Lean Thinking in Healthcare
Effective use of associates, resources, and technology to meet the highest level of service required by the healthcare customer: the patient.
Currently, extreme competitive healthcare environment has compelled healthcare administrators to do more with less - less associate requirements, less technology, less time, and less workspace and while in the meantime, the high level of service to patients, doctors, nurses, and coordinators cannot be compromised or sacrificed.
How is this possible? The answer - Lean Thinking! Lean Thinking focuses on the identification and elimination of waste of any activity performed within a healthcare facility. It zooms in on how effectively resources are utilised, and how each process step is determined. The thinking can be used to enhance service to any department within a facility and removing of processes that provide no value to the customer: the patient.
Lean Thinking involves 5 steps to improve a selected process: value, the value stream, flow, pull, and perfection.
Every process step should produce value for the customer. If a process does not add value it must be reviewed or removed.
Patients get stuck in processes that do not add value to their care. They wait 30 to 60 minutes to see their doctors. Those processes were designed to add value to the healthcare professional, not the customer.
The Value Stream
Value stream represents all the process steps required to complete a service. Understanding the value stream enables one to observe wastes and non-value add process steps.
Example - doctoral examination of patient process step is a value add process step for the patient. The process steps of waiting 30 to 60 minutes to see the doctor is non value add process step and should be removed.
Silo processes that use batches and queues produce multiple wait times, excessive movement and frequent interruptions.
The Malaysian healthcare system is built in batch and queue systems. A patient who is unwell calls his doctor and makes an appointment. At the appointed date and time, he arrives at the doctor’s office and waits to be seen. Upon examination, the doctor may recommend the patient see a specialist, have lab tests performed, and start taking a prescribed medication.
The final objective of flow is to ensure that a process step is continuously worked until it is complete. This means that the patient receives the care required without waiting excessively long, bear with interruptions, suffer unnecessary pain, and being ‘transferred’ around.
Performing work as it is requested or needed by a step in a value stream
Example, during the transfer of a patient from a surgical suite to a high dependency unit (HDU), the room, bed and the physiotherapist are not ready for the patient, there could be issues.
Pull thus ensure that the room, bed and therapist, are prepared and ready to provide care.
Strive for perfection! No matter how many times a process step is improved, it can be further leveled up. The challenge of continual improvement!
Waste in Healthcare?
Healthcare has its own specific types of waste, which include information, process, and physical environment.
Healthcare is full of information waste. Example as follows:
- Redundant information input and output
- Gathering irrelevant data
- Incompatible IT programs - unable to communicate, lead to medical errors and consumption of valuable computing and staff resources
- Re-entering data
- Converting formats
- Errors in data
- Medical errors resulting in deaths
- Redo or correction work
- Work around or expediting excessively
- Excessive Approvals
- Excessive Waiting.
Physical Environment Waste
- Safety - doctors do not wash their hands or members of the operating team did not follow sterilization procedures
- Movement – excessive and unnecessary
- Unclear roles, responsibilities, authority, and accountability
- Lack of training
In summary, Lean Thinking is a philosophy and methodology to create change for the better. Healthcare administrators can fall into the complacency trap and chose to believe that their way of managing things are the industry leading best practices.
Lean thinking challenges this belief by asking associates, departments, and administrators to re-evaluate the value being produced for the customer and then get involved in continual improvement practice.
Without the involvement and acceptance of healthcare professionals and associates, any lean thinking initiatives will fail to launch. All, Everyone, Everybody within the organization must be involved and be committed to the due process to ensure effectiveness and success of the Lean initiative.