The Promise of Lean Processes
American health care faces challenges in access, cost, and quality and in marked geographic and socioeconomic variability. While these challenges will require actions by federal and state governments, they also call for action by individual health systems. Actions by individual health systems will not only help to address these challenges, but also can provide models to inform government of practices that could be taken to scale. As individual health systems look for innovative approaches to meet these challenges, looking outside the health care industry holds promise.
One approach that addresses both cost and quality is the Toyota Production System, or Lean. While Lean’s roots are embedded in the automobile industry and manufacturing, the philosophy and toolset fits with health care. The philosophy is built on two pillars: respect for people and continuous improvement—great pillars for health care. A focus of Lean is identification and removal of waste from every process from the customers’ perspective—our patients and each other, for those of us in health care. This focus on waste is integrally linked to respect for people and improvement. Toyota’s leaders have said that waste is disrespectful to humanity because it squanders scarce resources and that waste is disrespectful to individuals because it asks them to do work with no value. In health care we could add that waste is disrespectful to our patients because it asks them to endure processes with no value. The fact that health care is consuming 17 percent of our gross domestic product means that this consumption is preventing precious resources from being used to improve our educational system and infrastructure, or for other needs. We are challenged to recruit and retain an adequate number of high-quality health care workers and providers. Asking them to do meaningless tasks stifles their talents and makes them look to other work. For patients to wait for long periods in waiting rooms or to undergo procedures that are not indicated is respectful of neither their time nor their person.
We substantially underestimate the waste that occurs in our health systems. Most of us agree that we have some waste—maybe we would guess 10 or 20 percent. Lean experts will tell you that between 60 and 90 percent of every process that has been untouched by Lean is waste from the customer perspective. Lean tools provide ways to let us see the waste that is right in front of us. One simple way to gain quick insight into the magnitude of waste is a
“waste walk.” Take 8 or 10 people from a variety of areas into another part of your system and ask them to write down everything they see that they wouldn’t want to pay for as part of the process—it will be a long list.
Learning to see waste is a first step. The second step is using the tools to remove it. One of the appeals of Lean is that the tools are simple, allowing the entire workforce to be engaged.
Those health care institutions that have embraced Lean can attest to the impact on cost, quality, and employee engagement. Since Denver Health began its Lean journey in 2006, we have realized $159 million in hard financial benefits, have achieved top-10 ranking in the University Healthsystem Consortium Aggregate Accountability and Quality Score, and were awarded the Shingo Bronze Medallion for Operational Excellence, and 78 percent of our employees state that they understand how Lean helps us maintain our mission. Lean is one approach to some of the challenges we face.
