Reflections on Almost 10 Years in Lean Healthcare
I often get asked, “How did you get into healthcare?” I was working on a chapter for a Lean healthcare compilation book that's being published in Holland and I wrote the following material that wasn't the right fit for that chapter, but I wanted to share below:
It has now been just about ten years since my interest in Lean healthcare was sparked by a visit to a hospital emergency room in Scottsdale, Arizona. Thankfully, I was there as a visitor, not a patient (no offense to the hospital, I'm just glad to not be a patient anywhere). At the time, I worked for Honeywell, a global manufacturing company, in a “Lean manufacturing” role. Within the Phoenix area, we had an informal network of Lean practitioners from different companies who met quarterly to discuss Lean and to do a “gemba walk” at one of our facilities.
In early 2005, we had the opportunity to visit Scottsdale Hospital to see how Lean was being applied in the emergency department. The efforts were being led by two women who had left Motorola, bringing their Lean and Six Sigma experience with them. I was impressed with what I saw and it opened my eyes to the potential of Lean in healthcare.
Although it was the very early days of Lean in healthcare, I tried reading as much as I could find on the internet about the challenges faced by hospitals and health systems and how Lean principles were being applied (or could be applied, as the hypothesis would be stated). This interest and research led to me taking a new job, with Johnson & Johnson, as part of a consulting group that helped introduce Lean to hospitals through training classes and project work.
In 2005, when I started that job, we still spent much of our time trying to convince people that Lean would be applicable to healthcare. Much of the early convincing took place in hospital laboratories, which was somewhat natural since labs are more like a high-tech factory than other parts of a hospital. Even if laboratory directors weren't interested, at that point, in Lean as a management system, they were greatly interested in the results that early adopters of Lean in labs had achieved, including 30 to 70% reductions in test turnaround times, improved productivity, and reduced error rates.
While there was a fair amount of interest from the labs and hospitals in “cost cutting,” our work at Johnson & Johnson was based on a commitment that nobody would lose their jobs as the result of Lean. To use Lean to drive layoffs would ensure that people would not participate in the Lean improvement process. Instead, we used Lean to reduce spending on supplies and reagents and to increase the volume of lab testing that could be done without hiring more staff. There was also great interest in improving quality – both through reducing turnaround times and reducing labeling errors and the like.
Over time, Lean became established as the new “best practice” in laboratory medicine. We then spent time, as others did, convincing other parts of the hospital that they could also use Lean methods and management practices to improve patient care and performance in many dimensions.
It's easy for healthcare professionals and leaders to focus on how they are different than manufacturing. Yes, it's true that healthcare is very different than manufacturing in many ways, but that means that we need to, if anything, figure out how to adapt Lean thinking to healthcare instead of making excuses that prevent us from trying.
Even as Lean spread within healthcare, different disciplines and departments would often focus on how they are different. If Lean had been adopted initially in the core clinical laboratory, the microbiology and histology areas might complain that they are different in their volumes and processes. Areas like the emergency department or radiology could argue they are different than lab because they directly interact with patients more often. But, we've found and proven, in practice, that Lean principles are robust enough to solve problems and improve the workplace in many different environments.
With all of the books, case studies, and journal articles published over the last ten years, we have moved beyond the early days when the primary question was, “Can Lean work in healthcare?” That question has been definitively answered as a resounding “yes.”
We now know Lean can work in healthcare, but the question today is more specific to our own organization – “can we make Lean work in our organization?” The answer to that question depends on the leadership that's present (or not present) throughout the organization. Lean can work, but that does not mean that it's guaranteed to work in any given situation. That's, perhaps, the challenge for the next decade… helping people understand what's necessary to increase the likelihood that Lean will be successful, meaningful, and sustainable in their own organization.