Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Lean Healthcare: A Long Journey Worth Taking

3/11/2014 10:45:08 PM | 0 comments

Today I spent my day at a client hospital's kaizen lean event. Throughout the week, the emergency department team is conducting tests aimed at rapid quality improvement. The pace of the process is fast and the work demanding. The "experiments" fail to produce expected results as often as they succeed. The participants, many of whom started with great hope and excitement, are beginning to look tired.

Everyone involved in this process cares deeply about providing the highest quality patient-centered care to patients. They want patient care to improve as rapidly and safely as possible. But they are finding out (as have many teams before them) that becoming a lean organization takes an incredible amount of work and commitment — not to mention huge shifts in thinking, values, relationships and responsibilities.

Given these realities, it's natural to question whether the long, hard journey to lean is one worth taking. The goal is to drive out waste so that each person's work adds value for the customer (in this case, the patient).

In 2002, Seattle's Virginia Mason Medical Center became the first healthcare facility to integrate lean philosophy across the entire organization. Within two years, the hospital saved over $1.35 million in inventory, cut its floor space needs by 41 percent and increased employee productivity by the equivalent of 158 full-time workers. In 2013, the Harvard Business Review (HBR) blog profiled an emergency department that boosted patient satisfaction scores from the 6th to the 99th percentile within four years of implementing lean methodology.

Given these and other highly publicized successes, it's no wonder that many hospital administrators see lean as a weapon against the waste and fragmentation that has plagued healthcare for years. Unfortunately, lean methodology isn't a quick fix. For the process to work, lean methods must be practiced rigorously by all, from upper management to the front-line providers and staff. Going lean usually requires a massive transformation in organizational culture — and an enormous commitment to change.

So is lean worth the effort? As someone who has been involved in lean events at various hospitals and witnessed some of its transformational powers, I've come to the conclusion that it is. When leadership is fully committed to the process, the time and resources required to evolve into a lean organization are well spent.

I value lean for the following principles that it promotes:

Focus on the patient. Lean management focuses everyone in the organization on achieving the type of value desired by patients. It sounds simplistic, but many kaizen participants are surprised at what happens when they reframe their thinking in this way. As one nurse put it, "It was eye-opening to see our process from the patient's perspective. Often, I'm so focused on what I need to get done and sometimes the patient's need may be overlooked."

Executive sponsorship. Successful implementation of lean principles is driven by "sponsors" within the organizational leadership. Lean healthcare executives act as more than gatekeepers of resources; they also provide a sense of mission — a connection to the organization's "noble cause."

Breaking down the silos. Through sponsorship, administrators obtain a deeper understanding of issues and work with front-line staff and leaders to solve them. Rather than relying on secondhand reports, a lean hospital administrator might spend time on the gemba, or "shop floor," interacting with nurses and physicians and observing issues firsthand. This allows leaders to respond to problems faster — often within minutes or hours rather than days or weeks.

Front-line staff involvement. An Institute for Healthcare Improvement white paper on lean methodology noted that, "The only sustainable process is one that participants believe in." To this end, lean methodology involves front-line staff directly in improvement efforts. They have a hand in designing their own solutions, and their knowledge, feedback and ideas are treated as essential to effort's success. As one nurse said at this week's kaizen event, "I feel like my opinion counts and my contribution matters."

Reframing failure. Lean methodology encourages teams to "test" ideas with an open mind. "Failures" are not only accepted but also treated as sources of insight.

True facilitators. Lean brings healthcare teams into contact with outside facilitators who view everyday processes with fresh eyes and who can keep the team focused on the project scope. Depending on the situation, this might be an external consultant and/or someone from the organization's lean promotion office. This fresh perspective fosters innovation by helping teams question their own norms and injecting new life into brainstorming sessions.

Value stream mapping. This useful lean method provides a complete picture of a healthcare process by identifying and quantifying the steps involved. Seeing the process in its entirety makes it easier to identify "pain points" and create a blueprint for change.

Eliminate waste. Through lean thinking, hospitals have reduced inventory costs, boosted employee productivity and cut set-up times. A notable example: by using lean methodology to improve ED throughput, one academic hospital was able to transform part of its ED waiting room into a 12-bed unit.

Circling back to the original question, it's true that going lean can be challenging at first. But once lean culture and buy-in are established, the focus on efficiency — doing the little things that mean a lot — becomes self-reinforcing. Employees are often pleasantly surprised to find that in adding value for patients, they enrich their own work lives as well.

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