In the new book, “Lean Healthcare Deployment and Sustainability,” author Mark Dean, PhD, explores how to best deploy Lean process improvement in healthcare organizations. Here, he discusses why Lean methods are especially useful for healthcare organizations and how to garner organizational support for their use.
Question: One of the goals of Lean process improvement, which you discuss at length in his book, is the removal of “waste” — processes or other efforts that don’t result in added value. Can you describe some of the most common types of waste you’ve seen in hospitals?
Mark Dean: Of the “Eight Wastes,” certainly “waiting” is by far the most common in hospitals. Most of us have experienced this waste if we have ever needed the services of an emergency room. The average time a patient spends in the emergency room is over three hours. Of that, perhaps less than 30 minutes is what the patient would consider “value added.” The rest of the time is “waste.”
A less obvious but nonetheless pervasive waste is not utilizing people’s abilities. Most hospital staff — nurses, techs, physicians and every other healthcare provider — are very committed to the care or our patients. Unfortunately, most are working as hard as they can in processes and systems that are much in need of redesign. They are so busy doing what needs to be done to care for our patients that we, management, do not often enough invite them in as partners to help improve these broken processes. Our people have a wealth of knowledge and the willingness to help us improve our delivery of care. We should engage them in that effort.
Q: Why is removing waste in healthcare so important?
MD: In general, removing waste from a process improves the flow, decreases cycle time and reduces cost, Perhaps most importantly, it also enhances quality. Consider healthcare specifically. By eliminating such wastes as waiting, defects (errors), excess processing and the others, we can significantly improve the patients’ experience, provide better and safer care, and do so at a lower cost. In today economic environment, healthcare providers face continuing uncertainly. Reimbursement continues to decline. Pay for performance continues to increase. Providers have little control over these factors. However, what providers can control is the cost and quality of the care they provide. Those that can do so will thrive. Those that cannot will not survive.
Q: You book includes a great list in Chapter 9 of some of the most common benchmarks hospitals apply Lean techniques to improve. In your opinion, what are some of the most impactful processes or benchmarks you have seen hospitals improve through Lean techniques?
MD: The list of indicators referred to include measures of clinical quality, labor costs, supply costs and overall operational performance. Process improvement yields great benefits in all these areas. The key difference is the amount of time and effort to achieve these improvements. The application of Lean as a process improvement approach can yield almost immediate benefits to revenue cycle and supply chain performance. Clinical quality and labor costs are more complex to resolve, and thus take longer. Bottom line operational performance is the cumulative result of many other initiatives and can be expected to improve more gradually over time.
Q: You devote an entire chapter to ensuring senior leadership support for Lean practices. Why is this so critical? And how can quality improvement leaders ensure senior leadership support their Lean transformation initiatives?
MD: In my experience, improvement is healthcare is simple, but not easy. What I mean by that is this: In most healthcare systems, there are ample and very visible opportunities for improvement. A 30-minute walk through any area, and conversations with the team members in that area, will usually identify these opportunities. That is the simple part. Implementing and sustaining them is the hard part.
This is where senior leadership support is necessary. Management, and especially senior management, “owns” all the processes and systems and has the authority and power to change them. Team members and consultants can identify opportunities and come up with plans but senior leadership must provide support in two extremely critical ways. First, they must empower and engage their teams to pursue process improvement. Their visibility and support of these efforts is a key to success.
Second, senior leadership must ensure a steady and consistent “drumbeat” of follow up to ensure that progress is made and barriers removed. Improvement plans take time. Senior leadership can help maintain a focus on achieving and sustaining these gains by having periodic, perhaps bi-weekly meetings with the leaders and teams responsible for the improvement. During these meetings, two different types of measures should be reviewed: measures of activity — in others words, is the improvement plan being followed? — and measures of outcome results — in other words, are the improvement activities achieving the expected results?
This ongoing “drumbeat” of process and outcomes reporting is perhaps the most effective tool a senior leader can use to ensure sustainable results.
Q: Another point you make several times in the book is that Lean is not a “one and done” approach to improving processes. Why is continual improvement critical, and how can hospital leaders ensure they approach change in this way?
MD: Continual improvement is necessary for a number of reasons. First, healthcare delivery systems are very complex. Such complex systems can only be improved using a step-by-step approach. That is why Lean is such an effective tool. The Lean approach is “do it now, do it fast.” It is better to get 20 percent improvement now than 50 percent a long time from now. This is why it is a continuous process. Recurring and cumulative “little bites” are much more likely to succeed than the mythical magical fix.
Second, the healthcare landscape, including reimbursement and technology, continue to change. We must continue to adapt. Continual process improvement, including Lean, is a tool that enables us to continue to do so.
I think successful hospital leaders recognize this. The drumbeat of follow up described above is a great tool for helping them to continue to change, adapt and improve.
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