This paper was published in Jan/Feb issue of Industrial Management. All rights reserved.
To cite this publication please use: Soliman, M.H.A (2018). Healthcare is Ripe for Lean. Industrial Management 60(1), 25-30. DOI: 10.6084/m9.figshare.9037805
1. january/february 2018 25
Healthcare is ripe for lean
BY MOHAMMED HAMED AHMED SOLIMAN
EXECUTIVE SUMMARY
Trucks are not as important as patients, but
through the Toyota Production System and lean
principles, car manufacturers often put far more
effort into supporting their front-line staff than
many hospitals.This is a shame, because properly
applied, lean tools like work standardization,
5S, visualization and kanban can deliver great
results in the medical field.A hospital lean
transformation can save money and,
more importantly, lives.
3. january/february 2018 27
Overprocessing
is replete in
medical care,
particularly with
patients who
have
to describe
their symptoms
multiple times.
butonthesametrip.Anotherexample
involveslabsthatusemoreofthehypo-
osmoticswellingsolutionwhenevalu-
atingthespermmembranetoassess
spermvitality.Theextrausedoesn’tmake
adifferenceandisjustwaste.Andsome
labsleavesperminthesolutionlonger
thannecessary,whilelessthanaminute
ismorethansufficient.
InherbookValueStreamMappingfor
HealthCareMadeEasy,CindyJimmerson
showedhowmappingtheprocess
cantacklewastesinpatienttreatment
processes.Theprocessofpatient
treatmentstartswhenthepatient
feelssymptoms,continueswiththe
patientreceivingcareandendswith
billpayment.Theprocessmayinclude
makingappointmentstomeetdoctors,
screeningsandanalysis,deliveringtest
resultsandreceivingtreatment,along
withfollow-upsuntilfullcure.
Standardization is the foundation
Standardizedworkisafoundation
ofleanandisakeyforgoodquality.
Withoutstandardization,allof your
nurses,technicians,physiciansand
administrativestaffwillperformtasks
differently.Thismakestrackingthe
sourceoferrorsdifficult.Without
standardization,thetraditionalgemba
walk–leadersexaminingwherethe
workisdoneandanalyzingprocesses–
ispointless.
Thestandardshouldinvolvethework
elements,theworksequence,thetools,
equipmentandmaterialneededandthe
amountoftimeitshouldtake.Without
thoseelements,workerswillhavenoway
ofknowingwhethertheyhaveimproved.
Doingthejobdifferentlyeverytime
makesconsistentqualityandproduc-
tivityimpossible.
Alackof standardsinprocessescan
leadtomiserableresults.CBCNews
reportedonNorthernHealth,ahospital
inEngland,thatperformedprocedures
on10,000patientsoverthreeyearswith
improperlycleanedendoscopes.
specimensandotherhospitalstaff.
Wastedmotion,whichcanreferto
workplaceergonomics,alsoappliesin
hospitals.Iftoolsandinstrumentsaren’t
handy,peoplewillmovehereandthere
searchingforthem.
Medicaloverproductionusually
involvesunnecessarytestsandcheckups.
Overproducinginformationthatisnot
usefulorwon’tbeusedisawastethat
candelaytreatmentandaddcosts.
Hospitalsalsofacethetraditional
trade-offbetweenkeepinglimited
inventorywithoutrunningoutof
necessarysupplies.Leanencourages
havingtherightsuppliesandinventory
onhandtoensuretherightpatientcare
canbedeliveredontime.Aleantoollike
kanbancanensuretherightsuppliesare
availableintherightplaceattheright
time.
Overprocessingisrepleteinmedical
care,particularlywithpatientswhohave
todescribetheirsymptomsmultiple
times–notjustinfollow-upvisits,
4. 28 Industrial Management
Waste …
will delay
patient
discharge and
keep rooms
from opening
up for new
patients.
Standardizing common daily tasks
frees up healthcare professionals
who can use that time to focus on
value-added work,proactively solving
uncommon problems and daily
pop-ups.
Standards guard against calamity
Industrialandsystemsengineersare
oftenremindedthatpatientsaren’t
widgets,somanufacturingprinciples
mightnotalwaysapply.Andit’strue
thatstandardizationmaynotbedone
forallprocesses.Butstandardization
canbenefitmanyprocessesthataffect
patientsafety.Hospitalsshouldhave
commonprocessesforhandwashing
andhygiene,preparationstepsfor
cardiacsurgery,labelingpatient
specimens,administeringmedication,
communicatingwithpatientsand
cleaninganddisinfectingpatientrooms.
Examplesof standardization
problemsaboundinhealthcare.And
nonearemoretragicthanthosethat
affectlifeatitsbeginning.
