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'Lean’ thinking trims fat from processes

Written by Sarah Lamberti   
May 4, 2009
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Like an over-pumped blood pressure cuff, today’s economy is cutting off the circulation to an already ailing healthcare system. Many hospitals and practices are seeking ways to reduce spending and costs without adversely impacting patients. While many consider healthcare IT a panacea for all their ills, others are realizing that technology is only as good as the processes it supports.

If not done properly, an IT investment can in fact create more waste for an institution already fraught with inefficiency. Many organizations might turn to lean thinking only in a time of great need to operationally improve or reverse their fading fortunes. However, organizations like ThedaCare, a community-owned health system of three acute-care hospitals in Appleton, Wis., are using lean management to start a culture of change about process improvements—before finding themselves in dire straits.

Lean thinking looks at the processes in place to determine how things can be restructured so that all processes lead to a verifiable quantitative value, as rapidly as possible. Lean thinking seeks to eliminate wasteful intermediate steps, while leaving in place the people and processes that add value for the customer.

Why not just turn to IT for process improvements? Technology and software solutions are frequently top-down approaches that impose a work standard on a healthcare practice that fails to take into account local culture, patient needs and work force involvement in selecting and applying the most appropriate approach or solution, says Marc Hafer, CEO of Simpler Healthcare, a consulting company focused on healthcare lean management, based in Ottumwa, Iowa. “By employing lean management principles, practices from the early stages of planning can identify and eliminate waste processes to ensure positive outcomes prior to a large IT investment,” Hafer says.

Michael Rodman, cath lab supervisor, says that ThedaCare started “thinking lean” five years ago, to relieve overburdened employees, improve patient care and impact the bottom line by applying a hospital-wide strategy that seeks process improvements across the network.

The result has been an increase in inventory turns, room turn-around times and $27 million in total cost-savings for the organization. How could something other than a technology deployment result in such benefits? The answer is a participatory style of management that involves the people engaged in workflow processes from the most fundamental levels and up.

The ThedaCare lean team—a mix of physicians, administrators and CV techs—looks at the current state of a particular process, sets a benchmark to achieve and looks for gaps to see what needs to be accomplished to reach that goal. This has helped them make process improvements in the cath lab special procedure area, where they now meet a 15 minute room turn-around time. Additionally, by taking a lean approach to STEMI door-to-balloon times, they have gone from 120 minutes in 2006 to 60 minutes today. “We wanted to spread that to our seven outlying hospitals and field ambulance services in the form of remote STEMI and by thinking lean, we have been meeting a 90-minute metric for the last two years,” Rodman says.

So start thinking lean, but think lean for the long-term, Hafer advises. “Healthcare executives who are interested in learning more about lean management should realize that it’s not a quick fix; it’s a system-wide transformation—a cultural transformation—that can help organizations continuously improve patient care while reducing costs,” he says.
Last updated on May 4, 2009 at 2:53 pm EST