Using a Lean Approach to Improve Clinical Processes

This article from Midmark examines how Lean management principles, often employed to reduce operational waste that occurs at the point of care, has the potential to also dramatically improve clinical outcomes.

As healthcare continues to undergo significant change, many healthcare organizations themselves are understaffed and ill equipped to meet rising patient demands. Simply put, healthcare organizations are struggling to find a way to create more value (e.g., accurate diagnoses and easier treatment/care plans) for patients with fewer resources.

The Quadruple Aim has provided a framework with focus placed on improving patient outcomes and the patient/provider experience while reducing cost and waste. However, it is easy to underappreciate the foundational work that goes into improving the point of care ecosystem. That’s where the Lean methodology for process improvement can help.

Lean management principles have been applied, including improving scheduling methods, enhancing revenue cycle and identifying patient flow bottlenecks, traditionally by healthcare organizations to make operational tasks more efficient. Some providers are now realizing that a Lean approach can also help improve clinical processes.

First developed in the manufacturing industry, the Lean methodology for process improvement offers a systematic approach to implement continuous improvements that minimize or remove waste or unnecessary steps without negatively impacting efficiency, productivity or quality. The approach focuses on seven forms of waste, five of which can be directly applied to clinical work:

1. Overproduction. Making too much of something before it is needed, resulting in excessive inventory. In clinical settings – seeing patients that do not need to be seen.
    
2. Waiting. Delaying processes or next steps to wait for a previous step to occur or finish. In clinical settings – waiting for test results, not having information needed to treat now.
    
3. Transport. Involving unnecessary steps or locations in the movement of material.
    
4. Motion. Requiring motion of people or equipment that does not add value. In clinical settings – having patients or clinicians leave exam rooms or go elsewhere for tests.
    
5. Overprocessing. Adding more value than is required or needed by customers. In clinical settings, requiring diagnostic or treatment steps that are not necessary to make a sound clinical decision.
    
6. Inventory. Stockpiling more supplies than are needed for producing products or services “just-in-time.”
    
7. Defects. Deviating from what’s required, often caused by unclear operating procedures or specifications. In clinical settings – having clinical information that is not precise enough to use to treat immediately.

Today’s clinical workflows may be filled with unnecessary steps when clinical protocols are either poorly defined or sub-optimally implemented. Too often, actions and processes that comprise routine care delivery are “rework,” where tests or exam steps are repeated because there is a lack of confidence in — or access to — the first study. In a Lean setting, tasks and studies done at the point of care need to be carefully designed to ensure accuracy, access and timeliness.

Imagine if providers had all the information on hand at the point of care at the time of the patient visit. Next, imagine that information was of high precision and accuracy, sufficient to drive clinical decision making when the provider is still with the patient. Having this level of efficiency and accuracy could eliminate a number of cumbersome steps.

Tasks such as ordering and reviewing labs, setting up follow-up visits, making phone calls, managing medication formulary issues, explaining a non-existent disorder to a patient, working up insignificant (but present) abnormalities found on labs, and documenting encounters and lab results all could be minimized or even eliminated in a true Lean clinical scenario.

Patients could also avoid unnecessary labs, pharmacy and office visits, costs associated with medications, anxiety of waiting to hear if they have a diagnosis, and new risks from pharmaceutical interventions they may not have truly needed in the first place.

So where should healthcare organizations begin when looking at using a Lean approach to improve clinical work and outcomes? Consultants in the manufacturing industry recommend using a direct approach when attacking waste. This is often led by two common questions: “What are your core business values?” and “What is the most important value stream impacted by these issues?”

Translated into the clinical environment, these questions become: “What are the most important clinical findings for improving outcomes?” and “Which clinical care processes need to be optimized at the point of care to provide the most accurate and timely findings?”

Healthcare organizations have used Lean methodology to realize significant operational efficiency gains. The increased focus on the delivery of quality care offers further gains to be realized with a Lean methodology. By taking a Lean approach with clinical workflows and asking a few simple questions, healthcare providers can take steps that will help improve clinical outcomes.