Lean principles focus on preserving value by increasing efficiency and optimizing flow. Long used in manufacturing, these types of practices have many applications within the healthcare environment. The lean concepts discussed here include standard work, direct connections, and visual controls with daily metrics.
An estimated 80% of all improvements can be achieved through work standardization as opposed to increases in resources. For instance, consider the process for environmental services to perform a discharge clean. Variation can occur in the amount of time required to sanitize a room as a result of isolation, bacterial infection such as Colstridium difficile, and other factors. A typical room cleaning process shouldn’t produce a significant amount of variation, yet room clean times often vary by as much as 50%. These discrepancies might be explained by staff capabilities, supply processes, and differences in cleaning approach. Cleaning approaches vary, such as moving furniture, high dusting, pour versus spray cleaners, walls cleaned 6 feet versus 3, etc. Ask 3 cleaning staff members how long it takes to turn over a room, and you will likely receive 3 different answers—or, “it depends.”
Using lean principles, a standard work process would outline each step with required time frames and an explanation or reasoning to support it. Completion timing for a room cleaned to standard work for one organization was 26.3 minutes. Team members that performed in significantly less time or more time were observed to see which parts of standard work needed to be reinforced. A time savings of 5 minutes per room can create significant capacity for throughput.
Another lean concept, direct connection, attempts a request response by the most direct route. We all know that the lack of direct connections in healthcare processes is a substantial source of delay and waste. Using lean principles focuses on creating value and eliminating waste. On a widespread basis within healthcare organizations, nurses often request service from a maintenance mechanic only to be instructed to submit a work order. However, by applying a lean concept, a direct connection to the person performing the service can be put in place and often is the best approach. Ultimately, if maintenance requires a work order, the technician should handle that and allow nurses to remain focused on patient care.
Utilizing visual controls is another highly effective way to influence performance in an organization. Key department metrics should be made visible to the entire organization, and these standards should be measured and reported daily. For example, security response times will likely improve if they are posted in a highly visible location, perhaps via an electronic message board for staff, and measured against a particular goal. The consumer-oriented Hospital Compare website provides information on hospital performance, and improvements being made as a result illustrate the success of using visual controls.
Soriant has helped hospitals apply such lean concepts as standard work processes, direct connections, and visual controls with daily metrics. In the healthcare environment these can effectively increase efficiencies and support consistent outcomes.
To learn more about applying lean concepts in a healthcare environment, please refer to the Institute for Healthcare Improvement Innovation Series white paper, Going Lean in Health Care, available via the following link: http://www.ihi.org/knowledge/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx.