Lean Methodology in Health Care Quality Improvement
- November 26, 2016
- Posted by: marlenedubois
- Category: Home Health Aide Training
Lean production (Lean) is actually a type of quality improvement methodology which has been implemented in many industries. Its principles along with practices also have been applied to health care organizations with success. This particular has been accomplished with refinement for the nuances of health care. Lean is actually a process management philosophy which has its roots in manufacturing along with technology. the item was developed as part of the Toyota Production System for the process assembly of automobiles (Toyota Motor Corporation, 2009). The Toyota System is actually comprehensive along with spans a large number of methods along with practices. the item was initially influenced by the work of W. Edwards Deming along with Henry Ford along with was also inspired by innovation inside the American grocery store industry of the 1950s (Keller, 2006). This particular is actually reflected inside the Just-in-Time philosophy of productivity improvement, which emphasizes producing quality products efficiently through the complete elimination of waste, inconsistencies, along with unreasonable requirements (Toyota Motor Corporation, 2009). Though the Lean methodology was initially developed as part of an overall system focusing on the production of automobiles, its principles also have been adapted for health care. As certain case studies indicate, Lean thinking along with tools have been successfully applied to specific health care settings. The scope along with value of Lean production within This particular field will be explored in This particular paper.
A significant component of Lean is actually the concept of value: the theoretical concept of value, the measurement of value, along with the tangible processes behind delivering value. Lean is actually unique in which the item accounts for the reduction of waste in order to achieve both real along with potential value. Recovering This particular value can present itself inside the form of saved costs or some other tangibles. Lean thinking dictates which the expenditure of resources for any purpose some other than delivering value to the customer is actually considered to be wasteful. The reduced expenditure of time, money, along with resources is actually thought to bring additional bottom-line benefit to the customer. The customer-centric focus of Lean thinking is actually especially relevant to health care. Broader levels of patient/customer satisfaction are constantly being sought. This particular mode of thinking has been brought on by increased competition among organizations along with the need to differentiate services. the item is actually recognized which providing complete customer satisfaction can be vastly beneficial to health care organizations. Customer satisfaction can be an equally important measure of an organization’s performance as the delivery of quality health outcomes. This particular is actually a factor which is actually exemplified in Noriaki Kano’s product. Lean thinking dictates which processes along with methods must be efficiently optimized with the needs of customers in mind in order for organizations to be fully effective.
Problem Addressed: Waste
Lean focuses on the maximization of process velocity through the reduction of waste. the item provides tools for analyzing process flow along with delay times at each activity in a process. The focal point is actually the separation of “value-added” coming from “non-value-added” work. This particular is actually complemented by tools which aide inside the identification along with elimination of root causes of non-valued activities. The primary problem addressed by Lean is actually waste, which can affect value in several ways. the item may result in lower quality products, higher costs, less favorable customer experiences, excessive time or effort expended to complete goals, or fewer resources available for innovation which could provide potential value at a future date. Waste can be found in people, processes, tangibles, along with some other areas. Eliminating waste through the lens of Lean production can help to achieve the goals of health care organizations. There are eight generally identifiable centers of waste: overproduction, waiting (time on hand), unnecessary transport or conveyance, over-processing or incorrect processing, excess inventory, unnecessary human movement, defects, along with unused employee creativity (United States Army, 2009). There are variations on these categories of waste depending on the setting or industry. For the purpose of health care Caldwell (2005) slightly refines these measures into seven categories of waste. These consist of “in-quality/out-of-quality staffing or overcapacity, overcorrection, over processing, excess inventory, waiting, motion of patients or staff, along with material along with information movement (Caldwell, 2005, p. 46).” Regardless of the differences in terminologies used, there are common centers of waste in health care which can be targeted for elimination. These can be identified through Lean processes which focus on root cause analysis.
