Tuesday, August 12, 2008

Surprising use of Lean

A note from one of our rehabilitation staff, who had gone through an exercise in learning and applying Lean principles in the occupational therapy clinic:

The Lean organizational concepts have been helpful for me with patient care and in one case recently in particular!

Recently I treated a young patient with early Alzheimer's who needs to organize home etc. to help him with memory impairments. It was very helpful to show him some of the ways we have organized our department to improve our efficiency, particularly with the labeling. I feel that those same concepts will be helpful for him to organize in his home environment as it needs to be extremely organized to help him with memory impairments.

I don't know if people elsewhere have used this approach in a therapeutic way and put this story out there to see if so and to welcome comments if you have. (Mark Graban or others, do you have examples of this from your extensive experience?)


Mark Graban said...

That's a great story. It sounds like they are referring to the "5S" methodology of Lean for workplace organization. Labeling the locations of items is just one aspect of that approach -- glad to hear it could be helpful for a patient.

I think that's the key... using the tool in a way that solves a problem.

Normally, the 5S labeling in a workplace (nursing station, stock room, etc.) isn't done because employees "forget" where things are. It's done to help make sure items are always put back or restocked to the same, consistent location. Same method, slightly different purpose (but again, I think that's the key... making sure the purpose it being met).

The fuller 5S methodology would ask "which items are used most frequently and in what point of use?" so the most frequently used items/supplies are kept right at hand. That's probably more useful for reducing the amount of unnecessary walking a nurse (or other staff member) does in a shift... might not have an exact application for the patient at home.

So, long story short, I've never heard of an example like that, but was glad to read about it.

Anonymous said...

Yes, Mark, 5S exactly. The 5S training has changed the way this therapist sees and thinks -- and then she was able to make the connection to this use to help the patient's own life!

Anonymous said...

This is a great post. The more I learn about the lean methodology, the more I see how it can apply almost any situation.

Anonymous said...

Hi Paul,

I like to think of LEAN as a great operating system for compassionate adults, given that its core philosophy is respect, so it doesn't surprise me that it has great uses in direct patient care.

In the work I do around patient and family involvement in care using health information technology, there are great applications for principles like one-piece flow, because we go from instructing patients to do 10 things verbally in parallel (most of which they forget within 5 minutes), to using teach-back and written information to verify understanding with 1-2 priorities, and providing contact online before and after to increase confidence in managing health.

That's the great thing about respect. It pretty much works in any environment.

Keep up the great work! -Ted

Anonymous said...

A great perspective, Ted. Thanks very much.

RalfLippold said...

Hi Paul,

it is great to see that "lean" doesn't necessarily stick just to the manufacturing area. It can be of great use in several fields and the described one is brilliant.

As I am moderating a group around Lean Thinking with a special forum on Healthcare could be perhaps bring new insigths and ideas to adapt in the clinical environment (http://www.xing.com/net/lean).

Thanks a lot for your work and enthusiasm (just watching the lecture at MIT you gave a while ago)


Anonymous said...

I imagine they're quite helpful with hyperactivity and attention deficit in children. Also, have you ever seen what parents of multiples have to do!?

Anonymous said...

I am Occupational Therapist working in long term care who recently was introduced to your blog by my daughter, an Industrial Engineering student who works daily with lean principles. And lo and behold it appears that I am often unknowingly practicing lean strategies with my patients cause it just makes good sense. For example ... yesterday just in rearranging a new knee replacement patient's room setup I managed to save him 75% fewer steps to the bathroom, opened up more free space to decrease risk of falls and made a more comfortable easy space for his family to sit and visit with him while also creating a better feng shui type of energy flow to the room. In fact it was quite startling that almost immediately after the room was rearranged the patient lay in the bed with his hands clasped behind his head smiling while his son & dtr sat in a circle near the foot of his bed also joking and expressing easy conversation. Prior to this scene when I had first walked into the room the patient was wincing in pain and tossing side to side trying to get comfortable and manage to talk to his son on one side and his dtr on the other. Sometimes I swear the best medicine isn't medicine at all but just sharing your compassion, intelligence and awareness to do the right thing to ease the patient's stress. It's like setting the stage for them to start healing rather than contributing to more chaos & confusion to wear them down. Don't know quite how to say it in "lean language" but you don't have to convince me to how powerful it all is! So proud of you for promoting the same with all of your clients and peers.