Takethecaseof onehospitalthat
performsintracytoplasmicsperminjec-
tions(ICSI).Onthedaytheclinic
retrievesthewoman’seggs,thecouple
hastowaitforthreehoursinthepatient
roomtosignformsrelatedtoembryo
cryopreservation.Whiletheroutine
formwasnecessary,thewaitingtimeis
unacceptable.If thehospitaldoes20
ICSIoperationsperday,thisis60hours
of wastethatwilldelaypatientdischarge
andkeeproomsfromopeningupfor
newpatients.
Standardizationalsocanbenefitthe
processof labelingpatientspecimens.
Thisisacriticalprocesswhereincorrect
labelingcanleadtocatastrophe.
ArecentarticlepublishedbyThe
AmericanSocietyof Reproductive
Medicinemaintainedthatfertilityclinics
haveanethicalobligationtodisclose
mistakesthatcouldresultinbabies
bornwitha“differentgeneticparentage
thanintended.”Incorrectlabeling
couldleadtoinseminatingawoman
withthewrongsperm,combiningthe
wrongspermwiththewrongeggsor
transferringthewrongembryostothe
wronguterus–devastatingerrorsthat
canresultinbabiesintendedforother
couplesbeingbornbysomeoneelse.
Suchcalamities,expertsinsist,are
rare.ThebodyrepresentingCanada’s
largelyfor-profitfertilityindustrysaysit
isunawareof anycasesof “misdirected”
embryos,butasmatteringof reportsof
in-vitrofertilization(IVF)mix-upsin
theUnitedStatesandelsewherehave
ledtoemotionallywroughtbattlesto
determinelegalparentageandcustody.
In1999,aNewYorkStatewomanof
Italiandescentgavebirthtotwinboys
–onewhite,theotherblack.Reportedly,
theclinichadn’tproperlyflushedthe
pipettebetweentransfers.In2015,a
womaninPolandgavebirthtoanother
woman’schildafterherhusband’s
spermwasmistakenlyusedtofertilize
someoneelse’segg.
Manyfertilitycentersusebarcodes
madefrompolysilicon,thesame
materialusedinglass,toprevent
suchIVFmix-ups.Eachtagisabout
one-tenththewidthof ahumanegg
andcanbemarkedwithpatternsrepre-
sentinganeight-digitbinarycode,
providing256possiblecombinations.
Toattachthesebarcodestoeggs,
clinicsuseaproteinthatbindsthe
carbohydratesonthecell’soutersurface.
Followingastandardprocesstocheck
thattherighteggisbeingused,the
barcodeisreadusingamicroscope
beforetheIVFprocedure.Thetag
doesn’taffecttheeggortheembryoand
isshedbytheembryowhenimplanted
intothewomb.
Communicationcanbeanother
keystandard.AdamInternational
HospitalisafertilitycenterinEgypt
thatstandardizeswhatdoctorsand
assistantssayintheoperatingroom
beforesurgerystarts.Thishashada
remarkableresultonpatients’satis-
factionandmorale.Inmanycases,
educatingpatientsontheirmedications
isverynecessary.Itusuallyincludeshow
totakethedosageandthepossibleside
effects,andpropercommunicationis
vital.
Communicatingefficientlywith
patientsandfamiliesbeforesurgery
Properstandardizationremoves
wastes,maintainsquality,controls
variationandimprovesproductivity.
Improperstandardization,however,
canamplifyproblems.Formsthat
patientsmustfilloutandsignoftenarea
frustratingholdup,soastandardization
processthataddstotheseformswillnot
improvethings.
GreathospitalsintheUnitedStates
andJapanhaveintroducedstandards
throughalllevels,includingtheirCEOs,
presidentsanddirectors.Whilesenior
leaderslikelywillhavelessoftheirtime
coveredbystandardizedwork,many
organizationshaveastandardforwhat
leadersandmanagersshouldlookfor
ingembawalks.Astandardizedwork
processshouldbeusedtotrainthenew
staffandeducatepatients.
Theseguidelinescanhelpyour
healthcarecenterwritetheright
standards:
1. Don’t rely on previous time studies
recorded at the engineering office.
2. Eliminate any wasted motion and
waiting times.Don’t include any
walking time in the work elements.
Don’t include any non-value-added
work.
3. Measure the time of each work
element separately.Don’t include
only the total time of the job.
4. Standards should be an output
from process mapping.Human
time usually should be separated
from the process time.
5. Allow people to share their ideas for
improving their work.
6. Use auditing to ensure people are
working to the standard.If the
standard is not being followed,
leaders must ask why.Leaders
should work with employees to
improve standards and remove any
obstacle.
7. Standardization should be a part of
any improvement efforts to achieve
the organization’s vision and goals.
Forcing people to follow a standard
because management needs to
make things look better is not what
adds value to the customer.