The concept of Lean was developed in the early 1990s from studies of the Toyota Production System. It focuses on eliminating waste in processes, waste being anything that impedes the flow of work as it is being transformed in the value chain. Lean to coin a phrase means ‘getting the work to where it is needed, when it is needed, in the quantity needed’.
The same “lean” principles that have saved countless businesses enormous time, energy and money can revolutionise your Healthcare operation. Lean is not merely a new set of tools or techniques to try on the hospital ward, in the examination room or in medical records – Lean is a fundamental change in how people in your Healthcare organisation think.
As the cost of Healthcare continues to rise, Healthcare providers are under increasing pressure to reduce internal/external costs, improve patient safety and care, increase profits, reduce errors and resulting litigation and decrease dependence on government funding.
The listed items above are just a glimpse of the changing environment of Healthcare. Much of the change is coming from legislation and government policy over which we have little control. The easy thing to do would be to just cost services and headcount, but the results may be undesirable. The smart thing may be to approach the changes head on. A reasonable objective is for organisations to address what they can control and get better every day.
Lean Healthcare helps achieve this by involving our staff and harnessing their expertise to lead change. Not only are staff encouraged to look at ways to improve the processes and systems that affect them directly, but also hospital-wide.
What does this have to do with Healthcare reform? If an organization can improve from the inside by –
- Reducing waste and improving efficiency
- Increasing capacity to see more patients and
- Improving quality
– it will be in a better position to absorb the reforms and continue to do business. As quality improves, never events are reduced. As efficiency improves, the ability to see more patients improves. As resources are more efficiently used, costs can be kept under control. This all leads to better experiences and outcomes for the patient and staff.
The tools of Lean are easy to develop. The methodology is not brain surgery. That’s one of the best features of Lean – with a little but structured training, everyone can apply it. Once team members are taught how to visualise the waste in a process, they begin to see it everywhere. The challenge is to apply leadership, priorities and resources to the identified problems to ensure that the right tools are used to find and fix the root cause of a problem and that the work is then organised to eliminate the problem.
So does lean really works in health care?
My answer is yes, yes, yes as long as it is introduced in a proper structured way. Healthcare systems are not designed to make the process of care flow smoothly. Hospitals are continually investing in significant information system projects that have either failed or not lived up to expectations. The primary reason for these failures is the lack of real process change to take advantage of the information system itself. Our structured approach to Lean Healthcare focuses on patient needs and uses a bottom-up approach to identify and fix broken systems anywhere within Healthcare organisations. This model engages all staff as well as leaders in redesigning processes for greater efficiency and quality.
Here is an example of how it has worked successfully:
Lean improves quality, safety and turnaround times in Phlebotomy services
Following completion of an SQT two day Lean Healthcare training programme the Phlebotomy team within a National Tertiary Care hospital used spaghetti mapping to illustrate the flow of work for the ward rounds, and used this along with demand data to inform the redesign of both inpatient and outpatient services.
The exercise identified a number of wastes including:
- Start of ward rounds delayed due to stocking up of trolleys
- Lack of standardisation of procedures at the patient bedside
- Unnecessary transportation of specimens due to layout of phlebotomy rounds
- Excessive inventory and non-standardisation of phlebotomy trolleys contributing to health and safety issues
- Delays in transportation of specimens to the laboratory due to batching of samples onwards.
The team undertook a 5S exercise and introduced visual management to achieve end to end turnaround time reduction of 57%.
Lean Methodology used to Improve the Patient Experience in Adult Outpatient Department
After completing basic Lean Methodology training the multidisciplinary team within the Outpatients Department of a large Dublin Teaching Hospital undertook a project to improve patients overall experience of the outpatient department.
The project had a number of key objective, these included:
- Reduce Patient Experience Time (PET)
- Decrease PET variability
- Improve flow
- Improve the working environment
The team used a set of Lean tools to identify waste and bottlenecks in the patient care pathway.
Having identified a number of bottlenecks and waste, the group then set about designing solutions that were low cost but high impact including;
- The restructuring of patient appointments,
- Providing a pre-booked schedule of appointments,
- Implementing a restricted check-in and ICT solutions.
The project team introduced a range of improvements that reduced PET for 1st visits and consultant appointments by over 25%.
Lean more about our Lean Healthcare courses here
Submitted by our Lean Healthcare Tutor, Padraig Kelly