If you examine each of the characteristics of a lean organization in the previous post you will find that it is not hard to apply them to a hospital or other health care organization.
- Continuous Improvement: Health care, more than any other field of work or knowledge, has practiced and developed through a process of continuous improvement. Imagine if doctor or nurses were doing their job today the same way it was done ten, twenty or fifty years ago. Every day there is improvement in health care services. It is the job of everyone, every team member and every manager, to participate in continuous improvement.
- Experimentation: Health care, in all its forms, has emerged from the scientific method of controlled experimentation. Applying the principles of experimentation to daily work practices in a hospital, long term care facility, or home care, should be a natural process for those who are trained in any health or healing profession.
- Respect for People: Most of those who enter the health and healing professions do so, not for selfish reasons, but to do something noble, to be of service to others. You have probably learned that there is no more reliable source of information about the health of an individual than their own voice, the voice of the customer. The best health care organizations demonstrate respect for the expertise and the spirit of those who chose to work in this profession.
- The Elimination of Waste: Everyone knows that health care organizations are experiencing tremendous pressure to reduce costs, from the university where we are educated to end-of-life services. What lean implementation has proven is that costs can be reduced while at the same time providing improved service to clients. If one form can be completed on a computer and be maintained by the client, rather than filling out multiple forms that provide the same information and consume the time of patient and staff, fill filing cabinets, and represent a source of error, costs can be reduced while at the same time reducing the frustration of patients. There are many forms of waste that can be eliminated in most health care organizations.
- Assure Quality and Safety, First! In healthcare we know that our first responsibility is to do no harm. Unfortunately, too often harm is done. That harm may be in the spread of infection in the hospital. It may be in a failure of diagnosis. It may be a delay in diagnosis or treatment. Quality and safety must be the first priority of any lean initiative. As in manufacturing, quality and safety cannot be achieved through a special committee or individual. It must be the responsibility of every single associate. This is accomplished by every team being clear of their area of responsibility and their measures of quality and safety.
- Blame the Process, not the People: A culture of blame and shame destroys motivation and creates fear. This destroys the capacity for experimentation and learning. Dr. Deming said that 95% of the problems are in the process, but more often we blame the people and fail to fix the process. Too often in health care organizations there is a tendency to search for the “guilty party” when the real blame lies in a process that is too confusing, too difficult, or that leads to errors. Every manager and every team of clinicians and service providers must become experts in their processes and focus on process improvement.
- A Culture of Teamwork: The Mayo Clinic, ThedaCare, VON Canada and other organizations that are demonstrating superior results are doing so through a culture of teamwork. Clinicians are organized into teams to provide the best possible care, as are service providers from those in the cafeteria to those who assure clean facilities.
- Joy at Work: You only go around once in life. Why not get all the joy you can? What is “joy?” Joy is the happiness that is derived by putting your strengths to work for a worthy purpose. You joined the health care field because you intuitively felt that you would derive joy from your work. Every time you see a patient get well it brings you joy. Every time you see a client that needed home nursing or support become independent it brings you joy. Unfortunately, that joy is often countered by bureaucratic procedures, sources of frustration to your clients, and fear created by management practices and behavior that are based on faulty assumptions about human nature.
- Lean is Interruption Free Flow: Several times in factories I have had teams take incoming material off the delivery truck and then stand there as the box stands there. When it is opened and stored, they move to the warehouse or storage area and wait. Then they move from production station to production station and stand there and wait as long as the actual part stands there and waits. This can be an incredibly frustrating experience. I ask them to imagine that the material never stopped moving, but continually flowed from beginning to end. Now follow the patient who feels a pain in her stomach. Where does she go? Stand there with her. Follow her to the next office, the next form, the next professional, the next phone call, the next waiting room, etc. How long does it take? Every second during which she is not receiving direct care for her illness, is an interruption and is non-value adding waste. It is more than waste. It is a source of risk.