I think this is a good time for a checkup, or physical as it is termed in the healthcare industry. I mean this is a good time to check the health of your site or setting. As healthcare providers, we are dedicated to curing our patients of their ills and keeping them healthy. My question is, “Do you have the same attitude about the place you work?” Is your site meeting its highest goals? If not, then it is time for a change.

I think that as a group healthcare sites are a lot like our patients. Some patients
don’t work hard at keeping healthy. In fact, many engage in behavior that is very
detrimental to their well-being. You probably can easily image such a person.
Maybe they are very overweight. Well, there are many healthcare facilities that are
like that. They have many processes in which there are steps which add no value,
that are a complete waste of time and effort. Then, there are patients who do a lot
of the right things. They eat correctly, get a good amount of exercise, and generally
have a positive outlook. There are a few healthcare facilities that are fit too.

What does a healthcare site in not so good shape look like? These sites, I believe,
have as their goals just to meet their compliance standards, those set by the state,
JHACO, or the FDA or some other body. As long as they are being accredited, they
are satisfied. Their attitude may be, “If it isn’t broken, don’t change it.” They are
like patients who are content to just sit on the couch, watch TV, and eat whatever
they like as long as they don’t feel poorly.

What does a healthcare site in good shape look like? I believe that such sites are
continually looking for ways to better themselves. They engage in “continuous
quality improvement” activities. They are really concerned about the health and
attitudes of their patients and clients. They use surveys and they question and
listen. Some even use a tool called quality function deployment when designing
new facilities or programs.

Besides listening to patients, they pay close attention to their employees. They
actively seek ideas from the employees on how things could be done better. They
want to have their employees enjoy working at their site and support its mission.
The leaders of such sites actively reflect this attitude.

Further, such sites seek ways to improve the processes at their site. They cut waste
and save time and improve the bottom line. Many tools for doing this can be found
in quality disciplines such as Lean Healthcare and Six Sigma. You can find a very
good white paper on Lean Healthcare at the www.IHI.org website.

What are the results of these positive and active approaches? Our patients are
happier, fitter, and find time to do the things they want. They generally live longer
with fewer health problems. Healthcare sites which are actively engaged in
continuous quality improvement programs generally find that they have the time to
accomplish their objectives and don’t feel rushed, they have an improved bottom
line, and they rarely experience adverse events. The doctors don’t have to work
impossible hours to accomplish all they want. They work as a team.

Let me encourage you at this time to sit down with your colleagues and leaders and
assess the health of your site. If you find that you fall short of what you should be, I
hope that you put in the effort to reach the best goals. After all, we expect the
same from our patients, don’t we?

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. More free articles
are at his web site. Be sure to visit.

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Over the last couple years, we have been working with Healthcare organizations to adapt Lean to their complex processes in laboratory and hospital environments. Predictably, there was much skepticism from Clinicians and administrators alike - and rightly so. They were perfectly justified in asking - ‘how does a thinking that grew mainly out of the automotive industry apply to the healthcare environment?’

The answer is, ‘it applies perfectly’.

But giving an answer like that does not (and should not) convince all healthcare providers to blindly accept Lean and charge forward in the process transformation.

It took a few very courageous and visionary leaders to step forward and attempt applications within their environments - even if they were still a little (or a lot) skeptical.

Within a matter of a few weeks, the skepticism faded and the results began to appear. It works! And who would have believed that in a scientific profession there would be such a vast amount of opportunity to remove ‘non-value’ or waste.

The ‘non-value’ activities were not the people trying to do something wrong. In fact, the people were just working at trying to provide the best service, both in quality and turnaround time. The barrier was the existing ’system’. It forced them to do things, which actually hindered them from providing their clients with the best service.

Once we applied Lean, and removed the non-value added activities, they found they were able to respond and serve their clients faster and better. In fact, they could respond to more clients while using the same number of people and equipment. The result was higher satisfaction for the patients/clients and for the staff while lowering their costs to provide the service.

