November 7, 2017

Lean Six Sigma Impact on Healthcare

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Understanding how the principles of Lean Six Sigma can improve healthcare.

Healthcare organizations have seen improvement programs come and go over the last few decades (TQM, or total quality management, CQI, or continuous quality improvement, reengineering, benchmarking, etc.). None seemed to have the “stickiness” factor that ultimately led to sustained improvement in value to the patient.

In the late 1990s and early 2000s, a few healthcare organizations embarked on serious efforts to learn and apply lean thinking. These organizations learned from other industries’ lean management philosophies, methods, and tools. 

The implementation of Lean Six Sigma in a healthcare facility or system is not an easy journey. It is difficult to break down the traditional notions that everything is done by committee and the most powerful people win, dismissing the ideas of the frontline workers (nurses, doctors, technicians, etc.), who actually understand the problems and can craft the best solutions.

The focus of Lean in healthcare is to add value by improving processes and removing waste in its many forms (see below).

The correct way to address and solve a problem or remove waste is by observing, on site, connecting with the key people, and fully understanding all steps and constrains of a process, not by theorizing during a board meeting, or worse, throwing money around or adding staff when this is not the root cause of the problem.

It is now clear that Lean principles can deliver better quality (and safety) and a better patient experience while at the same time allowing for better use of existing resources and improving the staff work experience.

Lean principles use the same scientific method to diagnose and treat organizational problems as doctors use to diagnose and treat medical conditions.

For Lean to take hold in an organization and transform its culture to one of continuous improvement, senior management must relinquish the role of master problem-solver to those who are closer to the problems to be solved under the guidance of Lean consultants specialized in healthcare.

Lean, in a sense, turns leadership upside-down, with frontline workers doing much of the innovating and managers trusting them to do it – and supporting them. Respect for the potential of frontline workers to have the brainpower and commitment to improve the work must pervade the organization. Respect flows downward, not just upward.

Lean can drive an organization to a high level of efficiency. It will improve effectiveness. It doesn’t just save time; it reduces costs. The tools are pretty simple. Many of them are visually based. They are common-sense things used in uncommon ways:

  1. Defects/Mistakes. Includes time spent inspecting or fixing errors. Example: an item missing from a surgical case cart. Administration of incorrect medications. Hospital-acquired conditions.

  2. Overproduction. Includes doing more than what is needed by the patient, or doing it sooner than needed. A broad example of this is the performance of unnecessary diagnostic procedures.

  3. Transportation. Unnecessarily moving patients, specimens, or materials throughout a system is wasteful. This type of waste is evident when the hospital has a poor layout, such as a cath lab located a long distance from the emergency department.

  4. Waiting. Patients in waiting rooms (or exam rooms). Staff members with uneven workloads waiting for their next task. Emergency department patients and physicians waiting for test results. ED patients waiting to be admitted to the hospital. Patients waiting to be discharged once medically ready.

  5. Inventory. Waste created by excess inventory, storage, and movement costs. One example is letting supplies expire and then disposing of them, including out-of-date medications.

  6. Motion. Do employees move from room to room, floor to floor and building to building more than necessary? That accounts for one type of waste. Example: lab employees may walk miles per day due to a poor hospital layout.

  7. Over-processing. Describes work performed that is not valued by the patient or aligned with patient needs. Unnecessary paperwork. Consultation by specialists that are not medically necessary.

  8. Human potential. This waste is caused when employees are not engaged, heard, or supported. Employees may feel burnt out and cease sharing ideas for improvement.

It goes without saying that healthcare is one of the most complicated industries in which to build quality systems.
Gustavo P. Camarano, MD, PhD, CPC, CDIP, CHCQM

Gustavo Camarano, MD, is a noninvasive academic cardiologist who gradually migrated to a physician advisor position where today he is a physician advisor with Allegheny Health Network, working with denials management and clinical documentation integrity (CDI)

Previously, Dr. Camarano worked as a coder reviewer, obtaining CPC and CDIP certification, and undergoing training in conflict management and Lean Six Sigma certification in healthcare.

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