Tuesday, February 4, 2014
Is Lean methodology just a fad for Healthcare?
Lean manufacturing has increasingly become a method of choice for hospitals seeking a creative solution to cost and quality problems. Originally envisioned by the Japanese automaker as a way of doing more with less, the much-copied management system is slowly being adopted by U.S. hospitals. They believe that going lean will streamline processes, increase employee satisfaction, improve their finances, and most importantly, enhance patient care.
In August of 2012 the provincial government of Saskatchewan signed an agreement with a consulting company to assist in the implementation of the Lean quality improvement system throughout their healthcare system. This deal, which will cost up to 38 million dollars, will see Lean quality improvement consultants working to embed the Lean system in the culture of Saskatchewan healthcare over the next 4 years. Is this initiative really going to revolutionize healthcare in the province?
Upon taking a holistic approach, I understand that lean solutions involve looking at processes, breaking them down into parts, and eliminating waste. Waste is an important concept in lean thinking. However, the issue is not just about reducing inefficiencies in processes followed in hospitals. It deals more with patient care and adding value to services. Though lean processes address multiple process oriented issues, its manufacturing roots can make Lean a challenging process improvement model for hospitals to fully adopt. While I was contemplating on these aspects, I came across a few articles pointing out the common mistakes and challenges hospitals make when implementing lean:
1. Not allocating enough resources: One of the most common mistakes hospitals make when adopting Lean is not devoting enough resources to Lean projects. Transforming hospital processes with Lean requires a commitment of time and energy by leaders and staff. Very few hospital organizations in the US have this kind of infrastructure with dedicated resources.
2. Lack of awareness of differences between a Toyota Facility and an American Hospital:
We would really have to think about the differences of the ‘production process’ of an American hospital. Every patient who arrives has a different medical or surgical circumstance, genetic profile, clinical history, socio-economic condition and on and on. Unlike Toyota, the inputs to ‘hospital production’ are not engineered to a standard. There are remarkable variations from patient to patient. This in no way invalidates the importance of TPS technique; it simply makes the process remarkably more complicated and, truthfully, more frustrating. Further, each major area of the hospital is like a separate production facility. Accordingly, the successful “outcome” in a hospital setting has little in common with a standardized 6-cylinder Toyota engine.
3. Lack of leadership engagement in Lean: Transforming a hospital to Lean means shifting the organization to an entirely new way of thinking about and designing processes, which requires full involvement of hospital leadership. The level of engagement Lean demands of leaders may be a new experience for hospital executives. Hospital leaders have been able to do IT projects implementing electronic medical records, or other projects in the past by delegating but this doesn’t work quite well in Lean transformation.
4. Not standardizing practices: Continuous improvement, one of the key goals of Lean, relies on standardized work. Marc Hafer, CEO of Lean transformation Company Simpler Consulting says- "One of the big challenges in healthcare is getting these highly educated, highly trained individuals [working in a hospital] to agree on what best practices are and to agree on conforming to standardized work. Without standardized work, there can be no continuous improvement."
According to Peter Drucker, an American hospital is the singular most complex organization in the world.
Deploying Lean in a hospital setting is much more interesting and exciting if done properly and supported with the necessary resources and institution understanding. What industrial leaders often miss is the added level of complexity of the hospital setting. Having said that, the main question to ponder about here is:
To what extent can hospitals be successful in implementing lean processes, if they educate themselves on lean and create a strategy around it to achieve their mission and objectives?