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The Lean Healthcare Code

Posted by Greg Jacobson

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Sep 26, 2018 8:02:00 AM

Doctor at the hospital talking to a nurseOne of the exciting things about the Lean management approach is that it is applied differently in every industry and organization. While it got its start in manufacturing, healthcare organizations have significantly benefited by using the same principles and practices with modifications. The exact tools and methods may vary from one organization to another, but there are a few core doctrines that Lean healthcare organizations all have in common. Together, they form a way of thinking that transforms organizations and changes the behavior of employees at every level of the org chart.

1 – Small Improvements are a Big Deal

Lean healthcare organizations believe that improvements are often based on small changes, not only looking for major paradigm shifts or new inventions. There is no “white knight” that is going to come in and save the day. Especially at the start of your Lean journey, positive change is likely to start happening one small step at a time. This concept is essential because often change can be frightening and destabilizing to organizations. By approaching change in small steps, the Lean model reduces reluctance to embrace change and increases speed to improvement.  The organization does not need to wait for a strategic shift to advance. Improvement becomes part of the culture and a way of behaving every day, rather than an event that will happen sometime in the future.

2 – Employees Can Identify Opportunities for Improvement

Healthcare is a heavily regulated and high-risk sector, so the idea of putting a lot of the responsibility for daily improvement in the hands of front-line employees may seem dangerous, but quite the opposite is true. Front-line employees are in the perfect position to recognize inefficiencies, safety hazards, and, barriers to patient satisfaction. It is entirely possible that administrative staff, clinicians, facility managers, and others already know how to solve the organizations most nagging problems. Lean healthcare organizations take the opportunity to ask. Leaders at all levels can initiate improvements and be involved, but the old model of ignoring the concerns and input of front-line employees should be in the rear view mirror.

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3 – Goals Are Clear and Aligned

Unity of purpose is essential in Lean healthcare. Everyone should know exactly what the short and long-term goals of the organization look like and what tactical steps are necessary to get there. In an ideal situation, management works with all levels of the organization to define the goals so that everyone has a sense of ownership and accountability. From the high-level strategic goals, department, team, and individual objectives are established. When an opportunity for improvement is identified, it is prioritized based on its relationship to the targets. This makes decision making easier and ensures that everyone is moving in the same direction.

4 – Respect for People is Paramount

Lean healthcare is about creating the conditions where every person can do their best work. When problems arise, Lean leaders look to flaws in the process, rather than placing blame on people. When employees contribute to positive change, they are recognized and rewarded for their efforts. They are provided with ample training in the techniques of continuous improvement and supplied with the tools and technology necessary to be successful.

5 – Standards are Essential, but Always Changing

In order to measure the results of improvement, a baseline is required. In Lean, the baseline for any process or task is known as the Standard Work. It is the documentation of the current best practice for the operation. Employees are expected to adhere to the Standard, but rather than stifle innovation; this approach invites it by asking everyone to think about how to achieve better results. Rather than changing the process without consideration or letting everyone do their own thing, improvements are only implemented after a careful review, often supported by the PDSA or DMAIC improvement cycle.

6 – Lean is Visual

Lean healthcare leaders know that the quickest way for people to understand the current state of a process or the results of change is through images. Process control charges, huddle boards, Kanban signs, wallboards, and status indicators are all used heavily in Lean organizations. Ideally, these visualizations are primarily managed in a Lean software platform designed to keep everyone informed and motivated with role-relevant dashboards and alerts.

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There’s no one right way to implement Lean in a hospital or other health system, but these guiding principles should be considered. In the best case scenario, they become part of the culture and inform decisions at every level. Lean healthcare is not so much a thing to do, but more a way to be.

Topics: Lean Healthcare

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