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Lean healthcare refers to using “lean”concepts within health care facilities to reduce waste in all processes, procedures, and tasks through an ongoing improvement program. All employees of an organization, from the clinicians to the operations and administration staff, must use lean principles to continuously identify waste areas and eliminate any that do not provide value to patients.
Healthcare industry members have used the Principles of Lean manufacturing to find solutions to the unsustainable 5.5% per annum projected increase in national health expenditures. This has helped to rein in costs and provide value for patients. The Lean Manufacturing principles focus on improving customer satisfaction (payers and patients) and making it profitable. Lean principles are fundamentally about eliminating waste at all levels of an organization. Because “lean thinking” requires buy-in by every member of an executive team, is deeply embedded in the culture, and results in innovation at all levels. Organizations can also improve patient satisfaction by implementing lean healthcare. Decisions and processes are becoming more patient-focused.
Lean Six Sigma Healthcare
Lean and Six Sigma can sometimes be confused. However, they are often used together in healthcare and other industries to make improvements. But they do it in different ways. Six Sigma, a metrics-driven system, is used to reduce medical errors and eliminate defects in healthcare delivery processes. Both methods aim to optimize operations and improve patient care. While Lean is focused on removing waste, Six Sigma focuses on decreasing defects to a particular statistical measure. The two systems have been combined to create “Lean Six Sigma,” a hybrid improvement process.
Virginia Mason, the creator of the Virginia Mason Production System, is a leader in implementing lean principles in healthcare. They argue that Lean is the best overall approach to healthcare improvement because it values all members and can be applied by anyone. Lean, unlike Six Sigma, does not require expensive training or advanced statistical methods. Lean values can be used incrementally in a continuous journey towards value-based healthcare. Every patient interaction and each care episode are opportunities to cultivate value and reduce waste.
Healthcare Lean Methodology – Get rid of the “Eight Wastes”
Taiichi Ahno, Toyota’s founder of lean principles, identified seven waste areas in every industry. Toyota later determined the eighth. Although it may seem counterintuitive, applying what worked in manufacturing to a hospital setting can be very effective. Organizations can still implement lean healthcare by reviewing their processes and systems using the eight wastes lens.
- Reduce Waiting Time According to lean principles, any time employees or patients are required to stand. Still, it is considered waste. Healthcare organizations have many opportunities to increase waste reduction. These areas include waiting rooms, latecomers being omitted from meetings, appointment waiting lists, and idle high-tech equipment.
- Minimize Inventory. Inventory is tied-up capital, storage cost, and inventory. Inventory waste comprises excess supplies, medication, redundant equipment, extra data, and stockpiles of pre-printed forms. Additionally, inventory waste increases the chance of inventory being stolen or obsolete. All employees can learn to identify excessive inventory and find new ways to reduce it.
- Reduce Defects in Healthcare to Improve Quality and Increase Reimbursement. System failures, medical errors, and misdiagnoses constitute healthcare defect waste. Defective healthcare includes conditions like blood clots and infection, medication errors, medical mistakes, misdiagnosis, and avoidable readmissions. Organizations can use lean principles to motivate employees to eliminate defect waste and improve quality. This will help them to reduce costs and avoid making mistakes as payers shift to pay-for-performance models that reward/penalize results.
- Transportation – Reduce the Movement of Patients and Supplies to Improve Patient FlowTransportation in healthcare refers to unnecessarily moving patients, medical equipment, and supplies. Moving patients around and running to get supplies can increase caregiver or patient injury and cause delays in care. To save time, reduce harm and improve patient flow, Lean Thinking can be used to analyze caregiver and patient movement within the hospital facility.
- Avoid Injuries and Reduce Motion Hospital workers who move in their work area that is not beneficial to patients are considered motion waste. Motion waste can be caused by hospital workers reaching or stooping to get frequently used equipment or increased walking because of poor building design.
- Maximize Resources by Minimizing Healthcare OverproductionOverproduction waste entails redundancies, creating too much of something, or creating it at inappropriate times. Healthcare organizations can address overproduction by preparing medications for discharged patients, extending hospital stays beyond necessary, and duplicate tests.
- Remove Waste from Over-ProcessingOver-processing occurs when unnecessary work goes into treating patients. Unnecessary tests, multiple forms filled out with the same information, and data entry in more than one system are just a few examples. If time, effort, and resources are not used to improve the quality of patient care or improve outcomes, then lean analysis can help to change or eliminate it. Staff can identify redundant, redundant, or less valuable processes by looking at them through the lens of poor healthcare. This will help save time and money.
- Untapped Human Potential results from Healthcare Waste – the pinnacle of healthcare waste. Workers cannot use their time for anything other than the above. Healthcare waste eats away at time employees could be using to pursue education, build relationships with patients, and implement system-based improvements. Lean culture leads to lower costs, better care, and increased employee engagement and morale.
Lean Tools and Concepts in Healthcare
Lean Healthcare Examples
Hospitals and other healthcare facilities can implement lean principles such as improving patient satisfaction, scheduling appointments, and decreasing overtime work. They also can process paperwork and increase clinic revenues. Here are some exciting examples of lean healthcare:
- Redesigned Patient Rooms At ThedaCare, supplies, medications, and electronic-record-keeping systems were relocated into patient rooms, allowing nurses to spend 70% more time with patients. Patient safety was also improved by installing ceiling lifts in patient rooms and beds equipped with alarms, scales, and other equipment.
- Crash Cart Inspections Nicklaus Children’s Hospital reduced inspection times for crash carts from three hours to ten. This was achieved through visual optimization and the elimination of excess equipment.
- Lean Scheduling – Due to long wait times and transportation issues, Dyad Mother/Newborn Appointments For Postpartum Care Denver Health’s Eastside Clinic saw many no-shows at maternal postpartum checks. The clinic combined the appointments of the mother and infant to solve the problem and promote patient-centered healthcare. This resulted in a drop in no-shows from over 50% to 15%.
- Patient Safety Alert System One of many initiatives at Virginia Mason is the Patient Safety Alert System (PSA). This system allows staff to report any patient safety concerns. All concerns reported are immediately investigated, and interventions are implemented promptly. This system has resulted in liability claims at Virginia Mason decreasing by 74% between 2005 and 2015.
Lean Principles and Concepts in Healthcare
More and more healthcare providers have been using lean methods to improve their quality of care
and reduce costs since the Global Lean Healthcare Summit in 2007. It has been challenging to apply concepts from manufacturing to healthcare. This requires a thoughtful approach to adapting these ideas to the hospital setting.
Organizations can use tools to implement change when applying lean principles in healthcare. It is crucial to eliminate steps and processes that don’t contribute to patient satisfaction or superior care. Healthcare leaders value the perspective of front-line clinicians as they can offer new insights. Every organization member must ask, “Does it add value to the patient?” Gary Kaplan, CEO at Virginia Mason Health System, says leaders need to be more than lean. They must create a sense of urgency, develop a shared vision, align expectations, and show “visible and committed leadership.” This allows them to harness the collective intelligence of their team members and maximize patient value to reduce healthcare’s unsustainable costs.
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