What Lean means in healthcare
Written by By Jacob Stoller on November 30, 2009 for Canadian Healthcare Manager
Buoyed by a growing number of success stories, Lean is now a common fixture in Canadian hospitals.
Hospitals and car plants are worlds apart, but when it comes to making them more efficient and customer-focused, the challenges are remarkably similar, and both are turning to Lean, the discipline that helped Toyota become the world’s biggest car-maker, to address them.
These parallels were evident at the second annual Insight Lean Conference, held in Toronto in September. Presenters used real numbers to show Lean project gains such as shorter wait times, quicker turnarounds, increased capacities and better working conditions for staff.
“I’m tired of hearing that Canadian healthcare is broken,” said Larry Cote, conference chair and president of consulting firm Kaizen Institute Lean Advisors (KILA), setting the tone in his opening remarks.
At Toronto’s Hospital for Sick Children, Lean projects have reduced turnaround times in clinical labs by as much as 70% in less than four months. The real work there, however, is just beginning.
“Our mission has to be that we address not just process improvement, but really innovative process management — ensuring the best possible experience for the patient from first contact until discharged from care,” said Susan Jewell, vice-president of clinical services at SickKids. “And so obviously these changes will cross services, they’ll cross units, they’ll cross the organization. So that’s really our next step — working with a group of areas that can really realize big change across their whole continuum, between the services.”
The urgency of this broader approach was stressed by Jennifer Mackenzie, vice-president of strategic planning, transformation support and innovation for the B.C. Provincial Health Services Authority. “You’d think that actually doing the surgery would be the riskiest part, but it’s not. The handoff and communication between care providers are responsible for about 66% of the sentinel events that are happening in healthcare. So linking up care and getting away from thinking about ‘just what I’m doing,’ but making sure that you’re communicating with the next person downstream or upstream, is a really key activity.”
“The most important ingredient in success is engaged clinical leadership”
Achieving this level of participation takes significant buy-in from senior managers. “The most important ingredient in the success of these endeavours, I think, is engaged clinical leadership,” said Dr. Kevin Smith, chief executive officer of St. Joseph’s Healthcare in Hamilton, Ont.
Smith took his senior management team to Toyota in Japan so they could observe Lean culture in action. “What was immediately striking was the flatness of the organization — that really and truly the hierarchy was very collapsed,” said Smith. “And everyone at Toyota really had created a culture of ‘how do we re-invent what we did yesterday to be better?’ The other striking feature was the importance of real-time data and measurement being available to every person in that supply chain.”
Measurement was very much on the mind of Steve Read, chief financial officer of Brockville [Ont.] General Hospital, when he spearheaded a number of Lean projects by projecting, and subsequently delivering, a positive return on investment.
“Lean provides us with the methodology or approach to identify the things that aren’t adding value,” said Read, “and gives us a methodology for eliminating those wastes, and redesigning those processes so a higher percentage of everyone’s daily activity, or the space that’s used or the dollars that are consumed, is going directly towards patient care.”
Read sees the potential for huge gains in hospitals, but cautions against playing the blame game. “It’s not uncommon in any industry for the value-added piece of the consumed resources to be very, very small — in the 15–20% range,” he said. “It’s difficult for people to hear that, because it incorrectly implies that they aren’t working hard or that they’re not doing their best. What it does suggest, though, is that people are working within systems and processes that aren’t designed to maximize the impact on patient care.”
“When we talk about waste, we’re valuing our staff,” said Jewell, “because we’re saying, ‘We don’t want to waste your time and your skill on unnecessary and redundant tasks, and we want you to use your skills and your expertise to provide valuable service and satisfying work, and have you enjoy your work and be satisfied by your work.’”
“People participate in healthcare for a reason,” added Melanie Beaumont, consulting advisor with KILA. “They’re kind of on a mission. They’re people who are dedicated to serving and helping others in whatever way they can.”
Jacob Stoller is a freelance writer in Toronto.