Lean Principles in Healthcare: 2 Important Tools Organizations Must Have

Lean Principles in Healthcare:
Two Important Tools Organizations Must Have

© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Lean Principles
Manufacturing organizations like automaker Toyota,
from whom a lean approach called “The Toyota Way”
originated, have developed amazing sophistication by
allowing frontline employees to participate in building
and honing processes.

Lean Principles
Lean is a proven, practical
approach to process
improvement in industries
such as manufacturing and
industrial engineering.
Applying it to healthcare,
however, can be much more
difficult. Many healthcare
systems have tried and failed
to implement lean processes.

Lean Principles
Based on our experience
working with scores of
healthcare organizations to
improve processes and
eliminate waste, we’ll outline
what worked best and share
some of the most successful
applications of lean tools and
principles.

Intelligence on the Frontlines
Lean is a counteraction to the
common top-down, command-and-
control approach to management.
In a lean organization, manage-
ment empowers employees to
define and then continuously refine
processes.
Lean organizations develop highly
specified and exact processes.
Employees own the process and
are encouraged to review and
continuously improve it.

The State of Lean in Healthcare
Healthcare is transitioning to a
value-based reimbursement, so
organizations have a pressing
need to fine-tune processes and
work waste out of the system.
Lean, touted for its ability to
remove waste from processes,
has obviously caught the interest
of these organizations.

The State of Lean in Healthcare
Some health systems adopt bits
and pieces of lean or invite a lean
expert to train their staff.
Either approach temporarily
translate to results or yield no
results at all; hence, the
skepticism about lean’s
effectiveness in healthcare.
The truth is, lean isn’t a magic
sauce. Lean works in healthcare
when it is part of a larger initiative
driving real cultural change.

Lean Principles in Cultural Change
Healthcare organizations shouldn’t
try to be lean organizations.
Instead, health systems should
approach lean in a practical way,
taking the pieces that work well
and applying those pieces in a
systematic way to help drive
cultural change throughout the
enterprise.

Lean’s focus on workflow efficiency applies very well to some
aspects of healthcare improvement, but not to others. This
diagram categorizes all work performed in a healthcare system.
Dr. David Burton
Dr. Burton is the Senior
Vice President, future
product strategy at Health
Catalyst)
Dr. Brent James
Intermountain Healthcare
Pioneered this healthcare-
improvement process.

Healthcare was divided into vertical
processes (the ordering of care)
and horizontal processes (the
delivery of care).
The vertical categories encompass
the full spectrum of care that
clinicians order for patients.
The horizontal categories represent
the work required to deliver the
care ordered by clinicians.

Improving the vertical processes
requires clinicians to order the proper
care for patients.
Improvement initiatives in these areas
don’t always lend themselves as readily
to the lean approach.
Lean may not offer the level of precision
needed to identify and develop superior
treatment guidelines and protocols.

Lean in Healthcare: Two Tools
To be successful within this
healthcare context, lean is applied
to improve the horizontal services.
Lean is pared down to bare
minimum concepts so people
within the organization completely
understand what to do and what
goals can be expected.
This approach borrows extensively
from Cindy Jimmerson, founder of
Lean Healthcare West, who has
helped pioneer the pragmatic
simplification of lean in healthcare.

Value-stream maps – process maps (for example surgery
workflow) reviewed at a high level to identify the best
opportunities for workflow improvement.

A3 diagrams – Once an improvement
opportunity is identified, the team
creates an A3 diagram.
A3 diagrams (named for the paper
size used by Toyota to create them)
are a simple problem-solving tool
designed for all to use—experts in
process improvement and non-
experts.
Example: Toyota A3 Diagrams

Successful Approach to Cultural Change
Although lean is a sound approach to
management, a broader healthcare-
improvement methodology is
necessary for organizations.
This approach can share many key
philosophical elements with lean:
• Highly specified processes
• A bottom-up approach to drive change
• Continuous process improvement
• Everyone works to update processes
• Servant leadership

Lean is usually implemented as a
set of tools and techniques, but
the tools and techniques have
only local, short-term success
without the foundational principles
that produced them.
Without organizational and cultural
adoption of these principles lean is
no more effective or enduring than
any temporary initiative.

