Lean in Healthcare

Since the 1900s, healthcare organisations have debated and discussed the adoption of lean management principles as a means to achieve quality services to patients and remove excess waste. Nevertheless, lean in healthcare entails a bit of adaptation and flexibility for it to be effective.

While lean principles are likely to improve the quality of healthcare, it requires continuous improvements. Notwithstanding, Lean has proved to be a more effective and efficient way of operation. Lean helps to boost employee satisfaction, quality health care services and financial management.

In addition, lean in healthcare helps to strengthen the communication links between all levels of management. As such, all staff work together as a team to eliminate excessive waste in the organisation and improve quality care.

Furthermore, lean management principles place responsibility on the frontline workers to get the work done. As a result, Lean encourages satisfaction engagement since it promotes “respect for the people who do the work”.

Adoption of lean principles in healthcare ensures a high level of efficiency and timely experience of patient care. It reduces the patient’s waiting time and ensures better workplace safety. Also, lean principles improve hospital admission processes. It improves diagnoses and ensures greater efficiency with patient appointments and records.

Thus, this article covers:

The definition and concept of lean in healthcare.
The history of lean in healthcare.
Lean tools for healthcare.
Some examples of lean in healthcare.

The lean management process was made popular by Henry Ford when he caused a revolution in the manufacturing sector by creating a better workflow for assembling vehicles. However, lean management is not restricted to the manufacturing sector but has been adopted by a number of other industries, including healthcare.

Lean is an innovative management approach that has shown great success in healthcare organisations. It improves quality and efficiency, enables quality patient care and helps control cost. Hence, lean in healthcare is a philosophy and principle that requires a continuous never-ending journey of improvement.

Consequently, Lean offers both opportunities and challenges that help to transform organisational culture. The implementation of lean in healthcare requires a major shift in roles. Therefore, managers and leaders take on the role of mentors and facilitators while front-line staff are totally responsible for improvements.

In other words, senior management hand over their roles as master problem solvers to clinical and non-clinical staff members who are closer to the problems trying to be solved. On the other hand, senior management team engage front-line staff in hands-on training to keep them abreast with lean methods for quality improvements. By so doing, teamwork is encouraged, the performance improvement is boosted and the organisation becomes more innovative. Also, employees gain more confidence in their problem-solving skills and keep raising the bar for quality improvements.

The role of lean methods in the healthcare system

Healthcare organisations are complex in nature. So it difficult for staff, by themselves, to know what tasks are most important. Lean helps to clarify and guide staff on how to properly execute tasks in order to improve the quality of work. With respect to this, the key role of senior management is to continuously communicate in clear terms to front-line staff members.

As a result, senior management should state in a step-by-step approach the goals that are most relevant and important in creating value to the organisation.

Moreover, the underlying aim of lean in healthcare is to channel the resources of healthcare organisations in a way that benefits its patients. Although lean is of utmost benefit to the patients, it is not meant for patients alone. Lean is beneficial to other stakeholders in healthcare like nurses, physicians, healthcare organisations as well as the community.

Besides, lean methods result in faster response time for emergency cases, improved communication about patients, faster operating room turnover, less nursing time away from the bedside and fewer medication errors.

Monitoring lean projects in healthcare

Performance of lean projects is often tracked visually. Thus, within a lean hospital or clinic, visual tracking centres are set up, in the form of information displays, in different locations. These tracking centres serve numerous benefits.

For example, tracking centres within a lean hospital or clinic help to present daily performance data based on patient satisfaction, cost and quality. It represents a culture of transparency in organisations. Also, visual tracking centres are beneficial because they provide a set-out area for staff members to gather for meetings.

Lean in Healthcare Definition

Lean in healthcare can be defined as the use of “lean” approach in healthcare organisations to minimize wastes and maximize patient care. By utilizing Lean principles and procedures, healthcare organisations become more patient-centered in their decisions and processes. Also, all members of staff including clinicians, nurses, physicians and administrative staff take part in identifying and eliminating areas of waste and inefficiency.

