The heart of lean healthcare is to create value by eliminating waste. It's hard to imagine that there is any waste when all efforts are for the patient. After all, where would the human race be without medicine and the professionals that care for us? So let's define waste within the framework of patient flow. Waste is the non-value added activities or the inefficiencies within a given process or workflow of a system; in this case, healthcare. Gain or value-added services are what the patient is willing to pay for. Every step in a process is either value added or it non-value added. Non-value added activities fall within these eight categories:
Defects: Poor labeling of tests, incomplete referral instructions or missing information in patient charts.
Excess Inventory: The cost to store, manage, and maintain (e.g., monitor expiration dates) is greater than the savings of buying in bulk (e.g., latex gloves).
Excess Transportation: Moving patients back and forth, moving information, and moving lab tests.
Excess Motion or Movement: Lifting, bending, and reaching more than is necessary. Not having the things that are used most often closest to your work; this includes equipment.
Overproduction: By producing in excess, faster, or earlier than needed (e.g., producing “just in case” IV solutions, or batching lab samples).
Over Processing: Re-testing, extra labels on charts, multiple insurance claim forms.
Unused Talent or Creativity: Sharing of knowledge and ideas, working to the top of a license or skill level, and a safe culture that respects creativity.
Waiting or Reoccurring Delays: Waiting to be roomed, waiting to see the provider, or waiting for an x-ray are a few examples.
According to Maureen Bisognano, President Emerita of the Institute for Healthcare Improvement and a Senior Fellow, the top reason to improve patient flow is to reduce patient that feels disrespectful to patients and families. This stress on the patient is also stressful on the clinicians and staff because it negatively affects them and creates burn out. Lean provides a way to create a more effectively designed and managed process that supports clinicians and staff morale resulting in increased joy at work, reduced stress, and increased productivity and job satisfaction.
There are opportunities to remove non-value added activities within the interconnected processes in any and all healthcare systems. Lean is a multi-faceted methodology that requires a simultaneous application within a healthcare organization in the micro, meso, and macro work levels. The Infinitum Healthcare Transformation System is designed to work with and integrate all three levels:
Some lessons from the field have taught the Infinitum Transformation Team:
It starts with leadership. Employees look to leadership for permission to be innovative, autonomous, and collaborative within a team.
Purpose (sets the direction), Process (how people do it), and People (organizational values that drive action). A shared vision is a co-created story that everyone plays a part in. Sustainable change happens when everyone moves in the same direction while aligning their actions to a shared vision.
The vital few must be identified. A system-wide transformation requires representation from each work area. It was Italian economist Vilfredo Pareto that reported in 1906 that 80% of the land was held by 20% of the people. He also noticed that 20% of the pea pods in his garden produced 80% of the peas. This principle of factor sparsity or the law of the vital few is known as the Pareto Principle. This statistical distribution of data states that 80% of a specific event can be explained by 20% of the total observation, or 20 percent of an activity will account for 80 percent of the results. Therefore, the 80-20 rule is a very helpful concept for life, time management, and work. A modern day example, Microsoft observed that 80% of the operating system crashes were eliminated by fixing 20% of the most reported bugs.
Identify issues through learning rather than blame. Learning is a curiosity rather than an assumption. The Infinitum Transformation Team asks "why" rather than "who."
Customer satisfaction through patient flow is the patient's perspective on how they move through a healthcare system.
Methods matter as much as results.
Back to the data; always back to the data. Not only the average, minimum, and maximum, but how often and within what control limits?
Healthcare organizations are businesses providing a service, and like all businesses, they need to focus on achieving a positive ROI (return on investment) to stay in business. The lean process can give you between 20%-60% cost savings and more work capacity which equals more profit. Lean methodology provides evidence that quality improvements are sustainable in the long term and are culture changing. The Infinitum Healthcare Transformation Team can help you get at the heart of the matter!
Bisognano, Maureen. "Flow Failures are Disrespectful to Patients." Institute for Healthcare Improvement. 25 Aug, 2016. Web Address: http://www.ihi.org/communities/blogs/flow-failures-are-disrespectful-to-patients
Teich, Sorin T and Fady F Faddoul. “Lean Management-the Journey from Toyota to Healthcare” Rambam Maimonides medical journal vol. 4,2 e0007. 30 Apr. 2013, doi:10.5041/RMMJ.10107. Web Address: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678835/
Tracy, Brian. "The 80-20 Rule Explained." No date. Web Address: https://www.briantracy.com/blog/personal-success/how-to-use-the-80-20-rule-pareto-principle/
Kenton, Will. Reviewed 80-20 Rule. 29 May, 2018. Web Address: https://www.investopedia.com/terms/1/80-20-rule.asp