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Testing the Limits of Lean

Philip Betbeze, for HealthLeaders Magazine, February 4, 2010
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Hospitals are into this management technique, but key employee buy-in can be lost in translation.

If you want to watch a roomful of healthcare employees tune out, just start talking about the waste generated in their work processes, as though providing healthcare is no more than production-line drudgery. Nurses, physicians, and highly trained technicians understandably resist attempts to cast their work environment as though they are workers on an assembly line and that waste and inefficiency in healthcare results from their choices.

Yet retooling healthcare's processes with exactly that assembly-line mentality is how a raft of hospital and healthcare system leaders have approached waste and efficiency in recent years, as they prepare for a future that will almost certainly mean less reimbursement coupled with demonstrably higher quality. Such evaluations are critical to success under a hot management technique called Lean. But how to sell the case that work-arounds and inefficiency really do reduce value for the patient as well as the hospital or health system?

Many leaders say Lean, a management technique developed at Toyota more than six decades ago, can help. Lean encourages frontline staff to look at any complex process as a target for elimination if it doesn't add value to the good or service being produced. Lean's success at a few big-name hospitals and health systems, such as Virginia Mason Medical Center in Seattle and SSM Healthcare in St. Louis, often comes with the caveat that the techniques associated with it need to be sold differently to people in the healthcare setting, because removing waste in processes comes not from senior management dictates, but from people involved in the wasteful processes themselves.

"Healthcare is not different," says Tim Olson, chief financial officer at four-hospital ThedaCare, in Appleton, WI. "We're not building a car here, but until you get over the hump and realize we're not different, it's tough to sell."

Management-led vs. management-driven
Lean is not management-led, proponents say. It's management-driven, but efficiencies must be found and implemented by frontline staff. Key to that is understanding that no one will lose his or her job due to process revision.

"The senior leadership made sure that people knew no one would lose their job, but might be redeployed," says Olson. "If we figure out a 10-person job that can be done with nine, we find another job for that person."

The tools put the decision-making in the hands of those who do the work, including decisions that traditionally might be handled by higher-level individuals. That fosters accountability and agreement, Olson says.

"As CFO, I shouldn't be telling people what capital decisions to make," he says. "In the old world, if you had VP or C in your title, you got to make that decision, but that's not necessarily the best way to do it."

An often difficult hurdle for senior leaders to overcome is the belief that staffers will resist recommending efficiencies that could end their jobs. The easy way to get initial buy-in is to work with employees to determine what wastes their time and frustrates them about a process, says Brett Esrock, president and chief operating officer at three-hospital Covenant Health System in Lubbock, TX.

"When they see that Lean is trying to improve their workflow, they immediately engage," he says.

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