DW: Lean healthcare is the process of improving patient satisfaction and streamlining your processes to increase productivity and eliminate waste in your office.
It's based on the Toyota Production System, otherwise known as TPS. The seven wastes are identified as waiting, defects, motion, inventory, overproduction, transportation, and processing.
NC: Can you describe each of these seven wastes?
DW: The first one is waiting or wasting time. The goal here is simply not to waste time. By involving employees, they're able to make sure that there's no downtime in their day. Everything is planned out and scheduled. This is not only true for employees, but for the patient as well. Elimination of waiting is the goal.
One of the areas that's often addressed is waiting time for a patient. While we want our waiting or reception area to be comfortable and pleasing to the eye, our goal should be to have the patient spend as little time as possible in that area.
Another example would be the telephone. How long is the wait time when a call comes into the office? How long does it take to reach a live person? These activities should be monitored to determine whether or not it's taking more time than needed.
The second area is defects. Defects should be reworked or repaired in a timely manner. Whether it's proactively maintaining equipment to prevent breakdowns or to fix equipment quickly when there is a breakdown, the goal is to keep equipment running effectively.
The services that you offer to the patient should also be defect-free. Patient safety is another area to be addressed for defects.
The third area is the elimination of unnecessary or excess motion. Movements need to add value to what you do in the practice. Again, this is both for personnel and for patients, whether it's the traffic flow of a patient, the movement of a paper file in the office, or the way a staff member does his job.
An example of this might be the way the receptionist handles a given situation. Let's say that a patient comes in to the office. Something's happened and he's in a huge rush. He's asking the receptionist if there's any way to get in and out quickly. The receptionist said that she'll talk to the clinical staff and see what she can do.
One option is that the receptionist can leave her post at the front desk, walk to where the nurses' area is, and discuss the situation. This way involves time-consuming steps and motion.
Now, if the staff had instant messaging, IM, the receptionist might IM the nurse, explain the situation, and get a response. It's quick and it's easy. The flow of traffic and movement must work.
The fourth area identified is unnecessary inventory. In Toyota's case, they manufactured what they needed when they needed it. The same holds true here. Order the supplies that you need for a given time period and keep just that amount or a little bit more on hand. There's no need for overstock.
I remember walking into an office a while ago, and when I looked in the storeroom there was enough toilet paper and Kleenex to last five years. I asked the office manager about it, and she said there was a paper sale. There is a limit to how much extra stuff should be on hand.
Next is production. Produce what you need when you need it. Now, depending on the type of facility you are, this may or may not apply quite as extensively. Laboratories and pharmacies often need to find ways to produce only what they need. In addition, in an office, it may be something as simple as running copies or some kind of papers off the computer. Why would you run 500 copies when you only need 100
Materials, stock, and people should be transported as needed. Therefore, the next area to focus on is needless transporting. Consider, for example, where the patient is in the office and where they need to be. If they're in the exam room and they need to go into the laboratory area, will they go straight there or will the patient be asked to go back to the reception area first? What is the patient flow and what makes it work?
Finally, eliminating inappropriate processes is important. A process has to add value. Removing inefficiencies and simplifying processes will make more time for patient care.
An example of this might be the filing or scanning of lab and test results into the chart or the computer. When the physician goes into the exam room to see the patient, all the labs and testing results should be in the chart. If not, time is lost waiting for those results.
The process of getting results to the patient's file should be efficient and streamlined. An image center may schedule patients every hour, and barely be able to stay on schedule. Lean healthcare offers practices the opportunity to streamline their processes and still offer a quality product to the patient. Lean healthcare can be incorporated into almost every area of healthcare, not just patient care.
Greenbranch Publishing published one of the first books dedicated to Lean Six Sigma in Healthcare, authors Frank Cohen and Owen Dahl. To learn more about the book (available in print or eBook, click here.
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