The Need for Lean in Health Care
Advice from Scott Regan, Executive Vice President
Health care is facing the perfect storm: Declining reimbursement, staffing shortages, spiraling wages, rising malpractice costs, pay-for-performance initiatives, clinical outcomes and patient satisfaction report cards, and the demand for increased transparency are swirling about the hospital board room like a category five hurricane. At no time in the history of U.S. health care has there been such a demand to improve clinical outcomes, enhance service quality, and reduce costs – simultaneously.
It is no wonder so many hospital executives have launched into – or are exploring – the more robust performance improvement methodologies of Lean and Six Sigma. The traditional hospital performance improvement tool – PDSA (Plan-Do-Study-Act) – just doesn’t have the firepower to achieve breakthrough levels of performance, such as a 20% reduction in cost per discharge or average length of stay, or the elimination of E.D. diversions and patients leaving the E.D. prior to being seen by a physician, or the addition of millions of dollars to the bottom line through revenue cycle improvements.
More and more, hospitals are invoking the mantra of “Lead with Lean,” meaning they are first deploying traditional Lean tools to reduce (dare we say eliminate?) the waste inherent in all health care processes before using Six Sigma methodologies to drive out variation. The reason for this is pretty straightforward; many health care processes are so broken that it is impossible to find the root cause of the problem, which is the focus of Six Sigma. Therefore, in order to bring some level of consistency and predictability to the process, hospitals are focusing on removing the non-value added tasks and activities through traditional Lean tools:
- Value stream management
- 6S events
- Rapid improvement events
- Standard work processes
- Mistake proofing
- Visual workplace design
- Changeover optimization (particularly in the O.R.)
Lean is well-suited for many areas of a hospital, and is particularly useful in redesigning emergency departments, operating rooms, pharmacy departments, and pathology departments. Lean can also bring about dramatic improvements in areas where there is a large volume of work that is batched as it journeys through the process, such as billing and registration.
The two critical elements of Lean are 1) to identify the requirements of the customer that are critical to quality (and deliver on those requirements in the newly redesigned process), and 2) to understand demand (in order to be both effective and efficient). Both of these are necessary ingredients for a redesigned Lean process. For instance, although an E.D. clerk registers patients one at a time, the patients only want to provide the information that is necessary to be seen by a physician and want to be seen as quickly as possible. However, some hospital registration systems require as many as 14 screens of information, with the vast majority of data fields unnecessary for medical treatment or altogether unused (the hospital started collecting a piece of data years ago, but nobody today knows what the data is used for).
Unless the hospital designs an E.D. registration process that is attuned to patient demand, it will have periods when the clerk is sitting idle and other times when patients are backed up out the door – the former not meeting the critical-to-quality cost-efficiency need of the executive team and the latter not meeting the critical-to-quality “I want to see a doctor right now” need of the patient.
If any of this sounds painfully too familiar, then perhaps your hospital, like so many others, ought to “Lead with Lean.
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