Lean will undoubtedly have a major impact on Healthcare over the next few decades. Many Healthcare organizations in both public and private sectors are already looking at how Lean could be applied to their administrative and patient processes.
Although many of the tools and methods of Lean are well-known to healthcare professionals, especially Process Analysis, what really makes Lean different is the change in how improvements activities are carried out.
Many Healthcare workers are seeking Lean-skilled people who have worked in manufacturing to guide them through Lean implementation. This includes helping to prepare the organization for Lean and to carry out specific improvement activities such as Value Stream Events, Rapid Improvement Events, etc. This is accompanied by the need to build the internal capacity of Northwest haulage companies organisations for improvement. This is done through the development of internal Lean facilitators or Change Agents.
As we all know, healthcare problems are not always related to manufacturing problems. There are significant differences in how people approach Lean Manufacturing improvement.
This article will review the key differences we found in Lean Transformation in Healthcare. We also share the structure to Lean activities we have developed to help organisations make continuous improvements and not isolated Lean “ram raids”.
Our work has provided some interesting learnings that can be reversed – from Healthcare to Manufacturing!
The same , but different
We have said that Lean will make a significant difference in Healthcare. It will also help them reach their operational and financial goals. However, it must be used sensitively within organizations that have been ‘pummelled by initiatives and legislation and who have a not unreasonable cynicism about ‘this new initiative called Lean.
Healthcare workers are worried that Lean could be used to reduce jobs, just as in other manufacturing companies. The recent NHS Lean Healthcare guide, which featured a Chainsaw logo as its main logo, has not helped this sentiment. It was referred to as the ‘Slash & Burn guide to Healthcare by a Service Improvement Lead in SHA (Strategic Health Authority).
These issues, along with the use manufacturing-focused terminology, photos, and case studies when working in Healthcare with employees, can lead to internal resistance. We have seen comments like “My patients aren’t cars” from a Renal Consultant.
The attitude to risk in Healthcare is another example of this. Manufacturing is prone to making mistakes with Lean, which can increase the chance of accidents. However, it is less likely that it will reduce productivity and profits. Similar mistakes in Healthcare can have a significant impact on patient safety (including increasing morbidity and even death) and can draw significant media attention.
This makes the situation more complicated because the ‘care paths’ patients encounter often overlap with Manufacturing value streams. Patients can switch between specialties and pathways depending on their treatment needs.
These processes and pathways are difficult to manage because of the need to balance clinical concerns, such as patient safety, medical best practices, and ‘business’ concerns (availability and financing). This is often a delicate balance that must be achieved between senior clinicians (and organisational managers) on these issues.
This complexity is not uncommon in manufacturing. For example, there is always a need to balance sales and cashflow. However, Healthcare management is more consultative than Manufacturing. It requires more analysis and takes longer to make decisions. And it is more difficult to prove things to skeptical clinicians.
The constant struggle to balance clinical and operational concerns results in one of the most significant differences we see, which is the difficulty in engaging the right people at the right time to make improvements sustainable. This problem is not new in Healthcare. Many improvement projects have failed to make the right decisions quickly enough, either because they changed priorities or were too slow to implement.
We thought it would be useful to point out one final difference between Healthcare and Manufacturing. It is the differences in what ‘customers” consider Value Adding between the two sectors. While it is valued to provide comfort and advice for patients (e.g., a nurse accompanying a patient to theatre), it does not easily translate into an equivalent manufacturing activity.
A Holistic Approach
Lean in Healthcare is a holistic approach to address these problems. It includes the following:
1. Understanding Customer Value
While the patient is the most important customer in any process, they are not the only one. There may be other customers in Healthcare environments such as a Primary Care Trust or a Hospital that has been commissioned to perform some activity on a patient. These activities will be invoiced.
We do however find that some patients (patients) have been conditioned by their past experiences. One example was a patient who went to clinics every week as part of their treatment plan. They were required to wait for at least two hours at each appointment. We discussed their values and the benefits of a shorter waiting time. They said that they have come to expect to wait and that they would rather have access to coffee and magazines for free.