A staple of the manufacturing world, the Lean methodology has been gaining traction in healthcare. Historically, “Lean” is a set of focused management practices based on the Toyota Production System. This includes tools for prioritization and alignment, tools to see and eliminate waste, and tools for quality and structure. Clearly, these practices and goals are relevant to providing excellent healthcare.
There are plenty of examples of healthcare providers that see the power of Lean. For instance, nearly 15 years ago, Virginia Mason adopted the Virginia Mason Production System to look more closely at the hundreds of processes that make up its delivery of healthcare. “From the kitchen to the operating room, Virginia Mason figures out how to eliminate waste—of defects, time, motion, transportation, inventory, overproduction and processing,” explains Charles Kenney in Transforming Health Care, a book that chronicles Virginia Mason’s Lean journey and best practices.
Similarly, Health Affairs reports that “Denver Health has used Lean to improve processes in the operating room, billing, imaging, supplies, pharmacy, primary care, and other medical and business areas.” In fact, because of its adoption of Lean practices, Denver Health is one of the few urban hospitals in the United States operating in the black—documenting cost savings and revenue gains while also improving the quality of patient care.
More recently, the Cleveland Clinic has seen success with adopting Lean. The Cleveland Clinic employs more than 43,000 caregivers, and follows a patient-centered model of care organized by departments and institutes. The Lean Enterprise Institute reports that in 2006, the Cleveland Clinic launched a formal continuous improvement department to help “different cross-departmental teams with collaborative problem solving and performance metric reviews,” but its activity and scope “expanded in response to internal demand.”
Some examples where improvements were focused include:
- Oncology: Cross-functional team reduced outpatient chemotherapy wait times from an average of 60 minutes to 20 minutes
- Operating rooms: Faster setup and turnaround times maximized operating room utilization.
- Emergency department: Split-flow triage paths dramatically reduced average wait times.
- Pathology: 3P and other lean design methods engaged the workforce and improved efficiency during the construction of a new pathology lab.
The Cleveland Clinic attributes its Lean success to its “Culture of Improvement.” In other words, it’s not only about the tools of improvement, but “the culture and leadership that’s required for improvement to happen…to build and sustain a culture of continuous improvement,” says Lean expert Mark Graban in a recent blog post that details the Cleveland Clinic Improvement Model (CCIM).
Graban explains that CCIM starts by asking: What matters most? This is all in an effort to create alignment. “Strategy deployment isn’t about forcing goals on people… it’s about creating alignment. Alignment between goals and actions, alignment from top to bottom, and alignment across the organization,” notes Graban.
And alignment—and buy-in—are key to making Lean work. According to Graban, “It takes real leadership commitment for a phrase like ‘Patients First’ to be a daily reality and not just a slogan.”
Bottom line: Health systems, hospitals, physician practices, and government departments are adopting Lean—and seeing marked improvements in not only how they run the “business side” of healthcare, but also patient care. Are you?
