What does 'lean' mean for healthcare? 6 thoughts

Since the 1990s, Lean management principles have been discussed, debated and deployed in healthcare settings as a means to remove excess waste and improve quality.

Paul Levy, former president and CEO of Israel Deaconess Medical Center in Boston, recently shared an anecdote on his blog "Not Running a Hospital" illustrating one surefire way to undermine Lean management principles in a hospital: don't get top leaders involved.

Though the anecdote centered on just one hospital, the lessons (backed by evidence-based research regarding Lean) are far-reaching and reinforce why hospitals and health system executives should be more adamant about implementing and maintaining a Lean way of operating.

Here are six thoughts on how Lean can contribute to healthcare.

1. It works. In his anecdote, Mr. Levy said the cultural change within the organization resulted in improved clinical care, employee satisfaction and financial management. Don't just take his word for it; a 2013 article published in Mayo Clinic Proceedings outlines the six principles of Lean and demonstrates and assesses the effectiveness of such principles using healthcare case studies.

2. Lean processes require a cultural shift. All employees need to band together with the shared vision of eliminating excess waste and improving value. This cultural shift also emphasizes the strengthened communication channels between all levels of leadership. Lean principles apply to all elements of an organization, and it requires enhanced interdepartmental relationships to make it work.

3. However, to make Lean work in healthcare, it requires a bit of adaptation and flexibility. Becker's Hospital Review editor-in-chief Lindsey Dunn recently wrote on this topic, suggesting that the key to applying Lean principles requires taking the project framework but then approaching its implementation not as a project, but as a process. "Continuous improvement is not an event or project, it's just that: continuous," she wrote.

While Lean management principles hold the potential for bettering organizational processes, they should not be implemented as episodic solutions.

4. The contiguous nature of Lean principles could offer lessons for hospitals and health systems to apply to other processes. One glaring exampling is health IT. Following federal incentives and program initiatives, hospitals devoted substantial resources to implementing IT systems and EHRs, but there always was an end point in sight. While meaningful use is broken down into three stages, it doesn't necessarily provide room for continued growth. Deadlines are not always conducive to healthcare, and Lean helps healthcare professional see the long-term vision.

5. One of Lean's six principles is "respect for the people who do the work." The system places responsibility on the front-line workers to get their hands in the dirt and oversee many of the changes. This holds a significant potential for employee engagement and satisfaction. Instead of a hierarchical system, Lean offers a more equitable management structure. Or, as stated in the Mayo Clinic Proceedings report, "Respect flows downward, not just upward."

6. The tenets of healthcare's triple aim are integrated right into the goal of the Lean principles, and the triple aim is the next overarching shift in mindset for those in healthcare. While Lean likely won't be a one-stop shop for addressing all the issues healthcare is facing, the cultural shift seems to be a promising place to start.

More articles on leadership and management:

A practical approach to population health: Report from the front-lines of healthcare transformation
100 physician leaders of hospital and health systems | 2014
What do physicians need to transform to value-based healthcare?

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