Implementing Lean in Healthcare Sector Part-II

In continuation to our earlier article, let us see how the PDCA model can be used to improve the processes

Value stream improvement served as the basis for many of the Lean Transformation Group’s hospital improvement efforts. 

                                The method is based on lean thinking, which has been around for decades and has its origins in manufacturing in Japan. Lean thinking looks at the delivery of services or goods as a stream of activities in which, ideally, all participants along that stream are creating value that meets customer (e.g., patient) needs and minimizes activities that do not create or add value.

Value stream improvement is based on the plan-do-check-act (PDCA) cycle to address specific problems and improve performance. Healthcare professionals are already familiar with the PDCA method even though they may not recognize the terminology. 

PDCA underlies all clinical care provided to patients:

• Clinical care begins with assessment of the patient’s condition, leading to a diagnosis and plan of care (plan). The treatment plan is a hypothesis about what is wrong with the patient and what will make the person better.

• The next step is treatment for the diagnosed problem (do). Treatment is the process or action performed to see if the hypothesis is correct.

• Follow-up with the patient determines if the treatment is working (check). The patient’s improvement, or lack thereof as observed in follow-up, tells us whether the process succeeded or failed.

• Additional action (act) is taken as needed.

Just as PDCA in a clinical setting is applicable even though every patient is different, PDCA in an improvement setting is applicable even though every value stream is different. Changes are driven by conditions in the value stream, and improvements occur as teams:
1. Make a detailed assessment of the current state and the need for change.
2. Create a shared vision of the future state.
3. Develop a plan to implement change through a series of actions.
4. Implement change and measure the results.
5. Take appropriate follow-up action.

Although some healthcare providers are new to lean and the concept of value streams, others have become aware of the methodology and its applicability to healthcare challenges. A patient’s journey through the healthcare system involves many value streams whose quality and efficiency in most organizations is insufficient. Improving patient journeys requires intervention at the value-stream level.

Working to improve healthcare value streams helps develop skills for a new way to work, manage, and lead. The effective leaders of transformational change in healthcare are tasked with sorting through the maze of problems within their function, unit, department, facility, or organization; establishing priorities; and focusing as a group on solving the right problems together. As they do this, they must also realize that anything they determine to be a “best practice” will be just one of many. There will be new best practices in the future as other problems are solved and improvements are made.

In addition, any best practice implemented from benchmarking other organizations might not automatically work for another organization. We must ask, “What does it take to make the process work in our culture?” Sometimes it won’t work no matter what adjustments we make.