“One of the greatest benefits of Lean versus previous improvement models in healthcare is its focus on removing “waste” in processes and systems via rapid change and employee involvement. Whereas previous models have focused on conference room activity and long-term action plans, Lean organizations begin reaping tangible benefits quickly.”
1. What benefits does lean bring to the healthcare organizations vis-a-vis the older models of functioning?
One of the greatest benefits of Lean versus previous improvement models in healthcare is its focus on removing “waste” in processes and systems via rapid change and employee involvement. Through the Kaizen methodology, teams of employees are trained in the methodologies and then empowered to make immediate, tangible change in their workplace. Whereas previous models have focused on conference room activity and long-term action plans, Lean organizations begin reaping tangible benefits quickly.
2.Do the benefits outweigh the costs involved in adopting lean?
Many organizations think they can shortcut the process by cutting corners. Others think Lean is a quick fix and is cheap. Both thoughts are incorrect. Organizations will reap initial and short term benefits, which typically provide a return on investment. Lean will lower your costs and improve quality and customer service over the long haul as well. But, if an organization perceives the Lean transformation to be easy, quick or cheap they are terribly misinformed and incorrect.
3. What steps does an organization need to take in order to implement lean?
There are a few key elements to a successful Lean implementation that organizations must address:
- Leadership Commitment: Lean must become a way of doing business, not just a program.
- Leadership Education: The organization’s leadership must be trained in basic lean principles and embrace the concepts.
- Communication: Enterprise wide communications must be made regarding Lean as a growth strategy positioning the organization for the future.
- Identification of internal champions/leaders: the organization must dedicate resources to sustain momentum and drive the necessary culture change. It is essential that solid and proven outside resources such as HPP be used to get the organization trained on the right path but it is a must that internal resources be developed for long term success.
- Get Started! Lean is an action oriented methodology and the best way to learn its potential is to try it. For an organization new to Lean practices, it may be beneficial (as mentioned above) to seek the assistance of a seasoned Lean practitioner to assist with initial Kaizen facilitation and Lean’s integration into the organization.
4. What operational areas of hospitals tend to benefit the most from lean?
All aspects of a hospital’s operation can benefit from the application of Lean principles. From using 5S principles to reduce wasted motion and increase the quality of care for patients on the nursing floor to the application of SMED techniques to reduce turnaround time in critical services (OR, Imaging, etc.). There are no departmental boundaries that limit the effectiveness of Lean principles. Support processes such as medical records; registration and pharmacy are also areas where the application of Lean principles will yield tangible results. Although we have seen success in all areas of the healthcare environment, incredible momentum can be gained by starting the process in the intensive patient care areas such as the med-surgical or patient care areas of the hospital given the significant care giving time required of the caregiver to the patient.
5. What kind of penetration has lean achieved in the healthcare sector over the years?
While Lean principles have been commonly applied throughout the manufacturing sector in the past decade, Lean Healthcare is in its infancy. Healthcare providers worldwide are beginning to adopt Lean Enterprise concepts and in some instances insurance companies and insurance providers are demanding that the healthcare sector embrace Lean concepts.
6. There are already talks of “Lean Six Sigma” in healthcare. What are your thoughts on this?
The Lean and Six Sigma toolkits are certainly complimentary although I would recommend implementing Lean Healthcare principles prior to applying Six Sigma tools. We at HPP have Six Sigma Blackbelts and Master Black Belts on staff thus we embrace Lean Sigma and Six Sigma as solid and proven approaches. While Lean methodology is an excellent front line process improvement tool, more complex projects may require the use of Six Sigma techniques to take a “deep dive” into the contributing factors and improve capability. An approach used by many practitioners is to use Lean tools to remove the waste from the process and then follow with Six Sigma tools to attack sources of variation and further improve the process. While both Six Sigma and Lean are effective “stand alone” process improvement toolkits, properly combining elements of each methodology can yield even greater returns. We have observed organizations that began with Six Sigma tools only to confuse their staffs with terms and more technical approach to performance improvement. Lean is a much better first step given most people, patients and caregivers alike, can much easily identify waste in their processes and can feel it first hand. Most of us can’t feel what standard deviation we are in the process, but we can easily feel “wait” and “motion” wastes in our value streams.
