resistance, especially given the complex nature of health care. But stay the course.
Lean has a successful track record in many industries so you will need to provide education, communication and reinforcement throughout the process. Lean may be challenging to implement at first, but it may be the best investment your organization can make to improve financial performance and the quality of care you deliver to your most important customers -- your patients.
DONNA DANIEL is director of performance improvement at Qualis Health (www.qualishealth.org), a nonprofit health-care quality improvement organization with offices in Washington, Idaho and Alaska. Reach her at donnad@qualishealth.org.
