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.
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.