tgba: Waste Not, Want Not — Lean as a Tool for Consolidation
The need to embrace Lean concepts is enhanced today by the present trend of consolidation of healthcare services into large organizations that can offer a continuum of care. In the United States, this is driven by a compelling need to reduce ballooning healthcare costs, which are the highest in the world, measured on a per capita basis. The recently passed healthcare reform legislation is historic in proportion and underscores the urgency of this problem. Generally, across the nation, it is hospitals and hospital systems that are stepping up to the task of consolidation. They are buying and building primary and specialty care clinics, and bringing them under the umbrella of a single organization. This brings the efficiency of scale to healthcare delivery and also provides a continuum of care from primary to tertiary care. While this trend holds great promise of improving quality and lowering costs, it also presents new challenges. As hospitals lead this process of change, they generally do it from a hospital perspective, based on hospital culture. Historically, hospitals grew up to care for an acute patient population. The culture of the hospital was formed to respond to events that are emergent, episodic, and life-threatening. For most of us, the hospital is the last bastion of defense against the eternal. The term “culture” is used here because it embodies a common way of thinking found throughout the organization. The best response to emergent, episodic, and life-threatening events is to create redundancy—redundancy in staff, equipment, supplies, and processes and protocol. This is a deeply embedded mind-state. We recently designed an ambulatory care building for a hospital that thought it necessary to put the whole building on emergency power. This represented a significant expense of a non-essential facility that might loose power once or twice a year. While redundancy is a good thing when caring for emergent, episodic, and life-threatening events, such events represent only a small portion of services necessary in the healthcare continuum. Outside of the acute care environment, redundancy is another word for “waste." Practices that whole cultures take for granted are extremely difficult to identify. This is where Lean management concepts becomes a powerful tool to expose these deeply embedded forms of wastes, and in so doing creates a new model of care.