Lean Healthcare Examples from Seattle and the UK

This linked article (“Lean cuts Healthcare Costs at Virginia Mason Hospital in Seattle“) summarizes improvements and Lean methods at Seattle’s Virginia Mason Medical Center and at the UK NHS Royal Bolton Trust hospital.

Much of the VMMC story has been told before, but it’s always good to read.   I’ll comment on a few aspects of the article:

  • “Kaikaku” versus “kaizen events” terminology
  • Reducing length of stay
  • Another instance of “3P”

The article talks about week-long events at the hospitals:

As with the Virginia Mason hospital, Bolton [in the U.K.] has used the kaikaku technique for implementing rapid change. These multi-disciplinary workshops aim to fix a problem in just five days with the new system up and running by the following Monday.

Most everyone in the lean world knows the term “kaizen” – a Japanese word that’s translated as “change for the better” or more commonly as “continuous improvement.”

Week-long events are often called “kaizen events,” which has always seemed like a misnomer to me. An event is by nature non-continuous. “Kaikaku” (a term used by Norman Bodek and for his book of the same name) means “radical kaizen” or dramatic improvement.

It seems that week-long events should be called “Kaikaku Events,” followed up with kaizen after the week is done. Lean is about daily improvement, not just events. We need both kinds of improvement. Even the terms “Rapid Improvement Events” or “Rapid Process Improvement Workshops” are better than “kaizen event” in my mind.

Here is one trap of the events approach, from the article:

The idea is that by Friday all the problems will have been solved and a new method of working will have been discovered and implemented ready to begin the following week.

Do we really “solve” all problems in just one week? Do we really jam in improvements in just a day or two at the end of a week and hope for sustainment? Terminology aside, this is one of the problems with events – they often don’t get the input or involvement from staff members who work on night shifts, those who work on weekends, or those who weren’t there that week.

It’s often said in kaizen events (I mean, kaikaku events) that “standard work is written and put in place on Thursday.” But what about the people who weren’t there on Thursday? They get no say? That might be the case, especially if there is no process for kaizen in the weeks after the event.

When changes are rushed, it’s no wonder that people don’t buy in. People own what they help create. A “write standardized work on Thursday” might work in a simple manufacturing operation where you only have one shift Monday through Friday and ALL people can participate in the event. Healthcare is hardly that simple. One week might be too short of a time frame to drive meaningful and sustainable change.

The Bolton case talks about reducing length of stay, a common Lean improvement measure:

Lean has also been successful in decreasing the length of time inpatients stay in the hospital from an average of 34.6 days to just 23.5.

That data really needs some context, as a typical American length of stay is 4 to 6 days, depending on the hospital and the type of patient.

Finally, the article mentions “3P” (Production Preparation Process) work done at Bolton, similar to what I wrote about at Boston’s BIDMC (via Paul Levy’s blog):

When redesigning the blood science laboratory at Bolton, the team even invaded the hospital’s car park and used cardboard cut-outs of the equipment to map their ideal positions in the lab. They have managed to decrease the number of physical steps it now takes a technician to process a patient’s blood sample. Fewer steps equal less walking time, which means a speedier service. Consequently, blood sample turnaround times have dropped by 90 per cent.

Once again, we see the cardboard mockups being a helpful method for creating an effective layout and process.

While the headline of the article talked about “Reducing Costs” with Lean in healthcare, it’s really about far more than that – it’s about quality, flow, and staff engagement, among other things – this is true in healthcare or any industry.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

3 Comments on "Lean Healthcare Examples from Seattle and the UK"

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  1. Dean Bliss Dean Bliss says:

    Good stuff, Mark. The whole kaizen/kaikaku discussion has created confusion, so to be honest, I don’t even bring it up when I’m talking to Lean beginners. But as we progress, I bring up the distinction to contrast one-time improvement efforts from a continuous improvement philosophy.

  2. Steve Martin says:

    I agree whole-heartedly…we need BOTH kinds of improvement. The underlying key concepts are CULTURE and RESPECT FOR PEOPLE.

    Respect For People is not a new concept…it’s a forgotten (ignored?) concept. Sad.

    YES! – We solve problems in one week. If we can solve them in 3 or 4 days…better. We jam in as many improvements as the team can implement without overburden. And we have FUN doing it!

    We do it to make our patient’s (customers) lives better, our co-worker’s lives better…OUR lives better. Career and life satisfaction.

    Such success can only be sustained within a culture of respect for people. Short-term success is achieved when we focus on ‘events’. For long-term success we need breakthrough thinking and continuous improvement, thriving within a culture that supports our efforts.

    The ‘one week’ provides context and focus. Our attitudes should be, “How can I help the team develop improvements that make everyone’s life a bit easier?” “What can we implement that would make the process better?” This week.

    We shouldn’t get hung up on the time-frame. Pick a ‘time for change’ duration and just start. Within the proper culture, you’ll discover the time-frame doesn’t matter anyway! Changes that used to take a week to implement now take a few days. BIG changes now take weeks, not months. Yeah!

    Changes need to be rushed. Not for the sake of rushing…for the sake of our customers. It doesn’t have to be taxing, overburdening, or at the expense of missing team members either. Long-lasting, deeply rewarding success is achievable within the right culture.

    People who KNOW they’ll have on-going opportunities to provide input and suggestions regarding newly implemented processes don’t fear change. They embrace change when they know they’re part of the continuing process.

    Lean isn’t about doing things TO people…it’s about doing things WITH people. Organizations that struggle with their folks ‘buying in’ after an ‘event’, don’t have an issue with implementing change…they have an issue with their culture.

    We need to respect the difference.

  3. Anonymous says:

    Yes it is possible to make lots of changes in 3 to 4 or 5 days. And sometimes we can even determine if the change has been an improvement. On the other hand, quite frequently the 3 to 4 or 5 days does not allow time to pilot, prevents coordination with key players, doesn’t give time to explore new findings, doesn’t allow for changes to IT systems, and frequently does not provide time to show that the change was an improvement.

    So even while we struggle to speed up time for improvement projects I believe that many improvement efforts don’t fit the 3-5 day model.

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