Although the Lean quality improvement methodology was initially developed to improve the quality and productivity of automotive factories, it has been used with great success in industries and settings of all types, including software development, government, retail, and other service settings.
Healthcare organizations, in particular, have found that the approach can be used to reduce costs and improve quality of care, patient safety, and satisfaction at the same time.
What is Lean Healthcare?
The core concept of Lean healthcare is to identify every step in a process, such as a patient visit, and determine which actions add value, which steps do not add value (i.e., "waste"), and which measures could be improved. The people who do the work (physicians, nurses, medical assistants, front desk staff, contact center operators) are usually in the best position to improve the process to make it easier to do the work and better for the patient.
The central principles of Lean healthcare are:
Continuous improvement - Lean is an approach built on continuous improvement. Lean healthcare means developing a culture of constant improvement in which leaders are continually raising the bar to drive more value.
Value-creation - The ultimate goal of Lean is to provide more value from the patient's perspective -- focusing not just on what we do, but also on what the patient is trying to achieve in terms of health goals.
Unity of purpose - Lean can unify teams around shared goals and desired outcomes.
Respect for the people who do the work - Healthcare leaders must empower front-line workers to drive positive change, supporting and coaching them, when needed, in a collaborative way.
Visual management - Visual management tools help identify problems, provide easy access to data, and serve as places for communicating concerns and new opportunities.
Root cause problem solving - In the context of Lean, workers must identify root causes of problems and change standards to optimize processes.
Eliminating Waste in Healthcare
One way Lean is transforming healthcare is by eliminating waste in care delivery. Let's take a look at the eight wastes of Lean in healthcare:
The waste of defects includes the time spent creating a defect, reworking these defects, and inspecting these defects.
- Administration of incorrect medications
- Hospital-acquired infections and other harm
- Incorrect ICD codes entered
Waiting in healthcare is a problem for both patients and providers.
- Patients in waiting rooms (or exam rooms)
- Emergency department patients and physicians waiting for test results
- ED patients waiting to be admitted to the hospital
The waste of transportation occurs when materials (or patients) are moved around inefficiently. In healthcare, it occurs when:
- Medication is transferred from the pharmacy to where it is needed
- Supplies are moved from storage to the floor
- Patients are forced to walk from building to building for different aspects of their care
- Some of this transportation is considered "necessary" waste to be minimized, even if it can't be eliminated.
Overproduction is challenging to spot in healthcare, but it occurs when providers do more than is needed by the customer at this moment. It includes:
- Unnecessary diagnostic tests
- Ordering medications that the patient doesn't need
- Uneaten meals
Over-processing means doing more work, making it more complex or more expensive than is necessary. It takes the form of:
- Ordering complex diagnostic imagery (MRI) when a simpler method would suffice (X-ray or physical therapy)
- Surgical intervention instead of an equally effective medical alternative
- Treatment by specialists that primary providers could do
Healthcare organizations seek to minimize inventory to reduce costs related to storage, movement, spoilage, and wastage.
- Medication that may expire
- Overstocked consumables
- Excess bedside equipment
Motion refers to the unnecessary movement of providers and staff within a facility or campus. This happens when:
- Office or hospital layout is not consistent with workflow
- Supplies are not stored where patient care occurs
- Equipment is not conveniently located
8. Human Potential
Some early sources in the Lean literature refer to 7 wastes of Lean. In recent years, though, most publications have started referring to the eighth type of waste—failing to utilize people's talent or human potential. Examples include:
- Not listening to employees
- Pressuring people to hide and cover up problems
- People habitually working below their level of licensure
Examples of Lean Healthcare Implementations
The way in which Lean is implemented varies based on the organization. Our clients offer a varied set of examples:
Healthcare organizations are using lean to effectively harness the collective intellectual capital of all their team members to maximize value for patients and to slow down the unsustainable cost trajectory of healthcare.