Lean methods

Some areas of waste that have been identified in the healthcare are patient waiting time, over-possessing waste, defect waste, idle human potentials, motion, inventory waste, overproduction and transportation.

According to lean principles, waste occurs whenever patients or employees are expected to standby. For example, when staff meetings are stalled for latecomers or patients sitting in waiting areas. In addition, idle high-tech equipment and appointment waiting lists are areas where waste occurs in healthcare organisations.

Therefore, lean methods help hospitals and clinics to understand how waste leads to idleness. When employees are idle, they become less innovative and unable to use their creativity to promote efficient patient care. This waste replaces the time employees could have used to implement improvements, build meaningful relationships with patients or for educational pursuits.

Similarly, lean removes defects, increases income and improves quality in healthcare. Some examples of defects that could lead to waste are wrong diagnosis, medical errors, process or system failures and injurious treatments. Besides, some hospital-acquired conditions like preventable allergic reactions, incomplete medical records, blood clot and infections could also lead to waste.

In general, the use of lean in healthcare helps to improve quality by minimizing all these areas of waste. It improves the culture of quality patient care and increases employee satisfaction and enthusiasm. Hence, to save time and money, minimize waste, prevent mistakes and improve patient care, healthcare organisations can leverage lean principles.

History of Lean in Healthcare

The history of lean in healthcare dates back only a few years ago. Lean originated from the Toyota Production System (TPS) manufacturing process. Since the mid-1950s, Toyota has been known for its efficiency, quality and employee involvement.

Today, lean has become the standard for efficiency and excellence in the manufacturing industry. However, in the last few years, the healthcare industry has succeeded in deploying lean principles to achieve quality in its operations and processes.

Although operations in the manufacturing and healthcare industries may differ in various ways, the requirements necessary for change are quite similar. Both industries demonstrate a commitment to the projects from senior management, engage practitioners and recognize shop floor expertise in identifying necessary improvements.

Lean in the manufacturing industry focused more on identifying value-adding processes and removing waste from the system. On the other hand, the healthcare industry involves high specialist influence, the variability of patient presentations and geographical protection of healthcare delivery.

Evolution of lean in healthcare

Before now, the implementation of lean in healthcare focused more on improving safety, efficiency and quality. These improvements were aimed at improving the flow of information and communication, the implementation of IT solutions and the delivery of new methods to enhance continuous improvement in patient care. In addition, the implementation of lean methods in healthcare focused on redesigning the patient journey to improve access and reduce waiting times as well as managing the chain of medical supply.

However, the introduction of lean in healthcare has underlined the influence of the socio-technical aspects of lean implementation. Owing to the fact that the health sector constitutes a number of professional identifications and is highly complex in nature.

So far, clinicians have accepted and implemented Lean practices and tools in healthcare. Lean has helped to remove wastes associated with duplicated information, delays, unnecessary movements, defective products, rework, missing supplies and staff burnout. Also, lean has helped reduce frustrations and dissatisfactions that result from work-related processes.

Thus, the history of lean in healthcare can be dated many years back. However, lean has evolved, focusing more on patient care. Today, over 100 hospitals and healthcare centres have adopted lean in their processes. The implementation of lean principles in healthcare has helped save lives by reducing the percentage of hospital-acquired infections. By so doing, hospitals have reduced waste and increased savings and revenue.

Lean Tools for Healthcare

A good healthcare system should be structured in a way that does not interrupt people’s day-to-day life. Thus, lean tools for healthcare are important for processes to be organized and resources used efficiently.

Lean in healthcare centres on shortening patient’s waiting time, adding value to patients and increasing patient’s safety. Lean ensures that patient’s journey in receiving quality care is smooth and effective. Therefore, lean guarantees an organised process and efficient use of resources.

