Health care: Going "lean"
Regardless of the impetus for change – legislation, technology or more competition – health care can no longer function as it has in the past. The provisioning of these services will also be impacted in quite a few different ways, shifting from volume to value, from quantity to quality and from activity to outcome- or results-based.
One way to understand whether these customer-centric efforts are effective is by tapping into VOC (Voice of the Customer). As this industry begins to feel the effects of competition, it will be more critical to determine, assess and respond to patient needs. Many health care organizations are implementing lean initiatives to address these issues. For example, satisfaction by OB-GYN patients at a local hospital was low. A tool called “5 Why” helped identify the source of the dissatisfaction:
Q: Why were the patients unhappy?
A: Because doctors told the new moms they could leave by noon, but they didn’t leave till after 4 p.m.
A: Because the babies weren’t ready (and the moms weren’t going to leave the hospital without their new babies).
A: Because they hadn’t received their last set of medications and had their final check.
A: Because the OB-GYN rounds hadn’t yet occurred.
A: Because they didn’t happen until 3:30 p.m.
A: Because that’s the way it had always been done!
So goes the day in the life of a typical patient at a normal hospital – great clinical care and sincere concern by clinicians/staff, but a disconnect within the process. By focusing on the customer’s needs, a very simple issue that had nothing to do with clinical care surfaced and could easily be addressed.
During the April meeting of CHSM (CO Health Care Strategy & Management), I moderated a session on Lean Health Care with a panel including Art Gonzalez (CEO of Denver Health), Dave Munch (prior Chief Clinical Officer and CMO of Exempla Lutheran) and Mark Graban (visiting author and lean guru).
The focus of lean, which Toyota is credited with originating, is to identify and eliminate waste in the work environment. There are eight main categories of waste:
- Defects - error in doing something (e.g. misdiagnose symptom, wrong strength/dosage of medication, incorrect code thereby creating an incorrect bill)
- Overproduction- doing something in excess, either as “backup” or “just in case” (e.g. preparing labels, making copies of electronic records)
- Waiting – this is self-explanatory as there are whole rooms dedicated to this! But there is also time wasted waiting for lab results, tests, data, babies (as in the initial example)….
- Non-utilization of talent – having personnel perform work that doesn’t maximize their capabilities (e.g. many administrative tasks performed by clinical personnel)
- Transport – physically moving patients/equipment/supplies from one point to another
- Inventory – inefficient use of materials (e.g. overstocking, expired items, supplies no longer used) which shows up in the financial ledgers as well as takes up space
- Motion – movement within a work space that doesn’t add value (e.g. looking for supplies, having to walk around items in the way)
- Extra-processing – doing things more than once (e.g. entering same information in system multiple times, asking patient same questions over and over again)
Once identified, waste can be eliminated to improve operations. And the associated benefits can show up in many forms: improved patient safety and quality outcomes; increased clinician/staff engagement; reduced operating costs; improved patient satisfaction; fewer errors; reduced inventory; increased productivity; and improved space utilization.
It’s like Pandora’s Box – once you know what to look for, you can never settle for status quo.
As an industry, health care will require innovative ways to improve access as well as deliver service effectively and efficiently. Lean methodologies, principles and tools can provide that construct. Whether implemented as a separate initiative or incorporated within some of the impending operational changes, it can provide value-added benefits.
So, if you are a patient (or any other type of customer), make yourself heard (e.g. surveys, complaints) to increase the chances that future service will improve. Once known, organizations can’t claim ignorance that something is wrong. Health care is finally realizing this and starting to not only more seriously listen to the Voice of the Customer but do something about it. Remember that recognizing good service – telling them what they’re doing right – is also powerful. Sometimes the carrot wields more power than the stick.