Lean and Health Care Reform

At Bizmanualz, process improvement — internal and external — is one of our main objectives.

Many of us in the USA and elsewhere are aware of the need for significant improvement in many aspects of the health care process — providing and insuring, for example.  In a recent blog post about the US Healthcare Problem, we presented a case for using the ISO 9001 standard to drive health care process improvement.  Now, we’ll look at ”lean” and how it pertains health care.

The concept of “lean” was developed for production environments (see the Toyota Production System) but with a few modifications, it applies to services as well.  In either case, Lean considers the use of resources for goals other than “creating value for the customer” to be waste and such wastes should be eliminated.

From the customer’s perspective, value describes an item or a service they’re willing to pay for.  Lean is sometimes said to be about “creating more value with less work”; in reality, it’s about “maximizing value while minimizing waste”.  And though people can’t seem to agree on much of anything in the health care “debate”, one thing we should all be able to agree on is that there’s plenty of inefficiency throughout the health care system.

Bicheno and Holweg (in their book, “Lean Toolbox”), describe seven service wastes:

1. Delay – customers waiting for a service;
2. Duplication — having to reenter data, repeat details on forms, copy information across, or answer queries from several sources within the same organization;
3. Unnecessary Movement — having to get in line several times, lack of a “one-stop” service encounter, etc.;
4. Unclear Communication – wastes of seeking clarification, confusion over product or service use, wasting time finding a location that may result in misuse or duplication;
5. Incorrect inventory — being out-of-stock, unable to get exactly what was required, substitute products or services, or not having the right provider available;
6. Opportunity lost to retain or win customers – failure to establish rapport, ignoring customers, unfriendliness, and rudeness; and
7. Errors in the service transaction — product defects in the product-service bundle, lost or damaged goods (famously, the airman who was supposed to have his gallbladder removed but had his lower limbs amputated).

As providers and as customers, we’ve seen these wastes…far too many times.  We need to remove as many of these wastes as possible and improve the process.  That’s where Lean can help, and many health care providers are already implementing Lean and other process improvement tools and techniques.

We need to take Lean, ISO 9001, and other tools deeper into the entire process of providing health care — more providers and insurers — if we’re going to make things better and make the improvements last.  The answer is certainly not going to be found in new legislation (see #4, above).

Now, shall we – at long last — begin?

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Originally published in 2009 by Bizmanualz, Inc. under the title Lean and Health Care Reform. All rights reserved. Reproduction permitted with attribution only. www.bizmanualz.com