1. Flowcharts

One of the lean tools for healthcare is flowcharts clinical processes. A process is a series of activities that translate data inputs to an output. Healthcare organisations should identify clinical processes in which patients are directly involved.

The objective of flowchart clinical processes is to define lines of action that would enhance quality and safety levels for patient care.

2. Visual management

Another lean tool for healthcare is visual management. Visual management involves the use of colours, pictures, signs, graphics, light and sound. They are used to monitor the process and send feedback where there are disturbances. They are also used to evaluate the current state of the process against the desired state.

Also, visual management is used to show critical conditions. For example, colour blue indicates the operating room is sterile while the colour red indicates it is non-sterile. It is one of the most useful lean tools for healthcare.

3. The 5S method

This method is one of the most popular lean tools for healthcare and other industries alike.

It aims to create an organized workplace so that errors can be reduced during a process. The 5S method as a lean tool for healthcare eases the flow of values in a process. In addition, it makes use of 5 steps that help to reduce waste and keep clinical processes organized.

More lean tools

Poka-yoke: This is a particularly useful lean tool in healthcare. It helps in mistake prevention.
Work cell optimisation: Useful to reduce the time needed to complete tasks. Thus, an indispensable lean tool in healthcare.
The 5-why and the Ishikawa diagram are other useful lean tools used for cause analysis. The Ishikawa diagram helps to identify the causes of errors. Then, it further divides these causes into groups in order to streamline and determine the most likely cause of the error(s) identified. The 5-why method is used hand in hand with Ishikawa diagram to question “why” errors are occurring in healthcare processes.

Examples of Lean in Healthcare

Lean in healthcare has improved patient satisfaction, increased revenue and decreased overtime work. Likewise, as a result of deploying Lean principles, improvements have been recorded in processing paperwork and scheduling appointments. Hospitals, clinics and healthcare centres have successfully deployed lean in various areas of their operational processes.

One great example of lean in healthcare is the Virginia Mason. By deploying lean tools, the hospital was able to implement a Patient Safety Alert (PSA) initiative. This system was devised for staff to be able to report problems that involve patient safety. Once reports were made, they were investigated, and necessary solutions implemented. As such, Virginia Mason was able to reduce their liability claims by 74% from 2005 to 2015.

More so, nurses in ThedaCare were able to increase their time with patients by 70%. By implementing Lean principles, patient safety was improved, and patient rooms redesigned. Hospital rooms were equipped with ceiling lifts and beds were fitted with alarms and scales. Also, supplies, electronic record-keeping systems and medications were transferred to patient rooms.

More examples of the lean system in health

Similarly, Denver Health Eastside Clinic observed that a good number of its patients did not show up for maternal postpartum check-ups due to long waiting times and transportation barrier. As a solution to this problem, the clinic merged mother and infant appointments. This drastically reduced the number of patients that did not turn up for appointments from 50% to 5%.

Another example of lean in healthcare is Nicklaus Children’s Hospital. The hospital employed Visual optimization, one of the Lean tools, and reduced excess supply of equipment. This resulted in reduced crash cart inspection times from 3 hours to 10 minutes.

Furthermore, a breast cancer screening centre applied lean practices to implement an interdisciplinary approach to its treatment processes. As such, patient call back for unnecessary biopsies reduced from 10% to 5%. Additionally, breast biopsy-related costs reduced by 35%.

Conclusion

Lean is a practice that helps to improve quality by identifying and eliminating wastes in processes. The history of lean in healthcare dates back to the early 1900s. However, lean has evolved significantly. In healthcare, lean focuses more on process efficiency, patient’s health and safety than cost.

There are many useful lean tools for healthcare to help improve quality of care. Similarly, many examples of lean in healthcare indicate that lean is a successful quality improvement method. The implementation of lean principles has reduced patient waiting time, eliminated waste in patient care processes, improved patient satisfaction, reduced liability claims and reduced costs.

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