Lean Healthcare: Enhancing the Patient Care Process while Eliminating Waste and Lowering Costs

Introduction

Lean thinking as defined by Lean Enterprise Institute is a set of concepts, strategies, principles, values and tools used to create and deliver the most value from the customer perspective while consuming the fewest resources and fully utilizing the knowledge and skills of people performing the work. If you visit Toyota assembly plants you can see how Toyota has put all the systems and supports staff in place to ensure that the production team members on the assembly line always have the parts and the necessary tools, they need to do their jobs. Trucks are not as important as patients, but Toyota arguably puts far more effort into supporting their front-line staff than many hospitals do. Toyota allows the team members to focus on their work and the truck in front of them, leading to better results and satisfaction for all. 

GOING BACK INTO HISTORY

In 1926 Sakichi Toyoda invented the automatic loom system. He is considered the father of the Japanese industrial revolution and has been given the title of king of inventors. Sakichi has set his own values that eventually became the guiding principles of Toyota Motor Company (contribute to society, get your hands dirty, respect for people, put customer first....). Built in quality was most evident in one of his most influential inventions- the loom that could stop itself when there is a problem. He called this jidoka. His son Kiichiro created the automobile company Toyoda. Kiichiro is a mechanical engineer, he created just-in-time JIT principle. Later, Taiichi Ohno developed a new manufacturing system turning just-in-time from a concept to a working system. Ohno methodology was endless kaizen. Ohno is the owner of idea cellular production and takt time. Kiichiro Toyoda's just-in-time and Sakichi Toyoda's jidoka are the two key pillars of Toyota Production System TPS.

Lean is inspired by TPS. Liker (2016) showed us how lean is widely applied for service organizations. Some of the best examples we can see of lean in services are kicked off by visits to exceptional lean factories. One of the best in healthcare is ThedaCare in Appleton, Wisconsin. John Toussaint, CEO at the time, had an epiphany after he visited a manufacturer of snow blowers whose president was totally committed to lean. During the visit Toussaint saw engaged people and a true flow of value through the factory. Certainly, this factory was at least as complex as his healthcare systems! He could easily imagine a healthcare system where patients did not queue up and wait, but were flowing through the healthcare experience without interruptions. He also learned that he needed to lead the transformation from the front. As his organizations learned and evolved, patient waiting time reduced dramatically. A new way of thinking led to many changes in the process include how and where blood samples were analyzed. In the past lab work was centralized and could take days. Now most tests are completed in on-site clinics in minutes. In fact, after years of improvement, about 90% of lab tests or imaging studies needed in primary care can be completed on-site, and 95% of the patients leave with a plan of care in a single visit.

What is Lean Healthcare?

As defined by Garban (2016), lean healthcare means delivering the most value to patients while consuming the least resources and maximizing the use of people skills and knowledge. Lean healthcare strives to improve quality, mistake-proof errors, improve patient safety, and increase value added through the removal of the wastes and defects possibilities. We say defects possibilities because in certain areas defects aren’t allowed to happen as they can be catastrophic, threat life’s and directly affect patient safety. In manufacturing, a defected product will cost three times more than doing it right first-time following jidoka principle. Re working a defected part add more costs and delay product to customers. In healthcare, defects or mistakes can lead to improper sterilization, wrong drug prescription, incorrect drug dosage, or improper diagnosis which can lead to health hazards.

Manufacturing organizations try to motivate their employees to improve the system and engage the front-line workers by explaining how lean can make their work easier and safer. They usually mention profitability and indirect financial gains. In healthcare, people who do the work are intrinsically motivated by the desire to help people. A desire that led so many to healthcare. Engaging them in lean thinking to improve the system for patient safety and saving life’s can be much easier. Lean can free time for healthcare professionals, so they can focus more on their basic work they learned to do in the college (providing the patient care) instead of spending their time solving daily problems. Lean leaders should make sure that this intrinsic motivation is not eroded overtime through frustration and burnout. Lean leaders should look at the system and process rather than blaming an individual.

How lean improves healthcare

Lean doesn’t accelerate the value-added works. The traditional improvement habits involve improving performance by accelerating work, and running things faster. Conversely, lean works by taking out wastes and the