What is Lean Health Care

The principles of lean are making their way into healthcare in more and more settings.  The successes in time saved, money saved, and improved patient health are almost always significant if there is strong leadership, the tools are used correctly and the new processes are made into standard operating procedure. 

Perhaps you have not heard much about Lean process improvement or know nothing at all about it.  Let me first give a definition taken from the February 2006 edition of “Quality Progress,” a periodical published by the American Society of Quality:

Lean Enterprise-A company organized to eliminate all unproductive effort and unnecessary investment, both in examining rooms, offices, and any other healthcare setting.  In fact the tools and principles can be applied almost anywhere in an organization and produce desirable results when used correctly.

In order to achieve these results staff need to be trained to use a few basic, commonsense tools such as process mapping and kaizen.  However, the tools are not the most important elements in applying Lean.  The most important element is a cultural change which accepts that:  There is power in teamwork and consensus through brainstorming.  To believe in the power of those involved in the processes one must accept that problems can more often be solved with creativity than capital expenditures since creativity taps into the experience, innovation and knowledge of the employees. 

So, once a site has been trained to work with a few tools and staff are ready to try them out in a team setting, where does one begin?  Ask this:  where do we have the most bottlenecks, delays and quality problems?  Can we reduce unnecessary work that produces no positive outcomes, whether in patient health or income earned?  There is typically no short supply to these answers.

In the beginning of this ezine I stated that Lean Healthcare is appearing in many settings.  Perhaps you are a bit skeptical.  In the June 25, 2007 edition of the Wall Street Journal there was an article about the adoption of manufacturing principles in healthcare management.  Let me quote a few lines from the article:  “Michael Roberto, an associate professor of management at Bryant University, says the trend (hiring manufacturing managers and engineers knowledgeable of Lean manufacturing and other quality principles) will continue as hospitals face increasing costs while improving patients’ safety and satisfaction… Skeptics say medical procedures cannot be standardized; they say patients, unlike car parts, may require differing treatment.  Still, hundreds of healthcare facilities have adopted some lean techniques.”  I know of a local group using a quality engineer presently with a group of healthcare professionals in a study funded by the Robert Woods Johnson Foundation to apply Lean tools along with the Wagner Chronic Care Model to improve the delivery of care to patients with various chronic diseases, such as diabetes. 

The application of Lean principles to healthcare not only improves patient health but can also produce improvement in profit and time saved, as the following two samples illustrate.  In the Wall Street Journal article quoted above is an illustration of the use of Lean processes at Lawrence & Memorial Hospital in New London, Connecticut.  The hospital was about to go bankrupt.  Then the chief executive hired a Motorola engineer to streamline processes and a former Dresser-Rand executive as vice president for human resources.  The two were instrumental in avoiding the bankruptcy.

In a recent article on the iSixSigma website, “Lean Improves Physician Office Medical Records Flow,” the authors described how medical charts at one family practice could typically be found in any one of 39 different places.  The staff typically spent 7 hours a day looking for missing charts.  After applying Lean principles, the time was cut to 2 hours a day, a savings of almost 72% in time alone.  Of course, a lot of frustration was probably avoided too.  Can you imagine what your site could productively do with a five hours savings per day in any single process?

These are just a couple of examples of the savings made using Lean principles.  There are countless numbers of ways to apply the principles in healthcare with good results.  It does take a lot of dedication, teamwork, creativity and a few tools.  If you are willing to invest in these, can you imagine the improvements at your site?