Process: Root Cause Analysis
A crucial process in Lean is actually the identification of waste through root cause analysis. Root cause analysis in Lean involves a method called 5-Whys (Toyota Manufacturing Kentucky, 2003). This particular method rapidly identifies root causes along with aides in determining the relationship between multiple root causes. the item can be learned quickly along with does not require statistical analysis. This particular method is actually especially effective for an implementation team inside the initial stages of problem exploration. The application of This particular strategy involves asking a series of why-related questions to drill down into a problem area. Asking progressive questions about a perceived difficulty forces team members to think critically about the actual sources of waste along with inefficiency. the item is actually suggested which at least several questions (5-Whys) are posed to arrive at the root cause, though a root cause may be discovered in more or less inquires.
The following is actually an example of a 5-Whys exercise used in a hypothetical hospital setting:
(Q1) Why are patients being diverted to neighboring hospitals?
(A1) Because wait times for our hospital are exceeding industry norms.
(Q2) Why are our wait times exceeding industry norms?
(A2) Because patient volume is actually exceeding capacity.
(Q3) Why is actually patient volume exceeding capacity?
(A3) Because not enough hospital beds are available.
(Q4) Why are not enough hospital beds available?
(A4) Because hospital patients are not being discharged efficiently.
(Q5) Why are hospital patients not being discharged efficiently?
(A5) Because ER staff is actually not following best practices for proper discharge.
In This particular example, waste inside the throughput process comes coming from incorrect processing. Once hospital management determines the root cause they can implement further training, ensure compliance with existing standards, or eliminate some other barriers. In This particular case the hospital might consider implementing a training program to ensure which ER staff is actually following best practices for patient discharge. The hospital might also conduct additional 5-Whys analyses to uncover some other problem areas. Once root causes of waste are uncovered, the elimination of waste or some other related action plans can be executed.
Sources of waste
Sources of waste vary greatly by industry. The majority of waste encountered by health care organizations occurs in flow along with throughput. As a result, Lean implementations in This particular field are primarily focused on the elimination of waste in staffing along with staff/patient processes. Unlike manufacturing industries most health care organizations have very little inventory. Thus, some of the Lean concepts related to inventory control are less applicable to health care. Health care organizations typically spend a larger percentage of operating expenses on overhead along with labor costs. This particular can account for 50 percent of the operating costs while inventory is actually inside the range of 2 percent (Caldwell, 2005). Understanding waste in throughput entails a comprehension of the relationships between process variables along with costs. Costs are not causes of waste however are indicators of interrelationships between processes. While the ultimate goal of most Lean implementations is actually to recover costs as tangible benefits, eliminating costs without fully understanding processes is actually problematic. Looking at the types of cost recovery is actually essential to determining an action plan.
Solution: Cost Recovery
The ultimate goal of most Lean implementations is actually to attain a tangible benefit, often inside the form of a cost recovery. However, not all process improvement opportunities will result in immediate returns. The actual realization of a benefit depends on the nature of the improvement as well as the additional steps which management takes to achieve the item. Caldwell (2005) cites three types of cost recovery through the elimination of waste: Type 1, Type 2, along with Type 3. In a Type 1 situation the process throughput improvement will yield a direct cost recovery. For example, a process improvement which reduces length of patient stay would likely recover costs inside the form of reduced resources expended. In a Type 2 situation, the process improvement saves time however does not result in cost recovery without additional hours worked per unit of service. A provider may spend less time per patient because of reduced length of stay however scheduling will need to be adjusted in order to capitalize on the benefit to workflow. Lastly, Type 3 yields savings inside the form of immediate optimization of capacity. In This particular situation a process improvement in an emergency room, for example, may allow a provider to see more patients inside the same staffed time without additional action taken by management. This particular is actually similar to a Type 2 recovery however with no adjustments to scheduling. This particular can occur if the provider is actually willing to see more patients per unit of time along with sufficient patient volume exists to achieve capacity. Maximum velocity is actually achieved without additional action needed to be carried out by management. These examples show which throughput improvement may not achieve an immediate benefit without some other factors. the item also brings to light the fact which throughput improvement may yield different benefits such as recovered costs, time saved, or increased revenues. Regardless of the actual benefit achieved along with the way which the item is actually realized, the ultimate outcome must increase bottom-line value along with satisfaction to customers in some way.
