Lean Management Approaches in Healthcare Systems
Lean management systems were developed some years ago and have evolved substantially since the first years when they were applied at Toyota. The principles are based on
1) value specification;
2) identifying value streams;
3) continuous value development and making value create flow;
4) maintaining the system driven by customers (internal and external to the system);
5) striving for perfection.
This approach has delivered good results, and the implementation in health care systems has offered substantial benefits that include cost reduction and an increased quality of care. Patient flows and organization of trajectories in health care systems, both of patients and of organization collaborators, demanded some benefits from the lean approach perspective, especially to eliminate waiting lines, excessive amounts of physically moving the patients, and wasted time.
Lean approaches are more and more common in emergency services and, even if indirectly, triage systems will need enablers and/or lean management facilitators. In line with this reasoning, reducing the amount of time patients spend in the health care facility is critical and motivates some planning and integration of activities. If the space available at the health care unit is constantly evaluated as being insufficient and the number of health care professionals is insufficient to serve the patients, lean management principles should be used to find solutions.
There are two sets of practices that should be re-evaluated and/or redesigned. First, these six issues (6S) must be confronted:
Sorting;
Setting in order;
Systematic cleaning;
Standardizing;
Servicing;
Improving Security.
Next, the waste-avoidance approach must be taken, which includes grappling with seven issues:
1) overproduction – too much or too soon;
2) defects and frequent errors;
3) unnecessary inventory, excessive storage, and delay of information about pharmaceuticals and consumables;
4) inappropriate processing – using the wrong set of tools, procedures or systems;
5) excessive transportation – excessive movement of people, information, or goods;
6) waiting – long periods of inactivity followed by intense periods of activity;
7) unnecessary motions – poor workplace organization of health care facilities.
Alternatively, or in parallel, the guidance provided by the following eight principles of the lean management philosophy would balance the available space with the scarcity of human resources in health care services:
1) the purpose of each activity should be aligned with the overall purpose of the organization;
2) considering all the processes, direction, core or enabling processes,
3) personnel, an area often misunderstood in lean management and that should include leadership,
4) pull, including pull-based delivery, pull improvement, and pull based-training;
5) prevention, ie, avoiding the excessive focus on tools and techniques;
6) partnering, escaping from island companies, or island territories and departments;
7) caring for the planet by providing green practices/approaches;
8) an attitude of perfection, which is the “holy grail” for lean businesses and management.
Together, these principles of the lean management philosophy have been presented as means to overcome the initial fifteen industry-centred problems.
Lean management principles, its philosophy or approach, may be applied at several points in health care practices, namely
in the redefinition of internal processes;
in the standardization of diagnostic systems;
in the standardization of work;
in communication processes;
in the preparation of preventive programs;
overall in health care programs aimed at the general public.
Among the practices just listed, those most frequently reported are patient flow reorganization and the application of a type of just-in-time approach to processes directly involving the patient. The reason for this is the capacity of these practices to achieve targets imposed by national healthcare systems to reduce the time spent by patients in hospitals, making it possible to free up beds needed for other patients. Their usefulness is also evident in emergency services, where the application of such practices leads to smooth flow, and also are having an impact on the reduction of resource consumption, accompanied by cumulative patient satisfaction.
It is also worth noting that these practices help to eliminate duplication of work, enabling professionals to devote more time to their patients and speeding up treatment and recovery, thereby allowing institutions to put patients first, at the center of care and focus on the real primary activities of the value chain of a health care provider.
The real-time effectiveness and efficiency of applying lean thinking and practices to the health care sector by the excellent results achieved, the main results of the implementation of lean approaches in health care services are
improved operating results,
increased quality of the services provided,
reduction of waiting times,
increased patient satisfaction
Always accompanied by cost reduction.
According to data from the American Society for Quality, the facilities that make the most use of lean principles are operating rooms and emergency services, because the operations and processes that occur there are those where value added is most significant from the patients’ perspective. It is ironic to contemplate, and this phenomenon is much more evident in Latin cultures, that when patients are attending an emergency service they know already from the outset that they will have to wait some hours before being seen by a medical doctor. As a result, a number of hospitals, particularly central hospitals, have adopted lean principles as a toolset to reduce problems experienced by emergency services, with excellent results in reducing waiting times and avoiding overcrowding in certain sectors, as already discussed