Should Your Hospital Be Operating on Principles of Lean Management?

By Jack Sieber on March 5, 2013
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Jack Sieber

Applying Six Sigma Principles to Your Hospital’s Operations and Management

Author: Jack Sieber

Even though “lean management” has been around for years, many hospitals are still reluctant to embrace the system. Lean management may not be the cure for everything that challenges your facility, but lean concepts are definitely worth considering.

Cut the waste

Lean management got its start from a Toyota automobile production system. The process involves removing waste and improving workflow. Lean management is sometimes coupled with Six Sigma principles. These use statistical analysis to minimize variations in process execution that can lead to waste.

Now, lean management is being adopted in health care settings. And for hospitals, the functions that typically benefit most from lean principles include admissions, discharge, radiology, purchasing and billing, and the ER.

Practically every organization, including hospitals, operates using a series of processes or sequences of actions that are designed to create value for their customers (or, in this case, patients). With lean management, you can distinguish value-adding process steps from non-value-adding steps, thus allowing you to cut any wasteful steps.

Not a one-time project

Employing lean activities doesn’t mean you can simply assign a handful of employees to do this as a one-time project. If your hospital decides to fully embrace going lean, every staff member will need to learn the system’s principles. Why? Because eventually they will all be called on to help streamline workflow and identify wasteful steps.

Being fully committed to lean practices means you’ll need to identify key processes in your hospital’s value stream. Perhaps it’s an inpatient stay, an office visit or a trip to the ER. You’ll also want to look at both internal processes (supporting primary processes) and primary processes (serving patients and their families) to determine the value that each one aims to create.

The next step is to conduct a kaizen (continuous, incremental self-improvement) event. It’s a three- to five-day session that not only analyzes the hospital’s processes, but also implements changes. Participants must map out how each process functions and then document and quantify the value that was created by each step — as well as the waste in steps or between steps.

Moreover, a conversion to lean may require you to employ the mnemonic PDSA (Plan-Do-Study-Act) system. PDSA describes the steps in changing a process:

  1. Devise small tests of a change (Plan),
  2. Conduct the tests on a small scale (Do),
  3. Measure results against the present state and consider how it could be further improved (Study), and
  4. Implement changes hospitalwide, monitoring the process for at least 90 days to ensure stability and sustainability (Act).

An exemplary use

Many hospitals use lean management in processes such as moving patients through OR procedures from beginning to end and preparing claims for submission to a payor.

The Exempla Lutheran Medical Center in Colorado provides a detailed case study. The Center wanted to address foot traffic going in and out of the OR during surgical procedures because excessive, unnecessary entry and exit can produce airflow disruptions that can increase the risk of nosocomial infections. Plus, such movement can become a distraction for the OR team, resulting in medical errors.

So the facility conducted a “rapid improvement cycle,” via a four-day kaizen event. They pulled together physicians and frontline staff to analyze the current state of OR work processes and determined how often, when and why someone left or re-entered the OR.

Once they found that the leading cause was the need to retrieve missing instruments, supplies and equipment, the kaizen team redesigned processes to improve equipment and supply availability in the OR. After the changes were made, total OR foot traffic actually dropped by 32% and surgical site infections fell by 14%. Another benefit: 7.9 hours of staff time per day were freed up.

Not for the fainthearted

If going lean sounds good to you, be prepared for a few bumps in the road. Why? Because it requires getting all staff members to buy into the system. Plus, it will likely consume a great amount of time and resources as you look at your hospital’s processes. The end results, however, will be worth it.

If you have any questions about lean management or any other healthcare issue, give us a call at 716.847.2651, or you may contact us here.

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