More Efficient, More Effective: Going Lean in Health Care
By Jean Hardiman
In 2012, HEALTHMEDX, a provider of information system solutions, reported that for every dollar spent in health care, more than 75 cents was being spent on the non-patient care activities of communicating, scheduling, coordinating, supervising and documenting care. According to the organization, waste in health care ranged between 30-40 percent nationally.
Officials at Cabell Huntington Hospital (CHH) knew they could do better, and in 2014, the hospital established a lean transformation program that has led to thousands of dollars in cost savings along with improved patient care and satisfaction.
“The lean philosophy is that the people doing the processes should also improve the processes, so at Cabell Huntington Hospital, we engage multidisciplinary teams of employees and physicians who are actually performing the processes to analyze and devise improvements,” says Keith Biddle, CHH’s lean manager. “We dedicate the time necessary to analyze our processes because, in the long run, well-designed processes save time and effort and improve quality. That way, our employees and physicians will spend less time and effort working around problems and instead spend more time and effort adding value to the experiences of our patients.”
Toyota’s Lean Success
The lean philosophy has been working for Toyota for decades and was implemented along with the founding of the Toyota Motor Manufacturing West Virginia (TMMWV) plant in Buffalo in 1997. There are two main pillars of the Toyota Production System, or TPS, according to Charles Jarrell, assistant manager for training and development at TMMWV: just-in-time delivery and jidoka, a form of error-proofing that involves stopping work quickly to find the cause of a problem and develop a solution.
According to Jarrell, the company only produces the product it needs, when it needs it, in the amount that is needed. The company runs very lean, and when a machine needs a part, it stops on its own, and the line is stopped so the problem is not passed along.
“Everything we do is a commitment to TPS,” says Jarrell. “You’d be surprised at how little inventory we have and our high frequency of deliveries. We have external trucks set up to run more frequently and internal trucks set up to run parts from one area to another. It forces us to do problem solving on a daily basis. We don’t have the inventory to cushion our mistakes.”
This leads to the practice of jishuken, which is a term related to studying and solving problems. “We identify a small worksite with a problem, and we put together a multidisciplinary team of usually 10 or 12 members to study the problem quickly. They report out in four and a half days, and then we make physical changes to the shop floor to address the problem,” Jarrell explains.
He remembers when the company was changing its model for V6 engines and officials realized how many extra parts the new model had. They determined they needed 40,000 additional square feet to store them. The projected cost was $1.6 million, and senior management said no. They then came up with a way to implement direct-to-line delivery.
“Now we pull stuff straight off the truck and bring it to the assembly line,” says Jarrell. Since then, TMMWV has reduced inventory by $800,000.
Growth has been the biggest impact of utilizing this philosophy. Twenty years ago, the West Virginia plant started with 300 team members and one model line. Today it has 1,300 employees, three engine lines and two transmission lines with a third on the way.
“It’s not necessarily easy,” says Jarrell. “The struggle that a lot of manufacturers have is that you do have to solve problems. It requires a commitment and discipline. Some people who try to apply the lean concept fail because they don’t have the discipline.”
Health Care Applications
In health care, the lean concept can be used in both the clinical areas involving direct patient care and the non-clinical areas that impact the experience and satisfaction of patients and their families. Using lean, CHH has improved its tactics for multidisciplinary patient care, which involve physicians, nursing staff, physical therapists and social workers caring for patients efficiently, and it has improved the logistical process for notifying staff that a patient room is ready for occupancy. According to Biddle, both changes have positively impacted the experience and satisfaction of patients and their families, as well as the hospital staff.
At CHH, utilizing a lean philosophy includes hosting lean events and training activities. For example, the hospital has conducted various process improvement events in major areas— also known as value streams—of the hospital’s organization. These are the same type of team-based, problem-solving efforts used at Toyota to analyze a situation and develop initiatives to create an improved future state. To date, CHH’s events have involved 750 employees and physicians.
Along with these events, there have been other educational endeavors to train employees in lean practices. Some employees have become lean facilitators who conduct small-scale projects in their departments, which has led to improved processes in more than 30 departments, from medical units to patient transport to housekeeping.
The investment of time and resources into incorporating the lean philosophy has been worthwhile for CHH. One financial benefit the hospital has seen has been a 19 percent reduction trend in total expense per operating room from July 2014 through June 2016. Another benefit has been an improvement in CHH’s Hospital Consumer Assessment of Healthcare Providers and Systems’ patient satisfaction scores through August 2017. These improvements were reported on key indicators like the overall hospital rating, patient satisfaction with communications by nurses, responsiveness of hospital staff, communications with doctors, management of pain and communications about medications.
“Small-scale lean facilitator projects have resulted in $450,000 in one-time expense savings and increased revenues and $550,000 in annual expense savings and increased revenues,” says Biddle.
Meanwhile, the hospital also makes an effort to reduce wasted items.
“We always try to reuse or repurpose anything we can: furniture, fixtures, flooring, lights, ceiling grids, et cetera,” says Tim Martin, vice president of hospital operations at CHH. “When we approach any project, we consider ways to enhance the new product and drive efficiencies and standardizations, which are the cornerstones of our lean process. In this way, the end user has a better organized and productive space, enhancing their productivity, which in turn is an economic and satisfaction win for our staff and customers.”
Biddle agrees that a commitment by senior management all the way down through each department is important.
“A successful lean transformation program requires the vision and support of leadership,” he says. “Our CEO, Kevin Fowler, came to CHH four years ago with a vision to improve our processes to increase the effectiveness of our operations and the experiences of our patients through the lean transformation program. His ongoing commitment and support of the program has accounted for its success.”