Testing the Limits of Lean

The quick results from the process reengineering are another selling point, Esrock says, leading to what he calls a "triple-win" that generates positive buzz among other departments that will be asked to seek their own kaizen (a Japanese term for improvement).

"If we do this right, we'll have three things happen," Esrock says. "One, we'll deliver better patient care. Two, they'll be happier staff members because they don't like work-arounds, and if barriers are there, they'll figure out a way around them. Three, you use less resources and you do save money at the end of the day."

Results don't lie
Esrock points to a big win with clinicians surrounding a surgical infection prevention program in which the team members already knew that within 60 minutes of surgery, the patient should receive one dose of antibiotic.

"We had a problem getting to 100% compliance," he says. "So this had nothing to do with cost. They figured out what the barriers were and assigned accountability that hadn't been there."

Compliance rose to the mid-90% range from mid-70%, translating to better patient care. An associated benefit was that the team also discovered a high level of differentiation in the type of antibiotic used, and by standardizing that, the hospital was able to save about $100,000 annually.

One big advantage of Lean is that it allows teaching through doing, says John Dickey, chief administrative officer at Luther Midelfort-Mayo Health System in Eau Claire, WI.

"We started out teaching Lean by applying it," he says. "Most of what we started off was project work. The first successes are at the departmental level. Next phase will be processes that cross departments."

What senior leaders perhaps like most about Lean is its simplicity. Changes can initially be made in several days, and results are usually visible immediately.

At Luther Midelfort, the hospital's maintenance team was struggling with managing a steady volume of around 2,000 work orders at any one time, Dickey says. Because of the Lean exercise, they've reduced active work orders for the team to 200 at a time, "so they're able to get to them faster and we've added little additional expense," he says, by giving them laptops to track orders.

"We've sped up their work with no increased staffing," says Dickey. "A tremendous benefit is improvement in employee satisfaction. People on the front line are taking control of their work and helping redesign their own work." Dickey says the up-front promise that no layoffs would result from changed work processes is powerful.

Here's another example of Lean improvement: "In cardiology, all our physicians have to review diagnostic tests," Dickey says. "We were averaging around 52 hours turnaround time, but through a change in process, that's now less than five hours. And staff aren't dealing with complaints about where the tests are."