How to Incorporate Lean Management in Healthcare

March 11, 2019

Originally applied in car manufacturing within the Toyota company, the lean principle hones in on the efficiency of resource use. At every step of the production process, the Lean Methodology asks ‘what value is being added for the customer?’

The Lean system follows five core principles:

Uncovering value means truly understanding what customers need (which sometimes, even they aren’t aware of) and delivering only on these needs.
Creating value streams. The next principle involves mapping out the processes and activities required to provide the customer with their end-value. Activities that are redundant or otherwise unnecessary are considered ‘waste’ and must be eliminated from the process.
Creating flow. Once ‘waste’ has eliminated from the value stream, creating flow involves following the process in a seamless and efficient manner.
Pull-based production. Within the Lean system, ‘pull-based’ production meets the needs of the end users — and nothing further. It reflects the just-in-time model: creating just enough, when required, and avoiding waste produced through surplus (or things that don’t add further value).
Perfection. Pursuing perfection is the final principle of the Lean process: while objective perfection might be unattainable at the end point of any process, successfully following the Lean system ensures that value has been delivered to the end user with minimal waste.

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Why Lean Management in Healthcare Works

While the car manufacturing industry and hospital operations are radically different sectors, Lean maps very well to both.

In Lean, workers depend on numerous, complex processes to meet their work goals, and to provide value for the customer. The same can be said of hospital operations, but with the patient as the customer.

How does the Lean system apply to healthcare?

In healthcare, Lean management helps create maximum value for patients by reducing waste (which lowers value). Waste in healthcare is usually considered wasted time for the patient, e.g. waiting in line for too long.

Implementing a Lean management system in a healthcare organization helps streamline processes, reduce cost, and improve the quality and timely delivery of products and services.

Here’s how to incorporate lean management in healthcare.

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How to Incorporate Lean in Healthcare

Step 1: Define Value

From emotional energy to materials, what defines value for patients?

Most management professionals applying the Lean system in their organization argue that a positive visit to the hospital, during which all needs are addressed, is the end value goal.

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Step 2: See What Achieves Value via Value Streams

This next step is crucial for incorporating lean management in healthcare.

A value stream map is a system of identifying every step in the healthcare process from start to finish, assessing the ‘value’ of each task along the way, and eliminating ‘waste’.

You can visualize this using a flowchart or similar illustration. The idea is to identify specific — i.e., at the granular-level — tasks and activities that provide value to the patient (e.g., administering medicine) as well as highlighting what doesn’t (e.g., delays due to EHR systems not loading).

The goal is to build a process that only involves the value and, be it through omission or fixes, removes the activities that don’t add value and result in waste.

Step 3: Set and Follow a Flow

Flow in healthcare examines and optimizes the entire patient journey from admission to discharge, creating a better overall ‘flow.’

This assessment stage optimizes each step of a patient’s journey through eliminating ‘waste.’

For this stage, interdisciplinary thinking is crucial.

Optimizing the flow of one department should not impact another.

The emergency unit is a common focus of flow optimization, as it tends to encounter a high amount of waste, including changing patient demands and access block (delays in patient transfer from emergency to inpatient areas.)

To set and optimize an ideal ‘flow,’ ask these questions:

At what points does the patient wait unnecessarily, e.g. from triage to blood results to inpatient admission?
How is the average total processing time?
Where do shortages appear and using what measures can they be reduced?
How can the process ‘flow’ more seamlessly?

Step 4: Keep Flow Aligned with Pull

In healthcare Lean management, pull is understood as the needs and healthcare journey of the patient from start to finish — from first stepping foot into the hospital to patient discharge.

In addition to following all steps, the flow implementers should always keep the pull (final ‘product’, or satisfied patient) in mind.

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Step 5: Approach ‘Perfection’

Though difficult or even impossible to attain perfection in healthcare, ‘perfection’ as a goal involves aiming for the best flow possible.

In Lean healthcare management, the ‘best’ flow — that is, a flow that is close to ‘perfection’ — could be understood through three key milestones.

First, was the final ‘product’ the most optimal it could be, and if not, was it improved upon based on the previous implementation? For example, does it take less time to process patients compared to the previous quarter?
Second, was the least possible ‘waste’ made? This can be assessed in examining the optimization of staff time, use of physical resources like tools and other materials, correcting mistakes (e.g., improperly prescribed medicine due to illegible handwriting), or overproduction of items like charts?
Third, did the flow system ensure the best patient outcomes: measurably lower costs, and a shorter hospital stay?

Though implementing a new system might appear to be a daunting task, many hospitals are finding that learning how to incorporate Lean management in healthcare is improving outcomes for staff and patients alike.

Conclusion

While implementing a full Lean methodology in your healthcare facility may seem like a daunting task — you don’t have to run out and hire a Lean Change Management Consultant just yet. Simply understanding some of these concepts can be enough to jumpstart your process improvement journey.

And it’s always important to remember the basics — like your staffing benchmarks and physician productivity.