Judy Worth talks on how Lean could be used to improve the healthcare sector and reduce the inefficiencies.
Headlines shout the message almost every day: The U.S. healthcare delivery system is unaffordable, inefficient, and sometimes downright dangerous. It is in need of true transformation. To do this, we must tap into the wisdom of those delivering care and equip them with the means to create a new system that works for both providers and patients.
Change is never easy, and U.S. healthcare is undergoing one of the most significant overhauls in its history. Patients must decide about multiple treatment options, which may soon be more accessible and affordable. Health professionals face new pressures for not only improving the quality and safety of care delivery, but also its efficiency. Likewise, those who pay for healthcare—employers, insurers, and the government—must reimagine how to organize, pay for, and provide care.
The expectation is that technology will address a number of healthcare delivery woes, among them improving efficiency and patient safety. This isn’t surprising, as technology has played a significant part in advancing medicine. However, sustainable healthcare transformation must come from changes in beliefs and behaviors.
Dr. Avedis Donabedian, considered by many to be the father of quality improvement in healthcare, gave us a model to use when tackling the task of improving care delivery. He suggests that we think about care in terms of structure, process, and outcomes, a framework that allows us to apply science to effect change. But this technique alone won’t yield sustainable change. As anyone who has led a change initiative knows, some individuals are ripe for change, and others resist all the way along. In between are the people waiting to see if the change will be a real improvement or simply a fad.
A fundamental part of healthcare’s current culture is tied to how we have isolated, encapsulated, and segregated the how, what, who, when, and where of patient care.
How do patients want to receive care?
There are difficult questions to ask about how we care for patients and how patients wish to receive their care. In some cases we have clinical evidence that supports changes in how we deliver care, but in other instances either there is no evidence base, or the changes are not clinical in nature. As we address healthcare reform, we must continue to gather evidence and rely on structure, process, and outcome.
During the past decade, the Lean Transformations Group has worked to apply both science and culture change to healthcare. Encouraging results have been achieved, such as driving infection rates to zero among participating hospitals. The group has helped healthcare organizations learn how to use the value-stream improvement method to create an adaptive, problem-solving culture, one that focuses on preventing fires rather than constantly fighting them.
The outcomes we are seeing, including the ones below, make us believe that we are on the right track:
• Reduced the average length of stay (LOS) in a large emergency department by 30 percent
• Reduced the number of patients who left without being seen (LWOBS) by 60 percent in the same hospital
• Increased (independently gathered) patient satisfaction scores by 73 percent
• Reduced operating-room changeover time, which increased the number of surgical procedures performed by 20 percent
• Reduced annual staff turnover by as much as 67 percent
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