It's easy for people to think that Lean is about cost-cutting. That would be wrong, but many people associate Lean with cost cutting.
Cost cutting is the old mindset. The old hack and slash approach, which focuses on layoffs or “everybody cut your budget by x%” mandates, dies hard.
It's easy for people to think that Lean is the new way of accomplishing old goals. But, again, that's not true.
If you look at the roots of the Toyota Production System, the two pillars are “just in time” (flow) and “jidoka” (quality at the source). Lean is very much a TIME-based methodology. Reducing waste often means reducing delays and interruptions. The process flows more smoothly, which often leads to better quality AND lower cost. But, cost is an end result, not a primary goal.
Lean healthcare focuses on improving flow – reducing waiting times and reducing delays in care. This, again, usually leads to better quality and lower cost.
Here are two videos that were shared by John Toussaint, MD in his keynote at the recent Lean Healthcare Transformation Summit (see my notes here). Both videos show “what good looks like,” as he says.
As Toussaint said in that keynote:
“Lean is NOT a cost reduction methodology.”
A “Model Cell” of Lean Surgery at Seattle Children's Hospital
I've seen this surgical center in Bellvue first hand and it's amazing. Built using “Lean design” principles, it rethinks the patient and family experience and designs the ideal space to support the ideal flow. Better flow means better patient care.
We see an example of “visual management” of the sign being turned when a patient and family are in the prep room:
It's a good example of real-time visual management that's used throughout the day. Visual management is not just charts and metrics on the wall. It's also any information that can be conveyed visually, to prevent miscommunications, to reduce the number of times somebody asks “is there a patient in that room?,” and to help people make decisions.
A red light in the prep room is a visual signal that the operating room is still being prepared:
Yes, the prep room, two prep rooms actually, is connected directly to the O.R. via a simple door)
Visuals, whether signs, lights, or electronic boards, are only useful when people are disciplined in their use.
A Lean ThedaCare Family Practice Appointment
John shared a more local and more personal video with the Summit attendees — a video showing the flow in primary care, as illustrated through HIS real appointment.
ThedaCare has lab equipment in the clinic so that his blood work is processed while he's talking to his physician. He gets the lab results DURING the appointment, instead of the usual routine of waiting a few days for results that the doctor's office may or may not call you about (my experience with my non-ThedaCare primary care physicians).
The value added time of most routine blood tests (hematology or chemistry) are just a few minutes. Most primary care offices can't afford lab equipment (which is especially true if it's a small practice), so tubes get batched up and sent to a centralized lab (often a third-party vendor) that processes them in big batches.
John also gets a clear plan of care that's printed out before he leaves. John arrived at 7:35 am ( “a few minutes early”) for his appointment and he was out of there by 8 am. That would easily be an hour-long visit for most of us and that's WITHOUT getting lab results.
That's flow. That's Lean healthcare.
Tweet of the Day:
Below average is not striving for EXCELLENCE – #VA "error rates for the lab are below national averages" http://t.co/8BZjvEMJQY
— Mark Graban (@MarkGraban) June 30, 2014
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