7. What challenges does the implementation of lean bring to an organization?
Many years of observing industries of all shapes and sizes, both industrial and healthcare, as they embark upon a Lean journey, have revealed a number of “truths”. It doesn’t matter if the company is part of the healthcare industry or the manufacturing industry; common truths permeate most all Lean transformations. Some colleques and I recently developed the following list of truths that describe the transformation that organizations experience as they move from waste ridden non-value added processes and systems to a Lean organization.
- Lean isn’t easy to do…if so everyone would have already done it!
- Waste must be viewed as the enemy #1 if you are to be successful.
- Ownership of the process is a MUST at all levels of the organization.
- Ultimately there can’t be an option to not embrace the philosophy.
- Lean will succeed or fail based upon the organizations leadership.
- Lean will highlight the strengths and weaknesses of leadership.
- Leadership’s commitment will be tested early and often.
- You will make mistakes! If made trying (not negatively affecting patient safety of course), then just try again!
- Ongoing and honest communication is both crucial and a must.
- Lean has to become more than a program or a few events. It must become a way of life, which permeates all levels.
- Lack of timely action or follow-through will cause the process to fail.
- Most Important! And No Half Truth! Lean is ongoing and never ending!
8. How valid are the criticisms of lean, such as, it doesn’t take the human factor into consideration?
One reason the Lean practice is somewhat foreign to many in healthcare is apparent to experienced Lean practitioners. Many other industries such as manufacturing have attempted to drastically improve their processes with increased automation and software alone. I have observed some in the healthcare industry are following the same path today, if not more so. Many of the necessary tasks required in today’s healthcare sector are inefficient if not impossible without a solid I.T platform, but despite the importance of such systems they cannot be looked to as a cure for all the operational issues that plague this industry. Recently one of our client organizations had a goal to decrease their turnover time on the Operating Room (OR). Through the use of LeanHealthcare tools, waste, idle time and efforts that added no value from the Patients or Physicians perspective were eliminated. Additionally, Visual Indicators were put in place to help reduce errors and rework. The Team was able to reduce the turnover time immediately by 50%. This was achieved with minimal investment and without any changes to the hospital or departmental IT systems.
9. What are the limitations of lean with respect to its application in healthcare?
Lean isn’t intended to target changes in the clinical medical procedure or nursing care, except to lower its costs and improve its availability and quality. Lean also isn’t intended to eliminate people and employees. Lean is only seeking to eliminate waste in all those tasks and processes that provide no value with an ultimate goal that more time can be dedicated to patient care, which in Lean terms is “Value-Added” in the eyes of the customer (patient).
10. Any other issues you would like to talk about
Physician Buy-in: It’s essential that the medical staff and physicians also buy-in to the Lean philosophy in order to receive its full benefits. We emphasize to organizations at the very beginning of a transformation that we must bring in one of our Lean experienced clinicians on our staff to talk with the medical team candidly about how Lean can improve their patient care and remove waste from the processes. We also communicate to them that Lean will make the patient experience a more positive one but that it will be a different approach to managing the organization than in the past. We have found that once they experience Lean firsthand, they are 100% sold on the approach.
Facility Design: It is also essential that new facilities and capabilities being added take into consideration Lean principles and concepts in order to be successful long term. We have seen way too many healthcare facilities build new buildings or add new services without designing out the seven wastes of healthcare in advance. The result is the caregivers having to work around the waste designed into the new facility when it could have easily been designed out while it was still a concept or lines on paper.
Charles Hagood, a Principal and President/CEO of Healthcare Performance Partners (HPP) (an affiliate company of The ACCESS Group (TAG)) has overseen the implementation of Lean Healthcare systems in numerous healthcare organizations across North America and is an in demand speaker on the subject of Lean and business process improvement. As one of the few Lean professionals that has translated manufacturing experience and the tools of Lean Manufacturing to success in the healthcare industry, he has proven experience in both single and system hospital environments as well as for profit and non-profit healthcare organizations. Charles also is a Principal with The ACCESS Group, LLC (TAG) and TAG Design Services, LLC, which are headquartered in the Nashville, Tennessee in the USA. Charles has consulted with numerous Fortune 500 companies located in North America and Europe in providing Project Management solutions, Process and Systems Design Services, and complete Lean Enterprise implementation and training solutions. Charles has a degree in Industrial Engineering, Mechanical Engineering, as well as a B.S in Operations Management and an MBA from Belmont University.
Charles publishes a weekly blog on the subject of Lean Healthcare at www.leanhealthcareexchange.com and has websites at www.hpp.bz and www.tag.bz for his firms.