While none of these healthcare cases have achieved perfection - their staff have moved closer to it and they have discovered a structured and practical method for attaining the level of service they and their clients desire and expect.

Here are some recent examples of typical results:

MRI processing time
20% increase in patients per day

Elimination of entire processing areas
Processing done in one lab instead of two without any new equipment expenditures.

Waiting Times
Found that techs in x-ray areas were waiting for up to 30% of their time, now they can use their time more efficiently and service the patient faster.

Overtime
Eliminated overtime by reducing the batch sizes and creating flow.

Lead-Time
Reduced lead-time for test results from 8 hours to 2-3 hours by decreasing batches and eliminating waste.

Motion
Delivery personnel were spending most of their time walking (up to 50%) to deliver specimens. A new schedule significantly reduced motion waste.

Equipment Uptime
Improved equipment uptime - On average 3 pieces of equipment down per week. Now through the use of TPM, they haven’t had any down time in 8 weeks.

Space Savings
Using 5S, one lab freed up enough space to add three more needed stations without increasing existing floor space.

Processing Improvement
One area doubled their processing volume with marginal increase in staff and has sustained it for the last 6 months.

Rework Elimination
Originally 66% rework - now virtually none.

These results are proof that Lean works in Healthcare and are motivating Lean Advisors Inc. (LEAD)

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I know that many of you want to make things better at your sitemake things safer,
have your chronically ill patients become much healthier, get home on time from the
office consistently, and much more. So, where do you begin?!! I like the answer
given by Stephen Covey in “The 7 Habits of Highly Effective People (if you haven’t
read it yet, I highly recommend it). He says to Begin with the End in Mind. What can
this mean? He states that all things are created twicefirst mentally and then
physically. So, the first step is to have a vision of what you want at your healthcare
site. Do you want to reduce infections 60%-70% if your site is an ICU? Studies at
the Institute for Healthcare Improvement show this is possible. If you are a primary
care physician, do you want to increase the income of your practice 10%-20%, leave
the office on time, and also dramatically improve the health of your patients? A
recent issue of Family Practice Management demonstrates how. If you have primary
contact with patients, do you want to consistently know all the prescriptions that
they take so as to avoid conflict in medication or other undesirable outcomes?
JHACO is requiring hospitals to reconcile medications for all their patients. A May
23, 2006 article in the Wall Street Journal discussed how hospitals are improving in
this area.

The point that I am making is to first have a clear vision of what you want to
achieve. You cannot make any long lasting improvements if you don’t have a clear
and detailed plan. As a builder needs a clear and precise blueprint in order to build
a property, so you too must have a clear vision.

You cannot have an achievable vision, though, without knowing what is possible.
Knowing what is possible will require that you become familiar with some quality
improvement tools. This will take some education on your part or the hiring of
someone with expertise. Don’t fall into the trap of the Management Flavor of the
Month, though; such a pitfall was recently discussed in a column by Carol Hymowitz
in a May 15 article in the Wall Street Journal. She stated that leaders often try
solutions that are popular at the momentLean, Six Sigma, etc. Rather, you should
find the tools from these and other management styles that you and others on the
staff can work with easily or that an expert can easily deploy at your site. The tools
you use should fit your site and the employees there. There are many good tools
available. Be sure to include ones that improve communication among all staff
members and patients. You might want to use a kaizen event, for instance. You
will want to find out how things exist in their present state so you can benchmark
your improvements. This will require some sort of mapping process and basic
statistical measures. Be sure to write a manual of the processes you adopt so that
new staff members have a ready reference on the practices you want to maintain.
These and many other tools can be found on the American for Quality’s web site as
well as the Institute for Healthcare Improvement’s website.

If you hire a consultant to help, be sure that they are have a variety of tools
available. American Society of Quality certified quality engineers possess such
tools. Be sure this consultant is willing to guarantee the results the two of you
agree upon if you follow his/her recommendations.

What then, is your first step in creating dramatic improvements at your healthcare
site? Begin with the End in Mind and become familiar with a variety of comfortable
tools.

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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