Examples of Lean implementation in Healthcare
The study of actual Lean implementations in health care is actually essential to understanding their application. One example of a successful implementation is actually outlined by Fairbanks (2007) at a medical center in Vermont. This particular implementation dramatically much better overall throughput processes within the organization. An implementation team was assembled along with delved into all steps of the processes they were analyzing in order to determine the sources of waste. They utilized various Lean steps along with methodologies to conduct root-cause analyses along with prioritize process improvements. The team measured time involved, identified activities, along with made rapid improvements through the elimination of non value-added activities. A large part of their improvements involved the elimination of redundancy. The topic of redundancy shows the importance of analyzing all processes, even those which are perceived to contribute to customer value. Even though a particular function may provide value in an organization the item is actually possible which a redundant function may exist which can be eliminated. In another case example Lean methodology was used to streamline the physical space along with inventory areas of a Denver-area hospital (Gabow, Albert, Kaufman, Wilson, & Eisert, 2008). The implementation team utilized the 5-S approach to organize physical work spaces within the hospital. 5-S is actually a Lean improvement which incorporates visualization management to organize objects along with supplies. The several Ss stand for sort, set in order, shine, standardize, along with sustain. These steps involve tasks ranging coming from simple clean-up along with organization to the implementation of detailed visual controls. In a 5-S environment there is actually “a place for everything along with everything in its place, when you need the item (Lean Innovations, 2003).” The Denver hospital used This particular approach in a series of projects focusing on individual offices, nursing stations, entire laboratories, along with financial services departments. These spaces were reorganized to achieve optimal work flow along with not bad space management. The successful outcomes included reclaimed physical work space, much better lab turnaround time, reduced time in locating equipment, along with better processes which could improve patient care (Gabow et al, 2008). The 5-s method is actually an excellent first step in implementing Lean programs in a health care organization. Improvement of physical work space can positively affect mindset along with mental perception of work. Another case example of a successful 5-S implementation involves a rural health clinic in Georgia. Lean techniques were used in This particular organization to resolve problems with bottlenecks, turnaround times, customer satisfaction, along with overworked nurses (Cross, 2009). 5-S is actually one of many Lean tools which can provide immediate benefit.
Lean is actually a multifaceted approach to quality improvement which has tangible benefits to health care organizations. There are aspects which focus on reducing non value-added work along with waste to achieve value in various ways. Successfully implementing Lean in health care depends on the setting involved along with the motivation of management along with teams. Health care encompasses a wide range of organizations along with each has unique characteristics which must be considered in light of Lean processes. Important considerations in implementing lean in any environment can be reduced to a few key points: Understanding the concept of value Understanding waste along with its sources Learning how to determine along with analyze root causes Prioritizing multiple root causes Devising methods to eliminate waste Determining ways to recover costs or achieve benefits Analyzing effectiveness along with repeating steps if necessary In addition, the item is actually important to note which eliminating waste through a Lean process may not immediately result in tangible benefit. Management must thoroughly analyze action plans along with make adjustments based on actual outcomes. Additional steps may need to be taken following initial process improvements. This particular is actually especially relevant in health care where process throughput improvement along with staffing are areas which are commonly targeted. These areas may involve more challenges when trying to extract benefit. Freeing time for providers cannot always be capitalized upon without some other capacity along with throughput improvements. Scheduling or work flow functions may need to be overhauled in order for providers to enhance overall process velocity along with maximize value per unit for time. the item is actually also crucial to realize which humans are not machines. Theoretical methods of quality improvement in Lean may not always be feasible to achieve at maximum levels. The Lean methodology developed by Toyota is actually very cognizant of respect for people. the item is actually reflective of a collective culture along having a holistic concept rather than a series of parts or steps. This particular is actually a fact which cannot be overlooked by management along with teams when planning an implementation. People perform processes with normal human variation along with improvements must be sensitive, appropriate, along with sustainable.