Going Lean in Health Care

Posted on August 17, 2005  Comments (6)

Going Lean in Health Care a report from the Institute for Healthcare improvement based on presentation by James Womack and others. This report is an another excellent resource from IHI, which I have mentioned before is doing great things. This is defineately worth reading.

Lean principles hold the promise of reducing or eliminating wasted time, money, and energy in health care, creating a system that is efficient, effective, and truly responsive to the needs of patients the “customers” at the heart of it all.

The concept called lean management” or “lean thinking” is most commonly associated with Japanese manufacturing, particularly the Toyota Production System (TPS). Much of the TPS way of thinking is based on the work of quality guru W. Edwards Deming, who taught, among other things, that managers should stop depending on mass inspection to achieve quality and, instead, focus on improving the production process and building quality into the product in the first place.

Virginia Mason Medical Center in Seattle, Washington, has been using lean management principles since 2002. By working to eliminate waste, Virginia Mason created more capacity in existing programs and practices so that planned expansions were scrapped, saving significant capital expenses: $1 million for an additional hyperbaric chamber that was no longer needed; $1 to $3 million for endoscopy suites that no longer needed to be relocated; $6 million for new surgery suites that were no longer necessary.

These types of improvements are needed system wide. As we posted earlier Health Care costs reached a record high percentage of GDP last year (15.3%). This problem continues to grow more than two decades after Deming included the high cost of health care as one of the seven deadly diseases.

Despite a ‘“no-layoff policy,’” a key tenet of lean management, staffing trends at Virginia Mason show a decrease in 2003 and 2004, after six years of annual increases in the number of full-time equivalents (FTEs). Using lean principles, staff, providers and patients have continuously improved or redesigned processes to eliminate waste, requiring fewer staff members and less rework, and resulting in better quality. Consequently, as employees retire or leave for other reasons, improved productivity allows for them not to be replaced.

Some try to implement lean ideas without properly setting the stage by instituting policy’s such as Virginia Mason’s no layoff policy. Lean ideas will not work, as they should, without changes to the way the organization makes decisions. Failing to understand this factor is one reason some organizations are frustrated with the results they experience when trying to apply lean thinking.

6 Responses to “Going Lean in Health Care”

  1. CuriousCat: Univ Michigan Hospital Adopts Toyota Methods
    July 23rd, 2006 @ 1:27 am

    Then read the the many available resources to learn about one-piece flow, poka-yoke, eliminating waste, identifying errors, kaizen… rather than relying on this article.

  2. Curious Cat Management Improvement Blog » Management Improvement History and Health Care
    September 18th, 2006 @ 9:16 am

    […] Squeezing the fat from health care by Hanah Cho is another article on lean healthcare. This one provides a better view of the overall picture – especially compared to all those claiming to be one of the first lean thinking effort in healthcare. A good sign was that the author referenced, Going Lean in Health Care, a great report by IHI (James Womack and others). […]

  3. CuriousCat: Lean Dentist Podcast
    August 8th, 2007 @ 11:30 pm

    The podcast offers a wonderful example of how to apply lean ideas (I really appreciate how obvious the focus on learning and thinking has been key to becoming a lean organization). Dr. Bahri does a great job of explaining how he learned and applied lean thinking with a big focus on one patient flow…

  4. CuriousCat: Lean Health Care: ThedaCare
    October 28th, 2007 @ 7:40 pm

    “Each week, ThedaCare has several rapid improvement events or RIEs. During that process, people from both in and out of the area affected look at an issue – for example the daily step pattern of medical surgical technician – and find ways to cut out the waste…”

  5. CuriousCat: ThedaCare: Lean Healthcare
    February 24th, 2008 @ 9:20 am

    “In 2005, ThedaCare was able to save $10 million thanks to its lean programs and officials hope to save another $12 million this year, Toussaint said…”

  6. kokoras
    March 14th, 2008 @ 5:27 am

    The February 7, 2007 edition of the Wall Street Journal described a local hospital’s efforts in regards to patient satisfaction. Briefly, the article stated that in 2004 the hospital had done a patient survey and had found that patients thought the staff offered poor service and that patients thought they were ill-informed about decisions and home care. The hospital’s response to this survey created some very positive results. The hospital formed a family and patient advisory council. Based upon the advice of the council several important changes were made. Visiting hours were eliminated. Staff worked with patients and staff to decide who would make medical decisions. Waiting times were shortened. Staff called home after patient discharge to make sure that instructions were clear and being followed. These improvements along with others led from a patient ranking in the lower third nationally to the 64th percentile. More improvements are surely coming and along with those a higher ranking.


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