Scientific Method - Without First a Standard There Can Be No Improvement

Lean Healthcare – What is it? Clarity and strong leadership are required to implement lean principles. Another way of saying this is “If you only have a hammer everything looks like a nail”. As commonly thought, Lean is not a way to get the low-hanging fruit in an organization. Rather, lean is a means of developing standard work and operational controls.

Lean Healthcare is a strategic business system, but more importantly a state of mind. This is true because eliminating waste in an organization is a simple concept to understand, but very difficult to implement. Lean is not easy because its principles expose challenges quickly and will lead to organizational friction and reorganization of personnel. Although lean originated in manufacturing companies its principles apply to all aspects of business; most importantly the vigorous involvement of its practitioners. To put it simply – implementing lean is a project that has no end date.

Lean's ultimate goal is to harness the knowledge and energy of an organization's employees - continually. Lean is the transformation of the value delivery process within this organization. Most importantly, the principles of lean expose challenges in real time because it deals with facts and forces problem resolution. The proper roll-out of lean initiatives should exceed patient expectations. Its impact on employees will not only give them the ability to recognize and identify waste, but more importantly give them the courage, confidence, and desire to call it waste. In the end, each employee realizes that failure to act raises costs, produces no corresponding benefit, and may threaten job security as a result.

Lean principals allow areas of specialization also referred to as departmental silos to become seamless and focused on patient transparency. This synthesis is “Value Stream” creation in a hospital setting.

Because lean is difficult to implement it is very important to focus on the fundamentals by solving any problem from the inside out and setting a foundation for continuous improvement. Here are the twelve operating principles of Lean:

1. Standard Work Methods
2. One Piece Flow (Patient Focused)
3. Continuous Flow (Pace)
4. Balanced workload across functional areas
5. Standard work in process
6. Visual Management Control (Transparency)
7. Multi-process capability (Multi-tasking)
8. First in-First Out Flow of Materials
9. Pull System (Supply based on Demand)
10. Rapid Change (Flexibility, Scalability)
11. Error Handling (Logical Backward Flow)
12. Right-Sized Equipment (Space Optimization)

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What is Meant by Waste in Healthcare?

After mentioning to a friend on Facebook that I want to attack waste in healthcare, he responded, "I think that is great and might be possible. The biggest prob is you deal with a lot of Biohazards. Recycling is always an option, but I'm not sure what kind of options there are for recycling. I'm very much behind less waste and better facility management, but this would take some investigation. In my profession, architects are probably the most underpaid most respected individuals. Quite the paradox. Considering we help shape the environment we all live and work in, it's odd." - Curt

My response: As an architect, shaping the environment I suppose would begin with a financial impact study on recycling. Complexity is added when you combine internal operating and capital costs that offset it...ah, regulations. With my own background, my Monday morning calendar says "tackling handling errors fraught with redundancy" You know, the $4,000 standard kit you didn't need that's tossed in the garbage. Oh, well. Did you say $4,000? Why is that?? -W

Curt's response: "I'm confused? Are we on the same page? I thought you had a question about medical waste."

This brings me to the point of this entry. There is some confusion among people outside the healthcare arena as to what is meant by waste in healthcare.

Although recycling is very important at a tactical level, I'm talking about activities in healthcare management that provide no value to not only an aging and increasing dynamic population with "time to kill", but also have no preventative or predictive measures in place on a large scale to limit costs of providing these services long-term. These costs derive from many sources, but mainly from information flow that is disconnected from the physical flow of all resources. As a supply chain consultant, my job deals with rationalizing all resources to generate capacity and increase the flow of people, materials, and processes which are principals at the heart of industrial engineering and operations research.

Curt responded further by saying, "Oh.! I get ya and agree with ya. As a healthy individual (knock on wood) this is why I set my health insurance to deduct. to a higher level, thus avoiding the "medical waste" I may incur. The health insurance industry in my opinion, hasn't gotten too big but rather it has become more like a mafia-run racket. We give some company some money to "watch over us" and still give them more when we actually need the help. Hell, I have 4 people in my family on my health policy. We use my insurance for medical reasons about once a year per person. After any out-of-pocket expenses for visits, I still am paying far more into the system than I am getting back. Makes you understand why so many people don't have insurance. I've thought a lot about dropping my coverage, but fortunately/or un, I have kids that make it risky. It's one of those necessary evils. For your case though, sounds like you're doing something good and should be telling the people up on Capital Hill that here's what's wrong with health care. Who knows, maybe someone will hear you. Whatever the case, you see my beef with the system and I'm not an old fart. Pretty good stuff."