Featured Lean Story - Meadows Regional
Article Link
"Since 2005, when Meadows Regional first applied lean operating
procedures in its emergency room, the average length of stay for
ambulatory ER patients has been cut by 44 percent. That in turn has led
to a 10 percent boost in the number of ER patients who received care, a
likely contributing factor to patient satisfaction scores that have
soared above 90 percent.
"Literally, all we've done is taken an
established body of knowledge and applied it to a very high-cost,
difficult environment," Kent says, referring to Toyota's renowned
principles of lean production."
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Hello!
I often get asked questions like, "What Lean tools should we use first?" I always say, "time out," as that isn't the proper way to frame a beginning discussion about Lean. As Taiichi Ohno, one of the founders of the Toyota Production System, said, "Start from need."
Discussions about tools and methods, "where should we implement 5S first?" -- these questions miss the point. Before talking about "what?" or "how?" we must first talk about "why?" Why Lean?
Lean should help bring benefits to all of the major stakeholders in a hospital:
- Patients
- Staff
- Physicians
- The hospital itself
To get the organization properly motivated and engaged with Lean, we must start with need. It's far easier to get people excited about improving care for patients than it is to get them excited about implementing some new tool (one that often has a funny-sounding Japanese name). Lean should be used to solve the most pressing problems our hospitals face.
For the Patients
What better motivation is there than improving care and service for patients? If patients are waiting too long for access to surgery, beds, or radiology services -- there's an opportunity to use Lean methods to improve patient flow. In the sidebar, there's a story about Meadows Regional Hospital using Lean methods to reduce waiting times in their Emergency Department.
Everyone is concerned about improving the quality of care and patient safety. The Lean methodology gives us powerful tools for reducing occurrences of infections, bed sores, and medication errors. Checklists and "standardized work" have help many hospitals improve quality in ways that are more productive than exhorting staff members to be more careful. Allegheny General Hospital virtually eliminated central line-associated bloodstream infections through the adoption of Lean methods.
For the Staff
Our clinical and administrative employees often face the brunt of "waste" and poor processes. Why do laboratory employees get interrupted by shortages of supplies, unnecessary phone calls, and other forms of waste? Why do nurses typically spend 67% of their time away from patients, with most of that time spent dealing with waste -- duplicated paperwork, missing medications, searching for information, etc.?
Lean helps provide solutions other than working harder. Lean methods help reduce waste that prevents people from providing patient care. Plus, engaging employees in Lean improvements helps improve morale, as employees are now part of the solution to "everyday problems" that occur each and every day.
Virginia Mason Medical Center used Lean methods to double the amount of time available for nurses to spend on direct patient care. In the UK, the National Health Service has a Lean program called "Releasing Time to Care: The Productive Ward" that is focused on reducing waste and allowing staff members to spend more time caring for patients.
These are just a few examples of how the daily pressure on staff can be reduced, allowing more opportunities for employees to enjoy their work.
For the Physicians
In my writing and speaking, there is often debate about breaking out physicians as a separate stakeholder group. There is a great deal of overlap in the motivations of hospital employees and the physicians. But, physicians also have a great deal of formal and informal power in the system -- the power to help make Lean successful or the power to derail our efforts.
As with any group of stakeholders, we have to ask "What's In It For Them?" Why would physicians want to be bothered with Lean? Since Lean is proven to improve quality and safety, there is very strong alignment with their goals. Lean can also improve the efficiency of physicians -- allowing them to care for more patients (by reducing waste and delays).
Hospitals that are successfully implementing Lean are engaging with the physicians, finding common ground and getting their involvement in creating solutions, rather than mandating changes. Geisinger Health System had a group of cardiac surgeons define standardized work for elective bypass procedures. The quality and outcome improvements would not have been possible if the physicians had not taken on the challenge themselves. Nobody could force them to change -- that's a good lesson that we should keep in mind with other staff members, as well.
For the Hospital
The benefits to patients, staff, and physicians all lead to benefits for the hospital. Lean truly does bring "win/win" solutions (or "win/win/win/win"). Improving patient care can lead to cost savings, but also leads to increased revenue by increasing capacity or gaining market share. Engaging staff members leads to less turnover and fewer open positions. Employees who are engaged in continuous improvement activities become everyday problem solvers instead of victims of the system.
Additionally, many hospitals have used Lean methods to delay or eliminate costly capital expansion. One major hospital system used Lean methods to allow the cancellation of a planned $11 million expenditure for a new food services operation. They used Lean methods to improve flow and capacity, freeing up space they thought they didn't have (and patient satisfaction scores for food went up!). We see this same story repeated in so many departments -- laboratories, pharmacies, operating rooms, emergency departments. Any hospital that is considering capital expansion should consider trying Lean first.
Now We Can Move Forward
Once you have identified your greatest needs and opportunities, now you can move forward with Lean. Instead of implementing a tactical Lean tool (or tools), make Lean a strategic endeavor that benefits all of your stakeholders -- patients, staff, physicians, and the hospital itself.
Good luck with your Lean journey,
Mark GrabanAuthor, "Lean Hospitals" Email: mark@leanhospitalsbook.com 
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Additional Book Endorsements
More endorsements for the book have come in, based on pre-publication material. For the full set of endorsements, you can visit this page on my website.
"Mark Graban's book has documented what is now happening in hospitals
all across America as we learn to apply the Toyota Production System
methodology to healthcare. This book lays out the nuts and bolts of the
lean methodology and also describes the more difficult challenges,
which have to do with managing change. Graban's book is full of wins --
these are the same type of wins that are happening at Thedacare every
day. I wish I could have read this six years ago, as it might have
prevented some of the mistakes we made in our lean transformation
journey."
John S. Toussaint, MD, President/CEO
ThedaCare Center for Healthcare Value
"Mark Graban is the consummate translator of the vernacular of the
Toyota Production System into the everyday parlance of health care.
With each concept and its application, the reader is challenged to
consider what is truly possible in the delivery of health care if only
standardized systems borrowed from reliable industries, were
implemented. Graban provides those trade secrets in an understandable
and transparent fashion."
Richard Shannon, MD, Chief of Medicine
Allegheny General Hospital, Pittsburgh, Pennsylvania
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Book Website
Visit the website for the book at www.leanhospitalsbook.com. The site's content is still being built out, but you can check out the outline of the book and some early reviews and endorsements. Check back for more content and previews.
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Spread the Word
Help spread the word about the book by forwarding this email to colleagues who may want to learn more about Lean in hospitals.
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