Lean Healthcare in Ohio


I found a few articles lately about Lean being implemented in some Ohio hospitals, so I'll share two of them here.

Crescent-News.com – Hospitals headed to the ER?

This first article focuses more on the problems faced by Ohio hospitals in the economic downturn. Beyond the pressures placed on them by payers and falling elective surgery demand, the state of Ohio has placed an additional tax on them.

According to the Ohio Hospital Association, about 35 percent of Ohio hospitals have already laid off employees or will do so in the next six months. The franchise tax is estimated to cost Ohio hospitals about $600 million with about $187 million returned to them over 18 months.

In five area counties, some hospitals are cutting people and construction while others are only spending dollars that are absolutely necessary. Some hospitals are facing even more grim decisions about their future.

Spending dollars whenever just absolutely necessary is normally a good idea. Thankfully, Lean is a strategy that can be used to avoid adding space or adding more staff. Every hospital I've worked with has had leaders or staff who think every problem can be solved by adding more people and more space. Now, if we were implementing Lean, we wouldn't want to use the productivity improvements to drive layoffs — we can find other operational ways of reducing costs so we don't have to fall back on demoralizing layoffs.

One hospital administrator mentioned using Lean:

“On the positive side,” Sutton explained, “our staff is actively engaged in lean management projects that improve efficiency and cut costs while at the same time improving service to our patients. These are challenging times, and we are committed to maintaining the highest standards of care for our patients and being fiscally prudent in order to maintain jobs and benefits for our employees.

I'm happy that the article didn't just portray Lean as a cost cutting strategy. Sutton has it perfectly correct – efficiency and service improvement go hand in hand with Lean.

Ohio.com – Akron Children's adopts lean operating strategies

From Akron:

When sterile processing technicians couldn't keep up with the demand for clean surgical instruments at Akron Children's Hospital, the only option appeared to be a $3.6 million expansion.

Here we go again, the “only” option was expansion. Until they found Lean.

They used a week-long kaizen event to improve the layout and process, leading to dramatic improvements. They boosted capacity by about 25% through simple means:

The ideas were simple and cheap — things like knocking out a half wall for more visibility, hanging up signs to let people know where supplies go and assigning workers specific tasks each day, rather than having the same people assemble equipment and then deliver it.

They improved the layout, they assigned better standardized work. Great stuff. And, they found out they didn't need more people, after all! The manager said:

”We didn't need more FTEs,” he said. ”What we needed was to redesign. . . . The staff members, the team, we're the ones who solved the problems.”

Let's repeat that over and over… we didn't need more people…. we needed to fix the process. And the people working in the process are the ones who can fix it (given some Lean training)!

As I've written about before, I have my concerns that a week-long kaizen event would really lead to sustainable solutions and processes that don't backslide to the old way.

The article and the consultant they used had an interesting way of breaking down their use of Lean and Six Sigma:

The Lean portion of the program focuses on getting rid of ”waste” to improve speed and quality, Dulin said.

Hospital customers — patients — face waste when they spend time waiting for procedures or moving from room to room for tests, he said.

The Six Sigma concept encourages employees to get rid of variations in the way things are done, Dulin said.

Participants use a system known as ”DMAIC,” which stands for define, measure, analyze, improve and control.

”We can improve the patient experience by reducing those nonvalue steps that those patients have to go through,” Dulin said.

Yes, Lean is focused on reducing waste in the process — for efficiency AND quality. I'm glad they didn't say Lean was only about speed. To say Six Sigma “encourages employees to get rid of variations in the way things are done” also sounds like Lean and standardized work again. Reducing nonvalue steps also sounds like Lean… so what are they really doing with Six Sigma again? Maybe the writer missed that. But it all sounds like Lean to me!

Akron Children's has been using Lean since last year, the article says, and they estimate that 10% of hospitals are using the methodology (I told you I didn't believe the ASQ survey that claimed 50%). They have learned that you have to work on redeploying staff (not using layoffs) and that Lean has to be a cultural change. Their early results are encouraging:

The hospital has spent about $248,000 on consultants and to train staff in the Lean Six Sigma strategies.

The investment already is reaping major rewards in terms of savings and improvements throughout the hospital, Watson said.

The first 28 projects saved the hospital an estimated $708,000 a year and eliminated lots of wasted time, Watson said.

Good news from Akron!

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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