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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There’s a lot of excitement today in the health care field about the benefits that Lean practice can bring. This is especially critical in an environment where patient care needs are climbing while the pool of skilled resources and reimbursement for services shrink. Lean Advisors Inc. is working in the healthcare industry to help them implement Lean in order to be able to do more with less while doing it better. The key is to apply Lean methods in an environment driven by the unique values that surround patient care.

As in other industries, the customer should come first. In healthcare that customer is the patient and the patient drives the definition of value. The product (test results in the laboratory) or service (patient care) can make the difference between life and death. That one element takes Lean to another level of importance in this industry.

The needs of the patient are paramount and give new meaning to Lean focus on the customer. The working environment is one driven by shared values and passion in delivering top quality products and services to the patient. Without Lean, healthcare will continue to have difficulty meeting the pressure to serve an increasing number of individuals at less cost.

As the population ages, healthcare must find new ways to meet the demand for their services. Turnaround time becomes a primary measurement that must improve whether it is in the hospital facilities or their testing laboratories. Further, space is at a critical premium in running all the functions within a hospital facility. Only Lean can provide a solution to space issues without either downsizing staff or incurring large scale capital building costs.

Lean Principles

Of course, all of these improvements can’t compromise the quality - in fact, the quality must improve while working to serve patients faster. This is the real challenge - and, as noted, it can be a matter of life and death.

The Lean principles of customer focus, speed of delivery, increased quality, and flexibility in meeting ever-changing demands fits ‘perfectly’. Hospital and technical laboratory professionals are surprised to see similarities with other industries when they sit down and look at the benefits of applying Lean methods in their environment. Once they have the ‘right’ Lean knowledge, and know how to apply the tools properly, they are able to see that Lean implementation is imperative in order to meet the needs of patients in coming years.

Lean Advisors Inc. has recently begun work with the laboratory service division of a world-renowned Clinic. We have seen the power of adapting Lean to the health care environment and its values driven processes. The results in only a couple of months have been phenomenal. They have been able to reduce lead times so Doctors can receive critical test information even more quickly than the organization’s previous world leading delivery pace. These health care professionals accomplished this without adding more staff and without any large capital outlay or increase in space. The impact has been immediate and patients are being serviced faster and better. And there is every indication that the change is sustainable over the long term.

You need passion for improvement to be successful when transforming your organization to a Lean Enterprise. Dedicated healthcare staff has plenty of that passion and this facility was no exception. They are passionate about their work and they, more than anyone, know the importance of speed and quality in meeting patient’s needs. The missing ingredient was learning the ‘right’ way that Lean could be applied to make the transformation in a hospital environment.
Lean Methods

The healthcare workers in this facility are used to change. Their profession is constantly adapting to new technologies, processes, regulations, and tools - they have learned to expect rapid change. These participants were more than willing to listen and learn about something new that could make patient care even better in a world of shrinking resources.

The passion we saw in how they dealt with patients transferred to the application of Lean in the same way they approached every other aspect of their jobs. They used what they learned as they learned it and quickly became totally committed to Lean. Our challenge was, and is, keeping them on Plan and completing their projects in the correct order so as not to create ‘exciting chaos’, all too easy under the pressures of day-to-day emergencies and deadlines. ‘Exciting Chaos’ happens when you apply tools in the wrong sequence and fail to improve the system as a whole. Incremental or ‘point’ improvements are, as we know, a recipe for disaster.

In healthcare, cost containment can be critical, but patient quality, care, and service have to be a priority. The industry faces growing financial constraints. The number of patients is dramatically increasing and the cost of the improved technology is rapidly going up. Administrators of facilities are being asked to accomplish much more with less and less. Lean methods are critical in bringing needed cost savings.

What we often see in health care are the same short-term, knee-jerk responses to reduce costs that we have seen in the traditional industries such as manufacturing. There is an immediate impulse to cut assets and labor resources. While these shortsighted responses may allow them to meet an annual budget, they certainly don’t create better service or long-term solutions.
Lean Results

Lean doesn’t focus on cutting people or assets; it focuses on improving activities and processes in the system as a whole. In order for any business or organization to get better, they must learn how to remove the ‘waste’ in their system and create value without adding staff or resorting to large capital outlays.

