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July 24, 2014
There are numerous names, titles, certificates and facilitation types for lean. But the benefits, process and potential outcomes are the same.
“Leaning” any work environment is meant to improve operational efficiencies. So what does that mean for a health care facility?
Value: Determined by your paying customer, in this case the patient and families, but also the bottom line for the hospital.
Value stream: The set of activities for each process that produces value. In this case, the care and treatments of patients.
Flow: You increase flow by removing “waste” from the processes, eliminating the bottlenecks, extra steps, overstocking and so on.
Pull: Providing a service or supply when needed. Outcomes can range from shortening wait times for testing to not overstocking supplies in units.
5 lean principles
• Provide the value customers desire.|
• Identify the value stream and eliminate waste.
• Line up the remaining steps to create continuous flow.
• "Pull production" provides a service or product when it's needed.
• Start over in a pursuit of perfection, “the happy situation of perfect value provided with zero waste.”
Perfection: Comes from the perspective of the customer, and the hospital’s bottom line.
What can leaning your health care facility do? Major impacts include improving staff efficiencies, reducing waste in inventory and cutting waiting times for patients, just to name a few.
Less tangible impacts, though just as beneficial, include producing better environments for patient care and reducing complications and infection rates.
Additionally, the lean process helps staff break old habits and analyze their decisions more carefully.
Adhering to lean principles can pay off financially in a number ways, including though improved revenues, reduced costs, avoided costs, capital reduction and capital avoidance.
Revenue improvements can come from providing new services that will increase market share. By providing better service, hospitals can garner higher patient satisfaction scores and increase repeat business. Lastly, faster turnover times mean the hospital can perform more surgeries.
Cost reduction incorporates savings in a number of key areas, from requiring fewer FTEs to reducing ongoing maintenance costs and identifying waste in the overstocking of supplies.
Cost avoidance can be time saved by increased production time and reductions in unnecessary potential future spending by cutting waste from processes. In updated or new facilities, promoting a better environment helps reduce infection rates and workers’ compensation claims.
Capital reduction in updated or new facilities provide more energy-efficient environments, reducing overall utility cost.
Capital avoidance can be achieved by eliminating waste streams. Look for opportunities to share resources between departments. In updated or new facilities look to decommission older buildings or adapt them to new functions that do not require future investments in infrastructure.
What to watch out for
Make sure first that the business plan for your hospital has been developed based on the market share available. Lean is meant to prevent overbuilding, increase throughput and reduce the need for physical space. However, the facility must determine though analysis and their business plan what their appropriate needs are.
Health care providers must remember that their throughput is their patients. Patient satisfaction is critical in hospitals. If your patients feel they are a car on the assembly line it will create a negative experience.
Remember that your staff are customers too. Ultimately, staff retention is critical to a hospital’s success. Leaning a process without full and enthusiastic buy-in by all those providing the services can lead to resistance and thus failure.
Don’t let outside consultants and facilitators tell you how to provide your service. A good facilitation team will guide your groups but not give them answers. No one should be saying you can cut your needed square footage by 30 percent, or you wouldn’t need all that storage space if your staff was more efficient. Your team will determine their needs based on their optimal flow with the help of the design team.
Keys to success
In approaching a new building project or major remodel, or if you just want to lean your processes for your hospital, there are key elements to follow first:
• Time, resources and financial commitments will be required. If this process is part of a building project, it can add as much as 50 percent to the length of the initial phases. An existing facility staff that is lean trained can and should get used for much of this, but often a facilitator is brought in by the design team or owner. These costs are in addition to physicians and staff that are paid to attend the process outside of their regular jobs.
• There must be a full commitment that is emphasized to all the staff involved in the process. This includes doctors, nurses, support staff, administration, as well as public representation.
• If the facility has an existing “lean team,” they should be the ones engaging the key departments on current state and future state mapping. These flows create a visual representation of a department’s operational processes in regard to people, technology and organization. This is in preparation for the “3P” events and is critical to successful “3P” workshops, which will be discussed below.
• Administration must select team members for all key departments that will commit to being actively involved in meetings and 3P events. Attendance should be across the board, nursing staff, technicians, physicians, administration and facilities.
• Staff that will be involved in process will be required to do “gemba” walks of their departments to help understand problems and opportunities going into the flow-mapping sessions.
• 3P (production, preparation and process) workshops: These are four- to five-day events generally broken down by departments for hospitals. The 3P workshops will develop the basic layout for the primary departments and will produce detailed design for key rooms through mock-ups.
At this point design development and equipment planning will start for all other spaces in the departments, as well as design development for the minor departments not included in the 3P process.
Next step: Engage your team. The value stream mapping of the current state and future states is the first step in identifying the waste in your facility and, more importantly, getting your staff engaged in the process.
You can start implementing these future state operations in your existing facilities before any construction. Don’t wait for the building to support the change the change is the people.
Cindy Cox is an architect at Soderstrom Architects in Portland and has 28 years experience in the health care field.