Would healthcare be better if everyone understood and applied the five lean principles described in the book Lean Thinking? As part of our team development at the ThedaCare Center for Healthcare Value, several of us have embarked on the process of taking the Lean Bronze Certification examination. To prepare, we are studying the various books that are required reading. As I was reading Lean Thinking I was struck by how much of our current healthcare system goes against these five simple principles.
Those workers that are enrolled in a company sponsored healthcare program have just experienced the annual open enrollment period when they learn the details of the costs and medical benefits that will be in effect for the next year. Each employee has to measure the Value of the benefits (Value = Quality / Cost) and how they will fit their individual circumstances. According to CMS, for 2016, the average cost will increase 7.5% for people in the healthcare exchanges while increases for employer sponsored insurance are higher, depending on your plan. But if you are paying more, will you receive better quality of care? Can you be 7.5% healthier, or will the healthcare industry continue to add costs without any additional value? In the end, Value can only be defined by the customer, it needs to be something they are willing to pay for.
No one can view the patient experience as well as the patient. No one feels the pain, the waiting, the confusion, or the financial burden as the patient does. Healthcare leaders have worked hard measuring, simulating, and optimizing each step of the process, but better planning of the entire value stream would result in smoother flow throughout the healthcare system. Like the saying goes, you can learn a lot when you look from end to end. For most Value Streams, waste usually occurs between process steps because of the legacy of our silo mentality.
This could be one of the more difficult lean principles to apply in healthcare. Patients are unpredictable. Sometimes you have an outbreak of health. And the opposite will clog up even the best designed system. To improve Flow one must look at ways to improve communication at each step of the patient process. Are there changes that can be made to eliminate waiting, rework or wasted motion? Flow can also be improved when the patient experiences standardized processes and each care team uses the same approach. One modern issue with Flow is that we hide much of our information in computers – where it is difficult to see the flow!
In healthcare, Pull can refer to both patients and all the supplies that are needed for patient care. Much of our healthcare today is pushed – we tell the patients what to do and when, independent of their ability to comply. To create Pull for patients, some healthcare systems have made improvements by making sure that patients are able to get to appointments and that they are reminded not to miss them. Having additional options available for patient visits like virtual or e-visits will help health systems meet patient demand.
On the supply side, many hospitals have a pull-to-demand system of supplies in place, but may lack a way to move those supplies to the point of use.
No healthcare worker wants to make a mistake. But the Journal of Patient Safety reported in 2013 that the number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. But for now, this crisis is not front page news. What would perfection look like in healthcare? Is it possible to have systems in place to catch errors before they occur, or have policies that prevent errors from happening in the first place?
Just because we are seeking perfection does not mean we will ever achieve it. The biggest gains in patient safety will be in the trying. Trying every day to eliminate waste, improve value, create flow, and improve pull, will keep getting us closer to perfection.
Radical changes are required and can save thousands of lives every year, and we now have many outstanding healthcare organizations to learn from. To help you learn about how to improve healthcare, John Toussaint, MD., has published a new book that outlines 11 healthcare organizations that have had success with these five and other lean principles. Please read Management on the Mend available at Amazon, bookstores and at ManagementontheMend.org
ThedaCare Center for Healthcare Value