Deploy the Lean Healthcare approach to an entire hospital?

Deploying Lean Healthcare is regularly discussed. The 2020-2021 pandemic has brought back to the forefront the difficulties experienced in health services. And some see in Lean the miracle solution. After all, this methodology has yield great results in many sectors.

What is Lean and why Lean?

The Lean approach was invented by Toyota. It has since been rolled out to all of its factories and support departments.

Lean consists of a philosophy, methodologies and tools. Lean is used in the sense of minimalist, uncluttered. Il s’agit de se questionner sur les opérations et de les optimiser pour livrer la valeur au client. The key concepts of Lean are

  • The customer is at the heart of the process. The value is expressed from the client’s perspective.
  • The operational teams guide the process: they know best.
  • It is a way of thinking, rather than tools. Everyone is concerned.
  • Improvement is a continuous process, it is a journey rather than a destination.
  • There are no wrong questions, everything can be challenged and questioned, to see if there are better options.

Toyota’s goal was to produce more vehicles faster. Toyota wanted to lower its development and production costs in a highly competitive environment: the automotive market. It is now one of the only brands that produces and sells its models around the world.

Hospitals face other constraints: the global shortage of nurses does not help in the daily work. The Lean approach is then a quality service issue. Indeed, it will improve both the service to the patient and the staff’s working conditions.

Lean Healthcare in hospitals, not so new

Back in 2010, CSSS (Center for Health and Social Services) Val D’Or published two press releases on the subject. A first explained the results obtained in his emergency service. The Lean Healthcare approach reduced waiting time to less than 3 hours for 70% of users. While others still had to wait less than 5 hours. The approach focused on different aspects, such as the division of tasks between the different parties involved or the spatial organization of the services. Encouraged by these results, the CSSS indicated its intention to deploy the approach to all its services.

In January 2012, I participated in a first conference on the implementation of Lean in health centers. One of the main speakers was Mark Graban, author of a book on the subject.

Setting up Lean Healthcare is a time-consuming process. If management has decided to implement it throughout the CSSS, it is that the return on investment is excellent. And it is, but as with all tools, there are precautions to take. A knife and fork help to cut food, but can become weapons and kill, intentionally or not.

The key difference in Lean Healthcare

Lean can be applied in industry (Lean Manufacturing), in services (Lean Office) or in health centers (Lean Healthcare), the philosophy is the same. The approach and tools are similar. What changes is the context.

It’s obvious, but always good to repeat… A patient is not a car. In industry, humans and robots transform objects. In services, it is humans transforming humans. Even if a certain number of things can be standardized, the emotions, the personal history of each person impacts the service offered.

The patients’ need is simple: to be cured. The performance and improvement of medical and care practices is a separate field, with methodologies validated by the Health Authorities.

Le Lean Santé s’intéresse à ce qui se passe autour des soins. It empowers field teams to improve their work. They know best what is not working, what is problematic. Whether it’s a one-time glitch, or a long-standing problem, we skip the finger-pointing and the blaming. The team focuses on what it can do to correct or reduce impacts in an iterative process.

Concepts that can help health services quickly

  • We have problems, but don’t know where to start: first ask yourself if you need measures to decide, then remember that perfection is not the target. Take a problem, fix it, then do it again.
  • We do not have the skills to improve things: it is the ones who perform the activities who can improve them. With the A3 or 8D, you can solve any problem.
  • Staff are tired of running around: a spaghetti diagram to identify recurring routes and efficiently reorganize the different areas.
  • We never find what we are looking for: the 5S, to store and organize materials, consumables and documents.
  • We spend too much time in meetings and not enough time in the field: decline invitations and reduce invited participants.

I am convinced that the philosophy, methodologies and tools of Lean Health can bring a lot to the health system. But as with any tool, it must be used with the right intentions. And since good intentions are not enough, we must ask ourselves what our actions bring to the organization.