Do We Understand Lean Deployment in Healthcare?

  • By carabernstein
  • in
  • on November 16, 2018
Posted on behalf of Researcher and Author, Aravind Chandrasekaran, PhD. Aravind is an Associate Professor and the Associate Director for the Center For Operational Excellence at The Ohio State University, Fisher College of Business. 

Anyone who has faced the prospect of a process improvement rollout – whether lean, Six Sigma, or a variation – at their organization has said, or heard, this common refrain: “(Insert industry here) isn’t cars on an assembly line. This doesn’t apply to my work.”

Lean thinkers in this world, founded on the efficiency-driven principles of the Toyota Production System, have helped teams work past these roadblocks. As a result, the tools and leadership behaviors rooted in lean practices have made their way into countless industries. But are there industries where these don’t have a place?

This debate reignited earlier this year with an article in the New England Journal of Medicine asserting lean practices “cannot be applied to many vital aspects of medicine.” The authors’ further claim that “patients aren’t cars” and the Tayloristic principles (referring to lean) may not work in these settings.

This criticism, I’ve found, isn’t new – and it’s rooted in a lack of understanding of how operational excellence deployments work in areas such as health care and product development.

The smart application of lean and continuous improvement principles can help develop a safe and patient-centric health-care system. Deploying operational excellence in health care minimizes unnecessary variation and frees up time to cater to a highly variable population in terms of illness, economic background, language and more. The catch is that these lean deployments are effective only when designed and driven by the people (i.e. caregivers) doing the work and not by external change management (i.e. consultants that are not part of the work). It is also important for healthcare organizations to develop change leaders who have the ability to continuously adapt processes to changing needs.  

As an example, I collaborated with other researchers and physician leaders at The Ohio State University Wexner Medical Center to study a lean deployment effort in its kidney transplant discharge process. The caregiving team of nurses and physicians found a number of variations in how post-discharge instructions were delivered. Although standards exist on discharge instructional delivery, they were not designed by the team and hence led to lack of compliance and variations. This inconsistency resulted in increased patient anxiety levels after discharge triggering readmissions. In fact, the risks of getting readmitted back to the hospital within 30-days is 110% higher for a unit increase in patient anxiety levels 1 week after discharge and that increased patient anxiety levels are associated with variability associated with the discharge process

Overhauling the process, the caregiving team then spent several months completely redesigning the standards of discharge based on operational excellence principles. The new discharge process was designed by the team in consultation with former patients and relied on evidenced-based standards. Preliminary Findings show that this approach soothes patients’ anxiety levels and has reduced the chances of readmissions in the first month after transplant. It also has improved the quality of work of the caregivers (who now have ownership on the process)   

This isn’t just a lean approach to a problem – it’s a smart lean approach that integrates leadership and problem solving. And in the high pressure field of healthcare that matters more than ever. At Ohio State, we have creating such change leaders in healthcare organizations for over a decade through our Master of Business Operational Excellence (MBOE).  

To learn how to incorporate operational excellence and MBOE in your organization contact, Beth Miller at The Ohio State University Fisher College of Business at 614-292-8575 or miller.6148@osu.edu

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