Integrating Lean Process Improvement in Healthcare

July 1, 2011
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  • Differentiating sterile/non-sterile supplies at the point of order. Supplies are pre-palleted for their final designation, thereby minimizing breakdown/holding at the loading bay. 
  • Creating an integrated transport service that can move patients, meals, and supplies, thus having more people available to move specific items at critical periods of the day (patients during morning treatment sessions, meals at noon, etc.). 
  • Reducing the time for special prescriptions to be administered by expanding the pharmacy communication flow beyond the pharmacy proper, tracking the medication until the patient receives it. 

Lean 2P/3P events

Lean 2P (Preparation/Process) and Lean 3P (Production/Preparation/Process) events are significant opportunities to marry design and operations. They involve running operational simulations through the proposed space, ideally at actual scale and under realistic conditions. 

The tools we use to establish vision, scope, and benchmark-based critical success targets require a commitment to rigor more than an extraordinary commitment of time. Functional-based programming requires strong executive direction rather extensive clinical input time. However, intensive Lean events require large amounts of staff time. 

Not every project will warrant full Lean events. When we outline the design process with a client, we determine the “must have” Lean events, identify “potential” events that may be worth the effort as the design develops, and also identify events not included in the process, so we can seek other, less costly, ways to approximate the value these events might yield. 

The ideal Lean 2P/3P event takes several days and up to a week, to implement. It requires broad participation of every stakeholder in the process, a solid background in Lean training, and a large space for running simulations. Cost in terms of staff participation is high, but the benefits can be even higher. 

Many Lean concepts are counter-intuitive to traditional modes of working (that batching is inefficient, that less space can make us more efficient, that we should avoid multi-tasking) but the intensive, hands-on experience of a Lean 2P/3P event can help staff embrace these principles, resulting not only in a more efficient layout, but a layout that staff is committed to making work.  

A recent Pharmacy 2P event for a large hospital included two days of staff training in Lean concepts, a break of several weeks to gather relevant data, then a full week of process mapping, PFMEA analysis, cut-out diagrams, and simulations. The event took place in a large empty space where we ran scripted simulations based on data of projected demand, filmed the process, reviewed efficiency, and modified the layout accordingly. After seven iterations, we developed a plan that was tighter than anyone initially conceived, but the staff enthusiastically endorsed the solution. 

Lean principles are relevant to different healthcare processes in different ways. As a philosophy rooted in manufacturing, Lean has its most direct applications in high-volume, repetitive operations, like pharmacy, lab, and materials handling.  

However, it would be wrong to assume that only back-of-the-house functions can be improved by applying Lean principles. The key precepts of standardization—maximizing value, minimizing waste, pull scheduling, and using triggers to stimulate flow—are relevant for every aspect of patient care. 

When we design 2P/3P events for patient care settings, our focus is less on scripted simulations enacted in large-scale mockups and more on creating standard processes that can adapt to the many variables encountered in direct care. We then test these processes in mockups of specific rooms or clusters. 

Target events

An adjunct to Lean 2P/3P events is focused exercises on specific areas of concern, essentially prescriptive rapid improvement events. 

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