Lean is not a manufacturing tactic or a cost-reduction program, but a strategy that has capability to improve processes and all industries including healthcare are composed of series of processes. This article by world renowned Global Healthcare expert, talks on lean management & lean culture implementation in healthcare, strategies to develop such culture and some best practices observed.
Lean Management in Healthcare | Published in Modern Medicare
The concept that originated in Japan, started as Toyota Production System (TPS) by Toyota, designed for continuous process improvement in automobile industry, has today become an effective business strategy across several industry segments throughout the world. Lean Management as we to refer to this concept now, for long was believed to be effective only in manufacturing industries. However, today the concept has been successfully implemented in non-manufacturing sectors as well, including the healthcare sector. This is because lean is not a manufacturing tactic or a cost-reduction program, but a strategy that has capability to improve processes and all industries including healthcare are composed of series of processes. This article talks on lean management & lean culture implementation in healthcare, strategies to develop such culture and some best practices observed.
Identifying value-added and non-value-added steps in every process is the beginning of lean operations, whether in a manufacturing sector or the healthcare sector. To put it in simple words, Lean management begins with removing waste. When the concept is applied rigorously and throughout the entire organization, lean principles can have a positive impact on productivity, cost, quality, and timely delivery of services in healthcare. For the hospital industry lean means simply ‘no waste, no waiting time, and no harm’.
Implementing Lean in healthcare
In hospitals, different processes are carried out on regular basis like operations, surgeries, medical tests, patient admissions, emergency care, routine checkups etc. While carrying out these processes, there are different types of wastes & errors that commonly occur.
Inventory, for example is a major contributing factor in hospital costs. Sometimes, more items are procured then required. This is considered as dead inventory. Lean management focuses on procuring lesser inventories but with frequent shipments. This saves money and place for more productive use.
Waste that occurs during transportation is another key factor that lean management can address effectively. For example, if medical facilities are not efficiently designed or do not have some necessary medical equipment, patients, doctors, nurses and other stakeholders waste their time in travelling to another facility. This is not only a considerable waste of time but also there are high chances of medical errors happening while transportation. Lean management focuses on reducing transport related errors by identifying the process that elevates such error and then it either eliminates such processes or suggests an alteration to these processes that would give desired results with utmost accuracy.
Defects in healthcare are intolerable, because they can cause irreversible damage to human health. Major mishaps can occur if operations or surgeries go wrong, improper test reports are generated etc. In lean management, concept of Mistake Proofing is used to avoid such defects. Mistake Proofing is a powerful set of techniques that either avoid errors and defects from occurring or indicate immediately when they occur so that one can take corrective action before a patient is harmed. It relies on creativity and common sense to create low-cost, effective design changes that reduce errors.
When it comes to patients, waiting time waste is main factor in customer dissatisfaction. Customer waiting time can be for operation, emergency treatment, getting test results, routine checkup etc. Lean management offers effective solutions in reducing the waiting time of the patient.
The biggest challenge in adopting lean in healthcare is identifying non-value added processes in which people invest their time and energy. The process can be as simple as providing medical supplies. For example, we often see paramedical staff or nurses in the hospital searching and running for medical supplies while on duty. They may not see this as a waste of time, and may not even think why those supplies are not there where they need them to be. But if the supplies were always readily available, the time nurses spend hunting for them would instead be devoted to something more appropriate to their skills and expertise. Lean principles encourage people in investing time & energy in value-added services.
Numerous other solutions are offered by Lean to the healthcare industry and it requires a thorough commitment by the people of the organization to successfully implement lean in their processes. For this, what is required is lean culture. Thus, lean culture plays an equally important role in implementing lean principles in any industry.
Culture receptive to lean principles
In order for lean principles to take root, leaders must first work to create an organizational culture that is receptive to lean thinking. To begin with, let us first understand what exactly is culture? In simple words, it is the pattern or a characteristic that is seen and followed in one particular area; say a country, region, association or a group. In an organization, culture is a set of rules and standards shared by members of an organization. It is a process developed by the organization and established by the management team, as a response to the working environment. If the environment changes, obviously, the culture would have to change with it. One needs to adopt and adapt innovation in business. Lean culture is this culture of continuous improvement and a culture that embraces change.
Adopt and adapt lean culture
For establishing a lean culture in the organization, the employees need to undergo a specific training focusing on lean activities. It would take time for the system to be set and sink in. One might need to actually redesign some processes.
Organization needs to invest in training and instill open communication with the employees to adopt lean culture. It will need to remove any roadblocks that people may encounter while practicing such culture. The primary reason most organizations fail in their lean implementation is because they fail to successfully change the previous culture. As the training programs end, with that ends the lean culture implementation. For success, one has to make sure that lean activities are part of an overall business philosophy and not a just a flavor of particular month till the training lasts.
Further, one must identify a perfect process. A perfect process is the one where every step is valuable; capable to produce the desired output & desired quality; adequate; flexible; and linked by continuous flow. To create the perfect process, one needs to first identify key processes that would deliver the desired results, then identify people capable of making the process work effectively and finally train them to adopt lean principles for getting the desired output.
Employee engagement is necessary at all the levels to achieve business objectives. For successful business, it is important to develop a clear vision for success as well as share its strategic objectives with the employees. Lean culture requires a strong commitment and investment from company management to make sure employees feel their input is valued & encouraged.
What is equally important is execution and getting down to the level of understanding difficulties faced while executing a certain idea. Corporate management sometimes is really fascinated by certain things irrespective of their significance and expects the same from its employees. For example, some managers are always infatuated by external appearance of glossy flyers or eye-catching websites with graphs & videos, without having a clue what the whole thing is all about, or the willingness to spend the time and efforts to find it out. In a recent seminar illustrating various functional aspects of business, at the end of it someone asked, “Now how do I get the workers to implement this?” It was clearly understood that the whole point of the seminar was lost. Thus, ultimately, what matters is does one have workforce which can deliver desired results.
A critical step in developing lean culture is timely assessment of the performance. This provides a snapshot of where the organization stands right from day one in terms of profit & loss, quality, cost effectiveness, safety, delivery etc. These metrics should be shared with the employees to encourage participation and suggestions for improvements. This also makes employees feel that their opinion is valued.
Lastly, sustaining lean practices requires continual effort and commitment. It requires adherence from the employees and the management. Training should be repeated at regular intervals for new people and to refresh long-term employees to help them think about eliminating non-value-added activities – the waste that is hardest to see & address.
Successful lean healthcare implementation results in improved quality of services; less harm, better access & shorter waiting times for patients; and better healthcare delivery. This is associated with improved work life for medical & paramedical staff, improved processes to prevent errors, reducing stress levels, and reducing waste so that hospital personnel can focus more on patient care. The hospital or healthcare organization benefits in a long-term due to reduced costs and an improved reputation, which is an outcome of better quality & service.
For lean implementation, adopting lean culture is equally important. For employees to accept lean, the management must make them understand the purpose behind every task. Employee participation must be there at every level and there should not be communication gap between the staff & the management. It is advisable to conduct workshops that help differentiate value-added services from non-value added ones. These workshops should specifically focus on eliminating waste from the system and utilizing resources, time and energy to optimum. Also, the leaders must evaluate the organizational structure and work towards eliminating hierarchical layers if possible.
Note: The article was also published in Modern Medicare, written by Dr Prem.