Monday, September 8, 2014

Lean Methodology in Hospitals: Does it Work?

In one of the readings for this week, "Factory Efficiency Comes to the Hospital," Seattle Children's Hospital is showcased for its success in improving patient care and cost effectiveness using Lean methodology.  The article points to additional hospitals that have jumped at the opportunity to employ Toyota's model, and indicates that those hospitals have been successful in their endeavors as well.

In researching Lean methodology in hospitals, however, I have found articles with conflicting perspectives.  Mark Graban argues that Lean improvements can be seamlessly transitioned from factories to hospital floors, and points to specific examples of Lean success stories in hospitals: a 95% decrease in deaths due to central line infections at Allegheny Hospital, an $800,000 increase in annual surgical revenue at Ohio Health, and a 29% reduction of length of stay at Avera McKennan. [1] These, indeed, are all positive accomplishments, and lend themselves to the argument that hospitals should be implementing Lean practices to improve quality and efficiency.

However, other articles make the age old argument that healthcare is different: too highly variable, when taking into account individual patient needs, to standardize - a key focus of Lean initiatives. [2] Many argue that an individual patient's needs are never the same, that the personal interaction between caregiver and patient cannot be standardized, and that doing so jeopardizes the quality of care patients receive.  Furthermore, in a Joint Commission report, "Guiding Inpatient Quality Improvement: A Systematic Review of Lean," a main takeaway was that the efficacy of such programs is difficult to measure, and there is not enough evidence of significant improvement to warrant wide scale adoption of the methodology. [3]

Additionally, many articles pointed to the dissatisfaction that caregivers feel when taking part in such initiatives.  One example described a hospital that had tried to script nurse interactions with patients so much that the nurses felt they sounded robotic. [2] An important difference occurred to me while reading the articles for this week as well as those I found for this blog post.  Lean methods have proven extremely successful in a manufacturing setting, where employees working in the factory line are not highly trained professionals in the same way that nurses and physicians are.  The personalities and egos of medical professionals contribute significantly to the challenges of implementing Lean methodology in hospitals, and may complicate many of these efforts.  Is this heightened level of professional education compatible with Lean methodology? And if so, what can hospitals do to counter this problem?

Finally, from the articles I read, it seems that hospital administrators support Lean initiatives and are willing to shell out large amounts of money to bring in consultants to define areas for improvement, while the care providers themselves often feel squeezed and demoralized by the effort.  How can hospitals use the Toyota toolset without losing employee goodwill?  How much is too much standardization?  Is there such a thing as too much?



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