Helping the Healthcare System get Lean

A major challenge in healthcare today is threading the needle between reducing staff exertion, technology, time, and workspace while providing a high level of service for both patients and healthcare workers. Those in management can look to lean six sigma, a system and way of thinking that focuses on continuous process improvement to tackle increasing demands.

What is Lean Six Sigma?

The lean methodology was developed with the ultimate goal of reducing costs and increasing efficiency by identifying and eliminating activities in a given process (service or manufacturing) that fail to add value and yet consume resources. In the lean terminology, value is defined as ‘what the customer is willing to pay’. As a result, lean is heavily oriented not only to efficiency and cost reduction but also to creating value to ensure customer satisfaction.

On the other hand, Six Sigma is a system developed with the goal of controlling variation and making processes more consistent and reliable to ensure the quality of deliverables. The combination of Lean with Six Sigma results in a faster creation of value at the lowest possible cost.

Lean within Healthcare

Innovation at every level of healthcare occurs when each member of the organization buys in to “lean thinking” such that it becomes embedded within the culture. Organizational behaviour undergoes a transformation as fundamental changes to thinking and values occur along the journey toward value-based healthcare.

A lean approach for healthcare improvement values all members of the patient care team, where each patient interaction or care episode is an opportunity to reduce waste and cultivate value. Patient satisfaction improves as decisions and processes become increasingly focused on the patient.

The five lean principles are related to: value, value stream, flow, pull, and pursuing perfection. Any step that does not produce value for the customer is considered waste and must either be altered to provide value or be eliminated. The value stream can be thought of the steps that the ‘product’ flows through to complete a process or service, which either create or fail to create value. Some steps that fail to create value are unavoidable, but those that are avoidable need to be removed, such as waiting 30 minutes to see the physician. The goal of flow in lean is to eliminate batching and queuing upon which healthcare systems often depend, where each step requires waiting for delivery of a service or product, introducing multiple wait times and interruptions. Perfection refers to the concept that there is no finite endpoint to process improvement, but rather continuous improvement can occur through incremental changes that are based on outcomes.

There are plenty of key healthcare outcomes that can experience improvements through the implementation of lean principles:

Health system improvement outcomes:

• Time required (e.g., admission, turnaround, triage, etc.)
• number of patient visits;
• length of stay;
• discharge rate;
• wait time

Patient outcomes:

• patient satisfaction;
• re-admission rate;
• mortality rate

Professional outcomes:

• time spent with the patient;
• employee satisfaction;
• staff overtime

Waste in Healthcare

Understanding how the 8 sources of waste relate to healthcare—transportation, inventory, waste in motion, waiting, defect, over-processing, overproduction, and underutilizing employee skills—is crucial for determining methods for their elimination.

For example, waste in motion occurs when movement of healthcare workers fails to add value for patients, which could include inconvenient locations of frequently-used supplies and equipment, inefficient routes due to poor layout design, or non-ergonomic patient transfers. Lean provides tools such as process flow analysis, value stream mapping, or spaghetti diagrams, which are all able to identify waste in motion as well as potential solutions to improve efficiency.

Waiting delays are also a common form of waste in healthcare. There is always room to improve waiting area delays, appointment waiting lists, or idle equipment through creative or innovative means. As an example, one hospital was able to save millions of dollars each year by applying lean tools to surgical tray configurations. Rather than having surgeons responsible for specifying their own tray setups, the hospital had the surgeons collaborate, which led them to reduce setup configurations from 12 to 2. This standardization in turn not only reduced setup times but also allowed the supplies to be compressed and be bought in higher volumes, which reduced costs.

Companies that have not yet adopted lean have the tendency to underutilize employee skills, which is made worse when their time is spent on wasteful activities. Lean seeks to enable employees to fulfill their creative potential in ways that promote patient care and optimize operations. In addition to positive impacts on employee morale, quality of care can improve at the same time that costs are decreased.

Lean Six Sigma Training & Implementation

At AMSaxum we provide onsite corporate training on lean six sigma/continuous improvement methodologies and help our clients with the implementation of process improvement projects. There are government grants available in Canada and the USA to cover the cost of corporate training.

Government Funding & Assistance Options

In addition to the tangible benefits possible through lean, the research and development efforts (labor, materials and subcontracts) required in the healthcare sector could be eligible to be recovered through government funding, such as through the Scientific Research & Experimental Development (SR&ED) program in Canada.

For companies in North America, specifically, there could be applicable grants to aid in upfront costs such as capital investment and employee training. AMSaxum experts in government funding help with the application of these grants and with the preparation of SR&ED claims.

There are additional tools that can aid in improving overall efficiency, such as an RCCA labor tracking solution we offer, which is an application for collecting data or for tracking labor or KPI efficiency.

For more information on continuous improvement and Government funding within the healthcare sector call AMSaxum at 905-315-6847 or contact us here.