Friday, July 20, 2012

No hype on Lean

I sometimes hear skepticism from hospital CEOs who are presented with the idea of adopting the Lean philosophy for their institution.  "Why does this feel like a religious sect?"  "I have no interest in learning Japanese."

Putting aside the ethnocentric context for the latter statement, in that the philosophy was actually introduced to the Japanese by W. Edwards Deming, let's admit that Lean is not for everybody.  But let's also acknowledge that it can make a huge difference for hospital staff and patients when it is undertaken carefully and in good spirit, with commitment from senior leaders.

Here is a short and thoughtful summary of some experience to date, an article in Hospitals and Health Neworks by Steven Garfinkel based on research conducted for the Agency for Healthcare Research and Quality.  The bottom line:

At every institution, staff at all levels reported improved employee satisfaction. They cited opportunities for front-line involvement in problem solving, employee collaboration across ranks and units, efficiency improvements, opportunities to spend more time with patients, and improved patient experience. 

Not surprisingly, cost-benefit ratios and return on investment were never explicitly considered when the organizations we studied adopted Lean. Instead, senior executives were committed to improving quality and efficiency. They adopted Lean because it was tractable — particularly when reliable estimates of cost and benefit were difficult to make. Once leaders adopted Lean, none paid much attention to implementation costs. Top managers saw Lean as part of an array of available quality-improvement tools. All said they were pleased with Lean's results. They viewed Lean as yielding long-term process and quality improvements that enhanced their institution's efficiency and financial viability.

We cannot be sure that Lean is more effective than other process improvement techniques. But we did find that Lean can be successfully adapted from manufacturing to fit the complexities of health care.

1 comment:

Mark Graban said...

I'm glad AHRQ is studying Lean and they are concluding that it's good for staff morale and for patients.

One comment I had posted on that blog post is about their definition of the word "kaizen" -- they got it wrong.

I'm glad to hear that AHRQ is studying the applications of Lean in healthcare. I hope this leads to greater adoption of this management system that helps improve quality and safety, while reducing costs, and improving staff and patient satisfaction.

There is one unfortunate misnomer that has really spread throughout healthcare and it's repeated in this article - the idea that "a kaizen" means a 3 to 5-day event.

So-called "Kaizen Events" (otherwise known as Rapid Process Improvement Workshops or Rapid Improvement Events) have been very popular and very helpful in healthcare.

The word "kaizen" means "change for the better" and originally really meant the context of ongoing continuous improvement - small improvements that don't require a formal project. More and more organizations (including Virginia Mason and ThedaCare, which are famous for their events) realize the kaizen is more than events -- it should be happening in small ways every day, everywhere in the organization.