Lean is “Taking Canadian Healthcare by Storm,” but Look Out for “L.A.M.E.”


In an article (“Assembly required: Health care from the Toyota factory floor“) from Canada's National Post newspaper says Lean healthcare is “taking Canadian healthcare by storm.”

The piece leads with some work done by Windsor's Hotel-Dieu Grace Hospital – a member of the Healthcare Value Leaders Network that's co-facilitated by the Lean Enterprise Institute. HDGH reduced waiting times for the emergency department, as documented in the peer-reviewed Canadian Journal of Emergency Medicine (“Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department“).

From the journal article abstract:

Results: Our ED has achieved major improvements in depart mental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles

I'm still waiting to get a copy of the whole journal article.

But back to the National Post piece, there's this quote from an Ontario healthcare leader:

“I believe strongly that we are creating a new norm,” says Tim Burns, who oversees an Ontario government program aiming to apply the Toyota system to 90 of the province's hospitals by 2011. “There is evidence that it works. It's a pretty enduring fad.”

Good evidence – yes. “Fad”?? Hmmm…. there are some who are more concerned about the fad-ishness. As Lean gets popular, even trendy, there's more of a risk that we get more “L.A.M.E.” activity if people have more enthusiasm for Lean than knowledge (or if they don't have a good mentor or coach).
The article says that “red flags” are going up, among some, about “watered-down” versions of Lean that will not bring lasting change. From the piece:
“A lot of health-care facilities are getting ripped off,” said Tim Hill, a veteran Lean expert based in London, Ont. “There is a lot of hit and miss out there…. You need to instill a problem-solving culture, so you can get to the root cause.”
So what methods did HDGH use to improve E.D. patient flow?

Staff realized, for instance, that they needed to not only get patients into the department faster, but treat them and discharge them sooner, freeing up beds for other patients. One solution was to put the less-acute patients in a separate stream with their own dedicated staff. That way, the person with a sprained ankle would not be left waiting for hours while his or her nurse concentrated on the patient next door with chest pains.

Porters in the past escorted patients to the X-ray suite, but would only make the trip after collecting several people, bunching up the system. So the hospital painted directional lines on the floors that allowed a constant stream of patients to guide themselves to the imaging room.

And it's not just Windsor:
The Ontario government program has already implemented Toyota Lean at five hospitals in the Waterloo area, bringing about significant — if not dramatic — cuts in wait times and the number of patients leaving before being treated, said Kate Pengelly, ministry lead for the project.

Success with the system, though, is not universal. Prof. Carter acknowledges that Toyota Lean has become a “buzz word” that is not always properly implemented. But at least, he said, the concept has prodded health care to look for waste and inefficiency.

“The word is out there. Lean has lit a fire under people,” said Prof. Carter. “From that perspective, it's great.

I'll be in Canada Thursday and Friday, at St. Boniface General Hospital in Winnipeg, another member of our Healthcare Value Leaders Network. They will be hosting a number of us from different Network organizations to learn about some of their Lean improvement efforts.

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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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