When done properly, Lean removes ‘wasteful’ activities and allows the professionals and staff of hospitals, labs, and clinics to focus on more patient value-based activities. The result is doing more with less - more people can be assisted with the same number of people, the same (or less) space, and reduced costs of providing services. Lean methods are indeed the answer to the challenges facing healthcare organizations and their staff.

The Clinic we talked about in this document has proven that it can be done. They are now expanding it to all their labs. They are engaging their physicians, administrators, scientists, lab professionals, and technicians. The people in this Clinic are pioneers and have paved the way for others in healthcare to follow. They have proven that with a passion driven by patient-focused values, the ‘right’ knowledge, and a proper plan, the tremendous challenge facing them can be more than met today and well into the future.

Larry Cot

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The best quality improvement initiatives are driven by data! Why? How are you
going to know how much you have improved if you don’t measure something?

All of you have been exposed to measures in many situations. Most of them were
important. In school, you were graded. Perhaps you own shares of stock; how do
you measure the success of the stockits increase in value, a measurement. How
do you know if your team wins? By its score, a measurement. The fact is that many
daily activities in life have accompanying measures to judge their success.

You might argue that you know if things are getting better; you can just tell. I am
sure that you can. This is not enough, though. In the healthcare field it is
important to measure improvement. One reason to do so is to prove to others that
things are improving. For instance, suppose you are in charge of implementing
electronic health records in a hospital setting. You meet resistance from several
staff members, including a large number of doctors. How can you overcome this
resistance? Collect datalower percentage of wrong prescriptions, for instance
from a pilot program of willing participants and then demonstrate the positive
benefits with your data. With such results in hand, you will overcome many
doubters.

Another reason to measure improvement is to demonstrate the saving of time and
money. With healthcare costing so much today that many find care out of their
price range, it is important to find ways to lower costs. For instance, suppose that
staffing at your facility is very expensive; the payroll costs are way over budget. I
recently read of a lean six sigma project that demonstrated through the use of data
collecting by staff charge nurses that staffing shortages and costs were significantly
reduced. The right staff was present when needed and the facility eliminated the
need for using short-term staffing of nurses through agencies; this saved a great
deal of money. Besides lowering costs, staff morale improved significantly at this
site.

I hope that I have convinced you that to make significant quality improvements, you
should be actively measuring. What should you be measuring? The most common
measurements are costs in providing a service, time taken in providing a service and
various measures of patient health, such as the lung capacity of asthmatics. You
can also measure improved bottom lines. One doctor I know improved his income
38% in 5 years by working hard to adopt quality measures in his solo practice. Many
ER’s now boast of how they have significantly decreased waiting time for patients.
One such local hospital did so well that they were overwhelmed by the increase of
demand for service at their ER. You might want to measure if spending a few more
minutes with patients talking about pursuing good life habits like eating the right
foods leads to improved health, like lower cholesterol.

Once you have decided what to measure, you should first measure the variable
(cost, time, etc.) as it is in the state before you begin an improvement initiative.
This is a baseline against which you can measure your improvement. As you begin
and proceed through a quality improvement effort, keep track of the measures and
see what improvements occur. I suggest that you keep the data in a spreadsheet or
database. For short term record keeping you might want to use charts. You will
want to check to see if your means are significantly improving (you can use
statistical tests if you choosethey are more accurate) and if your variation is
decreasing.

Once you have reached your goals, revisit the new processes once in a while and
collect new data on the variables you chose to measure. Doing so, will help keep
you from backsliding to the old ineffective state. Backsliding is all too easy. It is
hard to break old habits, but keeping data will help you. This is, in fact, what drives
the the success of many programs, such as Weight Watchers.

I hope that I have convinced you that data driven change is the best way to approach
quality improvement. It will concretely demonstrate how you are progressing and
will prove to others that your site is doing much better. It will help you earn your
just rewards!

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 his
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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