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Return to Newsletters Table of Contents
Lean For Healthcare
Quality While Six Sigma and process improvement will help you reduce defects, mistakes, and errors, you will also want to find ways to accelerate your speed, because it’s not the big that eat the small; it’s the fast that eat the slow. The methods and tools of “lean manufacturing” can be tailored to healthcare in ways that will help you cut the time to do almost anything by 50-90 percent. To embrace lean thinking, you may need to unlearn some things that you already know. The Economies of Speed I don't know about you, but I grew up on the wisdom of Henry Ford: mass production and the economies of scale. But while I was learning about Ford in the 50's, Toyota was mastering the art of lean production and the economies of speed. Today’s customers demand speed and customized solutions. When you shorten lead times and focus on a total speed imperative, you actually get higher quality, faster response times, better productivity and better use of equipment and space. Blood Draw Example One hospital I work with is using lean thinking to speed up blood analysis and smooth the flow through their lab. Before lean, technicians would go around the floor drawing blood from each patient. Once they finished their rounds, the batch would be sent down to the lab, which would start processing the batch, although not necessarily in order. After a simple lean change, each blood sample would be sent immediately to the lab. This reduced the time the blood sat in the technician’s tray, leveled out the workload in the lab, and reduced the cycle time to get an analysis. This, of course, leads to faster diagnosis, treatment, recovery, and discharge of the patient. Here are some typical results from implementing
lean thinking: Speed is not Haste You don't have to work harder or faster to gain more speed. Speed involves removing every speed bump, barrier, and obstacle from your path. It also involves shedding excess inventories along the way. The Seven Major Speed Bumps In Healthcare
The healthcare value stream includes every activity required to deliver a product or service. Sadly, only about 5 percent of any non-lean process adds value; 95 percent is non-value added effort and delay—what Toyota calls muda (waste). This leads us to the 5% Rule: The actual time required to produce a product or deliver a service is only five percent of the total elapsed time. Most people find this hard to believe, but when you take the perspective of the product or service and notice how long you sit around waiting for something to happen, how many things go wrong and have to be reworked, you get some idea of the waste in the process. Don’t believe me? Just follow a patient through a hospital visit. Most of the time they just lay around waiting for the next test or procedure. All of this delay and rework can be eliminated using Lean and Six Sigma. The goal is to line up all of the essential steps into a continuous flow with no wasted motions, interruptions, batches or queues. When you do, the amount of people, time, technology, space, and inventories required can be cut in half. Double Your Speed and Slash Your Costs Every 25 percent reduction in elapsed time will double productivity and reduce costs by 20 percent. All it takes is a slight shift in thinking. While Six Sigma and process improvement focus on the actual steps that cause defects, mistakes, and errors, lean focuses on the delay between steps. Hot Tip: Focus on the delays between steps in your process
You Already Understand Lean Thinking Kitchens have long been designed as "cells" for food preparation. The refrigerator, sink and stove should form a "V". Food comes out of the refrigerator, gets washed in the sink, cut up on the counter, cooked on the stove, and delivered to the table. Unlike big companies where different silos would be put in charge of frozen and refrigerated food, washing, cutting and cooking, there's usually only one cook that handles each of these steps. Each meal is a small "lot". You never cook in batches big enough for the entire week. Limited inventories of raw materials are replenished by a trip to the supermarket. Applying Lean Thinking To Healthcare You’ve already seen one example of using lean on blood work. There’s a lot more outpatient surgery than there used to be—another example of lean thinking. Aren’t hospitals already segregated into maternity wards, surgical wards, and so on? Another example of lean thinking. I’m just asking you to take it to the next level. Could emergency rooms be designed in “cells” to deal with different classes of problems, from broken bones to cardiac care? Sure. Instead of signing in when you arrive at the emergency room and waiting for someone to take your information, could you swipe a credit card or magnetic insurance card through a reader that would pull up all of your information like the express check-in counters at airports? Sure. Are there endless ways to accelerate the speed with which a patient flows through your facility? Will this save you time, reduce errors, decrease costs and increase profits? It must. How to Redesign Your Facility for One-Piece Flow While healthcare already focuses on each patient individually (i.e., one-piece), the trick is to eliminate all of the delay between value-adding steps and line up all of the machines and processes so that the patient flows through the value channel without interruption. The Redesign Process 1. The first step is to focus on the part, product or service
itself (e.g., patients, claims, etc.). Follow the patient or work product
through its entire production cycle. In a hospital you would follow a
patient through from admission to discharge. In a lab, you'd follow a
job from start to delivery. In finance, you'd follow an insurance claim
from admission to payment. This often means using simpler, slower, and less automated machines that may actually be more accurate and reliable. The goal of flow is to eliminate all of the delays, interruptions and stoppages, and not to rest until you succeed. The Five S’s To remove the waste, you can turn to the five S's. The principles of reorganizing work so that it's simpler, more straightforward, and visually manageable are:
Common Measures Of Speed and Flow: To analyze your workflow, you’ll need some measures of speed. Some common ones include: • Lead (or cycle) time: time the patient stays in
the system If you will accept the premise that every work process is 5% work and 95% wait, you’ll be well on your way to finding new and improved ways to accelerate the speed and quality of healthcare. Then, when you turn your attention to the time and space between actions, you’ll discover a world of opportunity that has lain waiting for you to explore. Your patients are no longer patient; think of them as impatients. Get faster, faster. Your patients will love you for it and your bottom line will reflect their love. About the Author: Jay Arthur and qimacros.com
Jay Arthur, The KnowWare® Man, works with companies that want to plug the leaks in their cash flow. He is the author of the QI Macros SPC software for Excel that will do all of the charts for JCAHO and process improvement. You can download a 30 day evaluation copy at www.qimacros.com/freestuff.html. Jay can be reached at: knowwareman@mindspring.com,
www.qimacros.com,
It is important that all members of MHQP know you are invited to attend Board Meetings. If you have questions, feel free to contact the Board Members.
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