Fellow lean blogger Mark Graban is the author of the just-published Lean Hospitals. The following is a brief Q&A
with him on lean in healthcare, although "brief" may be a bit of a misnomer. Mark is obviously passionate about the subject, and therefore can be almost as verbose as I am. In fact, in several places I’ll link to the full Q&A on Superfactory for the rest of the discussion.
1. From a lean perspective, how are hospitals and manufacturing the
same and different?
There are many things that are similar about factories and hospitals. They both involve, at a real basic level, people doing work and people who manage the people doing their work. There is a lot of waste in hospital processes (the standard “8 Types of Waste” actually works pretty well in a hospital) and often times there isn’t “a process” to speak of. What you often have is individuals or departments (or even sub-department silos) each working hard independently while the handoffs across the “value stream” (or “patient pathway,” as many in healthcare have traditionally referred to it) are botched because nobody owns the overall process. Most delays and waiting time in hospitals is probably caused by poorly planned handoffs. So the value stream view of the world helps, bringing people from different areas together to actually map out the entire process — it’s very eye-opening to people! They learn to identify waste and to, more importantly, drive improvement in their own workplace.
2. What are examples of lean improvements in hospitals?
There are many examples of department, value stream, and hospital-wide improvements as a result of Lean. Lean improvements can benefit all stakeholders — the patients, the staff (employees and contracted physicians), and the hospital itself.
First off, in the patient safety and quality area, Allegheny Hospital in Pittsburgh used Lean methods to reduce patient deaths related to central-line-associated blood stream infections by 95%. This is really powerful stuff. Focusing the Lean methods of standardized work and waste elimination can really have a life-saving impact. You see similar results in the use of the “checklists” methodology, leading to reductions in infections, bed sores, and other preventable “adverse events” that occur to patients far too frequently. These improvements obviously help patients, they help staff (who want a method to help prevent patient harm and unneeded stress), and the hospital’s costs.
3. What is the potential for lean in hospitals? Can it change the
healthcare policy dynamic?
Much of the public policy or political discussion of healthcare has been focused on “how do we pay for healthcare?” Since the cost of providing healthcare in the United States increases roughly 10% per year (and this doesn’t mean the cost of the providing the same care increases that much), there are pressures to control these increases. Unfortunately, when insurers and payers (public or private) focus on “cutting costs,” they are really just “cutting prices,” the way “non-Lean” companies pressure suppliers to unilaterally cut prices. The Toyota model is one of working with suppliers, in a long-term partnership, to reduce true costs and sharing the savings. Cutting the true costs of providing healthcare is a way for us to afford new technologies and treatments without increasing our total spending.
4. What hospitals (or networks, etc) have embraced lean?
I almost hesitate to name names, since so many hospitals are doing amazing things with Lean “under the radar.” I do think, though, it’s important for hospitals to promote what they’re working on to spread the word about Lean. A few of the noted and written about leaders in the U.S. include Virginia Mason Medical Center (Seattle) and ThedaCare (Wisconsin). Virginia Mason (which I’ve visited) and ThedaCare have had extremely strong leadership from the CEO level. At ThedaCare, John Toussaint is an MD and CEO, so that leadership played a major role in their Lean progress.
5. Although presumably manufacturers are further along on the lean
curve than hospitals, I’m betting that there are still things that
lean manufacturers could learn from lean hospitals. Anything come to
I think many hospitals are doing a great job of remembering BOTH pillars of the Toyota Production System — continuous improvement and “respect for humanity.” Many hospitals are taking a very people-centered view of Lean, making sure that Lean benefits all stakeholders, including patients, employees, and physicians. I break out physicians into a separate group because it’s a different (and more complicated) dynamic than “employee/manager.”
I encourage my friends in manufacturing to tour a hospital that is working on Lean because it will really force them to think about the basics of Lean. I think that will spur creativity that will help them back in their own process. I always cringe when I see a question like, “I am looking for a cement company that has implemented Lean” because that means someone is looking for shortcuts and to copy. If hospitals (especially the early ones who had nobody to copy) can figure it out, so can you, in your own industry.
6. What is the best way for a hospital (or medical group, or clinic?)
to begin the lean journey?
I think hospitals need to learn the lessons from failed Lean efforts in manufacturing and other industries. You have to “start from need” as Ohno said. What are you trying to improve and why? One failure mode is the approach of using a tool, or a set of Lean tools, without tying it to the mission of the organization and existing measures. Lean can improve safety, quality, waiting times, costs, employee satisfaction — hospitals are typically already measuring these things, Lean needs to support that.
Secondly, you can’t rely on isolated “kaizen events” to make you Lean. Kaizen events (or “rapid improvement events” or “rapid process improvement workshops”) are as appealing to healthcare leaders as they are to factory leaders. Just one week and your process will be “Lean” is often the appeal. Well, changes happen, but in the rush, tools might be implemented and improvements might be made, but without changing the underlying management system. Even Virginia Mason Medical Center, seen as a leader in the use of Lean, admits in their own publication that they had significant backsliding in 60% of their kaizen events. Many hospitals are being successful by taking a more systemic approach to Lean improvements — training employees and managers, planning for how they are going to make Lean a management system and a part of the culture rather than a one-time event.
Again, the full Q&A is here, and you can learn more about his Lean Hospitals book here. Until Amazon catches up with shipping delays, it can be ordered for immediate ship here. Thanks to Mark for the very detailed answers to my questions!