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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One of the most common tools used to measure quality improvement wherever
services are offered is the survey. It has many good applications if it is well designed
and can provide a lot of information if it is properly analyzed.

When and why should you use surveys? Of course one of the most frequent uses is
with patients and clients. In fact, Medicare is beginning the H-CAHPS survey of
hospitals to find patients’ views on many different facets of their service. The survey
is voluntary and results will be posted online in 2007. It is becoming a necessity for
physicians and healthcare professionals to find out what their patients think as
more and more information about care from insurance providers and other sources
is being posted online.

The employees of any healthcare facility should be surveyed too. They should, after
all, be considered clients. Since they provide many different services and are the
front line connection to patients, their input about their work environment and
satisfaction with it are to be taken seriously. You should not just be surveying
doctors and nurses, but also maintenance, administrative, and all other groups at
your site.

What are some of the basic ideas you should keep in mind when designing a survey?

1. The best questions are the anchored endpoint type. One end would be “very
satisfied” and the other “very dissatisfied” or something similar, with a 7 or 10 point
scale from one end to the other. The five point scale is too short. It doesn’t provide
enough variance.

2. You may ask a few yes and no or gather demographic data, as age.

3. Limit yourself to one open-ended question. They are too hard to provide
statistically significant data.

4. When writing the questions, work with a team of representatives of the people
who will be surveyed. This helps avoid bias and makes sure you have good
questions.

5. Be sure to choose a random sample to survey. It is better to survey 30 or 40
randomly chosen patients or clients whom you interview or have fill out a survey
while in the office rather than getting more surveys by subjects who return mailed
surveys or volunteer in some other fashion. Voluntary surveys are basically
worthless from a statistical point of view.

Once you have collected your surveys, it is time for analysis. For simple analysis, I
suggest using Microsoft’s Excel. It has some dynamite graphics. Too, you need to
get the mean and standard deviation of each question where appropriate.
Remember, you want your mean to be as good as possible with low standard
deviation. If you want some more insight and powers of prediction of what action
you should take based upon the survey, I suggest you employ someone who is
trained in statistical analysis or a statistician. The return on the investment of a
professional analyst should easily exceed the expense.

Summarily, surveys are a valuable instrument in finding out the opinions of your
patients and employees. Care should be taken in designing the instrument to insure
there is no bias and that there is randomness in conducting the survey. Investment
in professional analysis is well worth it. The result will be healthier patients who are
more loyal, a definite financial plus.

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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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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