Getting Lean...4/23

Here at PRMC, we hear efficiency, and we hear cuts....
I caught a guest post from Hospital Impact, a hospital blog that not only have I contributed (comments) to, and that I've read when I have the chance. The post is in the realm of what needs to be done...but it seem unlikely that Essent will ever do it--because it takes far more effort. Cutting FTEs is easy, making this a quality organization isn't in the cards...for them.

The balancing act of efficiency and quality
February 23rd, 2007
Guest post by Carolyn Kent

I'm going to venture into contentious territory and address what can be a touchy subject for hospital administrators: the application of lean manufacturing to a hospital setting.

First, a brief review. There are 5 basic principles to Lean (continuous process improvement):
1. Define value from the customer's perspective
2. Identify the value stream
3. Eliminate waste
4. Flow the process
5. Pursue to perfection

Is this management style transferable to a hospital environment? Cynics are quick to squash this idea, citing reasons such as "We don't make cars; we treat patients." (Harvard Business Review: Virginia Mason Medical Center) These individuals support personalized healthcare; after all, every patient is unique and by virtue of being such, deserves distinctive care. (No argument here)

Since, according to the cynics, achieving a lean state in a hospital is impossible due to the obligations to provide personalized care to every patient, one could naturally conclude that the hospital's management style should be one directed at increasing the quality of service, optimizing the patient experience, and improving customer satisfaction.

Again, cynics remind us that while this may be nice in theory, consistently delivering superior service across the board can be inefficient, as this approach to service consumes more personnel and time resources - things that are already limited.

So it appears that we are at an impasse. Lean process v. superior service quality - it's got to be one or the other in a hospital setting. Achieving lean presupposes standardization, which is nearly impossible in a hospital. Delivering superior service necessitates employee training, personal attention, significant time investments, regular performance measurement, et,c. all of which are counter to lean, right?

Let's revisit the first principle of continuous process improvement: Define value from the customer's perspective. It appears that lean and superior service delivery are inextricably linked thanks to the customer. Does this mean that they can co-exist after all? Is it too much of a stretch to assert that they may even complement one another?

How would we impart both continuous improvement and superior service quality into our process? Here are 7 quick steps to merge these seemingly dichotomous objectives:
1. Management must commit to the strategy
2. Determine the product line/department to start with
3. Gain a good understanding of lean (Lean Enterprise Institute)
4. Draw the current-state map of your selected process (MAMTC - Lean Building Blocks)
5. Determine the goals to strive for and the metrics to monitor
6. Draw the future-state map of your selected process (see "Lean Building Blocks")
7. Implement with a specific plan that includes benchmarking

Is it possible to achieve continuous process improvement in a hospital environment?

Is it possible to consistently deliver superior service to patients?

Is it possible to do both?

Carolyn Kent is Creative Strategy Specialist at Cleverley & Associates.