In quality improvement engineering there are many tools. I would like to illustrate a few and show how they can apply to healthcare. I will be using tools taken from Lean Manufacturing, an approach used at Toyota Motor Company for many years now. These tools are easily adaptable with a bit of imagination to healthcare. I am not proposing that all healthcare should blindly adopt Lean as the new “flavor of the month,” but if some of the tools fit your site well, then use them. From my experience, the best progress in quality at a site is in the identification and use of quality improvement tools that can be mastered by the employees of the site. There is no use in being a Jack-of-all-trades and master of none.

Two tools that seem to go hand in hand are 5S and Point of Use Storage. 5S is sort, set in order, shine, standardize and sustain. In the most recent issue of Quality Progress (American Society of Quality’s magazine) these tools were applied to storage areas. A storage area should only contain items that are useful to tasks that are performed nearby. For instance in an examination room there should be a good assortment of bandages, but it probably doesn’t make sense to store printer ink in the exam room. This is an example of point of use storage. Further, any storage area no matter the size should be well ordered. You don’t want to have too many of any one item; it is better to have in stock what is needed for a day or two and restock as needed. That way, you can have a wider variety of items in the storage area and will waste less time going to look for a supply when it is needed and it isn’t nearby.

Besides having the right amount of items in a storage area, you should have it arranged so that the most frequently used items are easiest to access. A way to make sure that this order is maintained is to have a diagram in the storage area showing where things are located. That way, whenever restocking occurs, items will be placed in the right place so anyone who uses the supplies can easily find them. With a diagram of the work area a person using it for the first time will be easily able to locate an item. A good rule is that anyone should be able to find any item in 30 seconds or less.

Finally, in arranging a storage area, be sure to get rid of any outdated items. If an item is rarely used in activities near that storage area be sure to transfer it to the point where it would be most useful or if no one uses it, dispose of it. Of course, this arrangement of stored items will only be successful if most everyone will work at maintaining it.

Another useful tool in lean is to eliminate wasted effort. One glaring example that I have seen is the amount of time nurses have to expend in getting prescriptions refilled for patients at primary care sites. The nurses and other representatives from the staff should examine the process of refilling patient prescriptions by drawing a diagram of the process (value stream mapping) and measure how much time each step takes and which are really needed in the process. I bet that some steps can be eliminated and thus time saved. One suggestion that I have is for prescriptions that are used over a long period of time, such as hormone replacement medications. Why not move the patient into ordering 3 months of the prescription at a time through a mail order pharmacy? It may take a bit of effort to move a patient into this habit, but is will save a lot of time in the long run for an office and will free nurses to do much other needed tasks. The patient will also be happier as they can usually save money by ordering in this fashion. My wife and I order all our recurring prescriptions this way and easily save over $200 per year.

Many in healthcare think that these tools are not useful to them. Recently I was talking to someone about using Lean principles in their office. This person thought that because health plans had so many rules applying to such things as coding and billing and other documentation that there was little room for improvement. To me this is an illustration of lack of communication among the various people on staff. If a team was formed of representatives from the staff and the above tools examined I know that the team could find many ways to find savings in time, money and effort similar to the ones that I chose to illustrate. Once the processes are identified and standardized, then the site can continue seeking ways to further improve in a process of continuous quality improvement.

Donald Bryant helps healthcare providers meet their challenges and writes
“Making Good Healthcare Better” a free monthly ezine for healthcare
providers who want to dramatically improve patient health, improve the
bottom line, and make work more rewarding, guaranteed. Go now to
http://www.bryantsstatisticalconsulting.com to get a free article with tips you can use to start making improvements immediately and to learn more about Lean Healthcare

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Have you heard of Lean Healthcare? I am sure many of you have and that quite a
few haven’t. The concept of lean healthcare has been adopted from manufacturers.
The idea of lean manufacturing and lean service are most visibly displayed by
Toyota Motor Corporation. Toyota has so refined and developed the techniques
that organizations around the world are using their ideas to improve their own
organization and are benchmarking against Toyota.

Lean healthcare is basically reducing waste in the delivery of service both directly to
the patient and to internal customers, such as human resource services to
employees. For instance, lean techniques help eliminate duplicated procedures,
such as a nurse taking the blood pressure of a patient and then the doctor doing the
same a few minutes later. It also makes sure that all of the necessary tools and
products are in an examination room when needed. It is beyond the scope of this
article to fully describe lean healthcare; many books have been written about it. In
fact, the American Society of Quality in their online bookstore has several titles,
including Lean-Six Sigma for Healthcare. I would like to define a few techniques
found in lean healthcare to illustrate its value, though.

One of the most commonly used tools is Value Stream Mapping. VSM displays in a
physical graph the process from beginning to end of the delivery of a service or
procedure in order to identify wasted effort or steps that don’t add value to the
results. For instance, in the April 2005 issue of Quality Progress the article Lean Six
Sigma Reduces Medication Errors presents the process by which a team of nurses
and pharmacists in a hospital setting reduced the waiting time and errors in the
delivery of medication from the pharmacy to the patient. By the use of VSM and
other statistical techniques, the error rate was reduced from 0.33% to 0.14% in 5
months and a savings of $550,000 was realized.

Lean healthcare emphasizes tapping employees knowledge to improve processes.
Leaders of an organization empower employees to present ideas for improvement
and then enact promising ones in order to save time, money and improve patient
health and satisfaction. One such technique for empowering employees is the
kaizen. This is a meeting of staff to quickly generate solutions to a process which
has been identified as needing improvement; the team members are representatives
of those actually involved in the process. A kaizen event is marked as a brief,
intense effort to solve such a problem. It may take several hours or a day or two.
The work time lost of the members of the kaizen is more than offset by the
outcomes of the meeting.

Lean healthcare is driven by the identified needs of the patient or customer. For
instance, waiting time is deemed waste. A patient having to wait more than a day or
two to see a doctor for an office appointment is waste. Many in healthcare think
that this is a problem which is almost impossible to solve. It isn’t. Solutions to this
problem have been described in several articles of Family Practice Management, a
publication of the American Academy of Family Physicians. The ideas are easily
adopted to sites which aren’t primary care physician practices.

Lean identifies the best techniques and strategies to deliver quality care and then
makes them standard operating procedure. In fact, it is a good idea to write a
manual of the best processes in order that any employee can reference at any time
and also in order to use it as a training tool for new employees.

I would like to urge you to look deeper into the ideas of lean healthcare. There are
many publications describing it, as the ASQ publication mentioned earlier. The April
2006 issue of Family Practice Management has a great article for lean in the doctor’s
office; it can be found for free online. Your efforts in implementing lean techniques
will be rewarding to both you and your patients.

Donald Bryant helps healthcare providers meet their challenges and writes
“Making Good Healthcare Better” a free monthly ezine for healthcare
providers who want to dramatically improve patient health, improve the
bottom line, and make work more rewarding, guaranteed. Go now to
http://www.bryantsstatisticalconsulting.com to get a free article with tips you can
use to start making improvements immediately and to learn more about Lean Healthcare

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