Permanent teams organized
around a particular clinical or non-
clinical domain—rather than
around a project—can truly
improve care and sustain
improvements over the long term.
These teams create a continuous-
learning environment for each
clinical domain. As new
knowledge is acquired, it can be
integrated into care delivery.

The flatbed of the truck in this example represents the five
process-improvement implementation teams in the Clinic Care
support service. A guidance team with clinical and operational
leads drives the truck and guides the process-improvement
teams.
The guidance team is
ultimately accountable
for the success of the
initiative and has the
authority to prioritize
resources for each of
the five process-
improvement teams.

Principal resources allocated by the guidance team is
represented by the truck wheels – The technical support staff.
These are the knowledge managers, data architects and
application administrators who work with the teams to identify
opportunities for improvement.
The technical staff is
usually comprised of
data stewards, data
quality experts and IT
personnel proficient in
data capture.

The knowledge manager is generally a clinician with a
significant technical background. The data architect knows
SQL, translates the aim statements into metrics, and builds the
reports and dashboards used by the team to report results to
leadership.
These three technical
roles support the
physician, nurse, and
operational leaders of
each team as they
redesign care delivery
and eliminate waste.
*For a more in-depth explanation of this approach, we recommend this webinar by Dr. Burton

Sustainable Healthcare Improvement
As the industry transitions from
fee-for-service to value-based
reimbursement, many healthcare
organizations are attempting to
leverage lean principles as part
of their improvement initiatives.
Most importantly they are
beginning to understand that
true, sustainable change will
never become a reality without a
committed organization
dedicated to making it a reality.
Commitment and Dedication

More about this topic
How Texas Children’s Hospital Reduced Their Healthcare Labor Costs
Bobbi Brown – Vice President of Financial Engagement
Driving Out Waste: A Framework to Enhance Value in Clinical Care (HFMA)
Dr. David Burton – Vice President of Future Product Strategy
Quality Improvement in Healthcare: Where is the Best Place to Start?
Eric Just – Vice President, Engagement and Product Development
Reducing Waste in Asthma Healthcare: The Impact of Data
Anne Marie Bickmore – Vice President, Engagement
The Best Clinical Data Management Strategy To Reduce Waste, Clutter, and Inefficiency
Jane Felmlee – Director, Financial Engagement
Link to original article for a more in-depth discussion.
Lean Principles in Healthcare: 2 Important Tools Organizations Must Have

For more information:
Download Healthcare: A Better Way.
The New Era of Opportunity
“This is a knowledge source for clinical and
operational leaders, as well as front-line
caregivers, who are involved in improving
processes, reducing harm, designing and
implementing new care delivery models, and
undertaking the difficult task of leading
meaningful change on behalf of the patients
they serve.”
– John Haughom, MD, Senior Advisor, Health Catalyst

Stephen Hess joined Health Catalyst as a Data Architect in January 2012. Prior to
Health Catalyst, he was a project manager and a certified Lean Six Sigma black belt
at Xerox Corporation where he worked for thirteen years in the business-services
division. He holds a Bachelor of Arts degree in English from the University of Utah.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Jason Burke brings over eight years of health care experience at University of Utah
Healthcare to Health Catalyst. At the University of Utah, he spent over four years as a
data architect on the Enterprise Data Warehouse and over four years as the business
system administrator of the Enterprise Performance Management tool used to
annually budget over $1.2 billion. He has also worked with a multitude of business
intelligence tools and was responsible for executive level reports and dashboards. Mr.
Burke holds a MBA with a Management of Technology certificate and a BS from the
University of Utah.

Lean Principles in Healthcare: 2 Important Tools Organizations Must Have

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Lean Principles in Healthcare: 2 Important Tools Organizations Must Have