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"Leaner, but Not Meaner" – In a Hospital


Leaner, but Not Meaner |

It's always nice to see a headline NOT using the cute (but usually inaccurate) “lean and mean” construct. It's especially nice to see it in the context of a smaller hospital, Meadows Regional Medical Center, an 87-bed hospital in rural Vidalia, Georgia.

First off, the results:

Since 2005, when Meadows Regional first applied lean operating procedures in its emergency room, the average length of stay for ambulatory ER patients has been cut by 44 percent. That in turn has led to a 10 percent boost in the number of ER patients who received care, a likely contributing factor to patient satisfaction scores that have soared above 90 percent.

“Literally, all we've done is taken an established body of knowledge and applied it to a very high-cost, difficult environment,” Kent says, referring to Toyota's renowned principles of lean production.

The improvements, facilitated by Georgia Tech, were a combination of employee ideas (from cross-functional input… an important element to help break down hospital “silos”) and more technical elements (such as electronic medical records and better patient “visibility” – in an electronic sense).

“When people see improvements are possible, it changes their attitude about making suggestions,” Kent says.

The culture of hospitals is for cost-reduction or process-improvement projects to get initiated at the top, and then get pushed down lower in the organization. It is a model that critics say often leads to projects dying before they can be implemented.

“Our approach is to involve front-end people in coming up with ideas, so that they have some ownership of the lean process,” says Frank Mewborn, the project manager who facilitated Meadows' lean team. Mewborn is with the Healthcare Performance Group, a newly created part of Georgia Tech's Enterprise Innovation Institute.

The “old” top-down model is more likely to be “mean” than true Lean efforts. Other than soliciting suggestions, it sounds like classic Lean analysis and process observation methods were used:

Mewborn helped Meadows' employee team analyze every activity used when patients are admitted to the emergency room. The goal was to identify which processes contribute value to patients and which ones don't.

Once wasteful processes were identified, the team's next chore was to devise a plan to reduce or eliminate them. Using the scientific method of learning, they also were instructed to analyze the potential impact before making any changes.

Great stuff. More evidence that Lean works in hospitals. It's also more evidence that, when Lean is done properly, Lean is Lean. Involve your people, look at the process, identify waste, solicit ideas, have the management and leadership required to help persevere, and measure your results. Congrats to Meadows – I hope they are able to keep it up.

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Mark Graban is an internationally-recognized consultant, author, and speaker who has worked in healthcare, manufacturing, and startups. 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 book is the anthology 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. He is currently writing his next book, tentatively titled Measures of Success.

1 Comment
  1. Dean Bliss says

    Good stuff, Mark. I hope the examples keep coming – we have a chance to improve healthcare delivery in America with these tools, and every time I see an article like this, it tells me we’re on the right track.

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