Monday, February 3, 2014

The Promise of Lean in Health Care ! What can a Medical Center learn from an auto manufacturer(Toyota Production System)?

An urgent need in American health care is improving quality and efficiency while controlling costs. One
promising management approach implemented by some leading health care institutions is Lean, a quality
improvement philosophy and set of principles originated by the Toyota Motor Company. Health care
cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing.
When well executed, Lean transforms how an organization works and creates an insatiable quest for
improvement. In this blog, we define Lean and present 6 principles that constitute the essential dynamic
of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for
front-line workers, visual tracking, and flexible regimentation. The goal of this blog is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.

With rising pressure on healthcare providers to reduce costs and improve quality, an increasing number of 
organizations are looking to “Lean” tools and techniques as a breakthrough solution for performance improvement. Over the last four decades, Lean has emerged as one of the most effective approaches to help increase an organization’s competitiveness through improvements in process efficiency and a reduction in operational waste. Today, Lean is used in most global industries and virtually all organizational sectors 
including healthcare.

What is Lean?
Lean is a customer-centric methodology focused on continuously identifying improvement opportunities by 
eliminating “non-value added” (or wasteful) activities and creating value. In a Lean process, a customer is any individual or entity that benefits from the Lean Program. For example, consumer/patients and physicians benefit from improving the turnaround time of critical laboratory tests. Value is defined as any activity within a process that is essential to delivering what a customer will pay for.

Seven critical wastes in healthcare that are addressed by Lean:
Excessive motion             
     -Incorrect floor layout (e.g., inefficient emergency department patient flow)
     -“Searching” for information (e.g., lack of operability of EMR)
Waiting time                     
     -Waiting for paper work
     -Waiting for response/approvals/beds
Over production           
     -Planning full utilization of assets/labor
     -Large batches of material and supplies inventory
Processing Time   
     -Fragmented workflow
     -Unnecessary processing steps
     -Cost of patient re-admissions 
     -Hospital acquired conditions
Excessive resources     
     -Non-optimized resource leveling
     -Redundant activities (e.g., excess administrative costs)              
Unnecessary/ineffective hand-offs
     -Verification loops
     -Unnecessary approvals

Principles of Lean:
Principle 1: Lean is an attitude of continuous improvement.
Principle 2: Lean is value creating.
Principle 3: Lean is Unity of Purpose.
Principle 4: Lean is Respect for the People who do the Work.
Principle 5: Lean is Visual.
Principle 6: Lean is Flexible Regimentation.

Adoption of Lean in healthcare delivery:
Many healthcare improvement groups have described Lean as a critical methodology for healthcare providers to adopt. The Institute for Healthcare Improvement (“IHI”) states that there is growing agreement “among healthcare leaders that Lean principles can reduce the waste that is pervasive in the U.S. healthcare system...Adoption of Lean management strategies — while not a simple task — can help healthcare organizations improve processes and outcomes, reduce cost, and increase satisfaction among patients, providers and staff .”

While Lean has proven successful in reducing healthcare waste and increasing provider profitability, surveys of hospital leaders continue to find full deployment of Lean in healthcare very low. In a March 17, 2009 survey by the American Society for Quality (“ASQ”), the same organization that administers the prestigious Malcolm Baldridge National Quality Award, disclosed that only 4 percent of U.S. hospitals reported a full deployment of Lean. However, 53% of the 77 hospitals responding reported some level of use of Lean in their organization. So why is the full deployment of Lean within healthcare so low?
According to ASQ respondents, the key reasons are:
Lack of resources (59% of respondents)
Not enough information (41% of respondents)
Lack of buy-in from leadership (30% of respondents)

The results of this survey stand in stark contrast to the successful implementations of Lean in healthcare organizations throughout the world. Studies over many years have shown Lean to have a wide range of applications to hospital operations ranging from:
1. Reducing inappropriate hospital stays.
2. Improving the quality and financial efficiency of trauma care.
3. Reducing the cost of temporary staff.
4. Improving operating room and emergency department efficiency.
5. Improving radiology processes.
6. Reaching better strategic decisions affecting marketing and capacity management, among other uses of Lean leading to improved hospital profitability.
Transformation from traditional hospital system to Lean Hospital System

Rooting out waste in healthcare by taking cue from Toyota[5]

Even if these problems are addressed and lean delivers on its promises, the challenges to increasing the role of lean thinking are daunting. They require no less than the redesign of the health care system as we now see it. Perseverance, high quality leadership, dedicated professionals and patience are surely needed. Skepticism and resistance will be high, success not guaranteed. Organizations may think twice before embracing on such a journey, or worse, superficially implement lean thinking, adding to existing resistance and making it more difficult to improve health care in the long term.

This week's question (Time to think):
Although lean can improve safety and quality, improve staff morale and reduce costs -all at the same time, don't you think such an overly positive conclusion fails to take into account the variety of issues surrounding the application of lean thinking to health care? 


1 comment:

  1. Since, you use our Lean Healthcare house as one of your images. Could you please link to our website as one of your references. Thank you -- JWA


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