Healthcare Embraces Lean Principles
A recent article from the NY Times Sunday business section...
“Factory Efficiency Comes to the Hospital” highlighted dramatic success at several hospitals who have leveraged “lean” principles to improve clinical operations. But even more important than the cost savings are personal testimonials from hospital officials that highlight the holistic benefits of applying tools from industry in healthcare:
1. Improvement begins with the customer – In this case, the patient is the recipient of increased value. What is not as clearly stated is that the definition of value MUST meet three criteria (all three):
a. The activity, to be value added, must transform the patient’s medical condition
b. It must be done correctly the first time
c. If the patient had to pay for the activity – they would
2. Those who do the work know it best – To successfully improve the process, those who actually provide the services to the patient know the hidden workaround and unwritten rules that are followed to make the system or process, likely designed long ago, work. Real improvement only comes when the unseen process is made visible by those who know it best, the process is diagnosed with data, and improvements are tested and put into place.
3. Improvement does not have to take months – Most improvement using the common sense of “lean” happens in hours or days. In most cases improvement is generated by the creativity and zeal of those who do the work themselves very quickly.
4. When implementing lean, it is best to take away the checkbook – “No money” is the mantra for creating lean and efficient processes – anyone can spend capital to improve. The best organizations know how to leverage the creativity of their “kaizen” teams before capital.
5. Leadership’s passion and attention span is the linchpin to success – Allowing a team of highly trained and talented professionals to work on the process and not just in the process takes broad commitment and support. Without these, improvements are rarely as dramatic as those shared in the story and even more rarely sustained.
In our experience working with some of the most effective hospitals in the nation, we have found opportunities for improvement not only abound in clinical operations, but in every aspect of the healthcare value chain. From primary care providers through payment of claims, there are substantial improvements to be gained by viewing healthcare through the lens of those who receive the care. In fact, clinical operations, while ripe for improvement, is only scratching the surface of improvement. We have found that even greater improvements are in applying the same language and tools in other areas:
- Claims management and revenue cycle where reducing work content not only drives efficiency but can reduce errors and prevent fraud and abuse.
- Understanding the continuum of care for chronic illnesses such as Alzheimer ’s disease and Cancer can provide opportunities to not only reduce the cost of care but improve the quality of life for both patients and care givers.
- Applying lean principles to information technology can not only reduce the cost associated with putting in place a new EMR, but also accelerate the implementation cycle time.
- “Lean” tools and practices are scalable and applicable to everything from major health systems to ambulatory care centers to primary care practices.
Everything from the development of new therapies and medical devices to the design and construction of new medical facilities contains waste that can be identified and removed through the adoption of “lean” and other process science methods. And with the requirements from healthcare reform beginning to be put into place in this country, the opportunity for improvement is more critical than ever. Every player in healthcare – provider to payer; managed care to pharma; federal and state agencies to information technology providers – can realize improvements which can more than offset the costs associated with the new regulations being put into place.
Improvement methods such as “lean” and six sigma will become as common place in the future of healthcare as they are today in manufacturing. No one will ever claim that the delivery of healthcare is exactly the same as manufacturing an automobile. But everyone can agree that focusing on the value of care provided to a patient (as a car company does its car buyers) will improve the quality, cost and delivery of healthcare now and long into the future.
