The Journey to a Lean Culture in Healthcare

Improving the quality of care and taking a patient-centered approach remain top priorities in healthcare today, along with mitigating the industry’s skyrocketing costs. The United States spent $3.8 trillion on healthcare in 2018—and that number is expected to reach nearly $6 trillion in 2027, according to projections from the Centers for Medicare and Medicaid Services (CMS).

The value-based care environment is demanding cultural change, but how to best juggle the competing priorities of quality, cost and outcomes? Many organizations consider – and some have already implemented — the quality improvement principles of Lean to help them make these essential transitions. Lean techniques are aimed at designing more efficient patient care pathways that prevent errors, decrease delays, eliminate waste and make core improvements in the system. Lean workflows can help a facility turn a pie-in-the-sky desire for efficiency into a real-world achievement of the Triple Aim: enhancing the patient experience, improving population health and reducing the cost of care.

The Origin of Lean
The set of principles commonly referred to as Lean was developed in the mid-20th century by Japanese industrial engineer Taiichi Ohno of Toyota Motor Company. Ohno was tasked with improving assembly-line manufacturing to help the company better compete with American auto manufacturers. After touring his competitors’ factories and studying other manufacturers’ techniques, Ohno recognized that the best way to manage cost was to eliminate waste whenever possible. He identified the following seven wastes:

      • Excessive delays or wait time with no value added
      • Overproduction, or producing more than you need
      • Overprocessing, or undertaking non-value-added activities
      • Unnecessary transportation
      • Unnecessary movements or motion
      • Wasteful inventory
      • Poor quality and defective products

Since then, his revolutionary Lean manufacturing principles have been applied to other industries—particularly healthcare—to winnow out waste, achieve quality and efficiency, and develop a culture dedicated to continuous improvement.

3 Ways to Start Getting ‘Lean’
Lean quality improvement principles invite a healthcare organization to identify which processes add value to the patient and which processes are time-consuming and wasteful. By simply naming repetitive and redundant tasks, staff can begin to eliminate them and usher in better workflows that will save time and money. Here are three ways to start:

  1. Look at each of your processes through the lens of the seven wastes. In the category of inventory, do you regularly have to throw away supplies and medications because they’re out of date? Do you have capital tied up in equipment that quickly becomes obsolete? In the category of overprocessing, do patients find themselves filling out different forms with the same information? Are staff members required to enter data in more than one electronic system? Encourage your staff to recognize such examples of excessive waste and brainstorm unique ways to decrease it. Reward them when they make creative proposals toward improvement, no matter how incremental the change.
  2. Don’t reinvent the wheel; learn from the experts. The Virginia Mason Institute in Seattle, Wash. used the Toyota Production System to develop its own management method that identifies and eliminates inefficiency in healthcare processes. “By streamlining repetitive and low-touch aspects of care delivery, staff members are freed to spend more time talking with, listening to and treating patients,” according to the institute.

    Senior managers don’t stay in their siloed offices; they regularly visit frontline staff to observe how they deliver care to patients. The system also invests in workflow collaboration activities such as five-day Rapid Process Improvement Workshops (RPIWs).
  3. Call for all-hands-on-deck. Transforming into a Lean culture demands that every person in the organization—not just the C-suite—is involved in improving workflows. “[Lean] requires new habits, new skills, and often a new attitude throughout the organization from senior management to front-line service providers,” write John S. Toussaint, M.D., and Leonard L. Berry, Ph.D., in this article for the Mayo Clinic. “Lean is a journey, not a destination. Unlike specific programs, Lean has no finish line.”

To learn more, listen to the recording of HealthTechS3’s recent webinar, Creating a Lean Culture in Healthcare.