The concept of Lean management is often misunderstood when it’s applied to healthcare. For example, some see Lean as a euphemism for cutting costs. But that’s far from the truth.
Lean in healthcare is about creating value and reducing burdens that patients and staff experience every day. So rather than focusing on saving money, Lean organizations focus on sustaining high levels of quality, safety, satisfaction and morale. They do this by aligning the entire workforce around a consistent management system and using that system to promote, test and implement process improvements on an ongoing basis.
Although cost savings aren’t the focus of Lean management, they are often an outcome. After all, redesigning tasks and workflows to improve care usually means saving time and other resources. It can have other benefits as well, such as helping workers feel more empowered and engaged and reducing their sources of burnout.
In the end, terms like Lean, Six Sigma, and other labels that get attached to quality-improvement concepts are less important than the concepts and strategies they represent. These concepts and strategies have been tested and proven in countless industries. In healthcare, they have tremendous potential to help organizations keep patients safe and satisfied, support and inspire staff at all levels, and sustain their success for the long term.
As healthcare experts who work alongside our partners to build their self-sufficiency, we regularly hear, “Isn’t Lean about cost-cutting? Won’t that harm patient care?”
Those questions come from the right motivation. But Lean healthcare is not about cutting costs. In many cases, yes, the changes you make by following Lean principles help your bottom line — but a patient-centered management system isn’t implemented with the aim of reducing costs.
As mentioned above, Lean is about putting the patient first. A Lean management system encompasses a range of big-picture characteristics and day-to-day practices, which take time to fully implement.
At a high level, we can define a Lean organization by a handful of core activities and principles:
In healthcare, success is defined by patient outcomes and experience. Lean healthcare organizations define every employee’s work by the same standards.
To do that, it’s necessary to walk in the patient’s shoes. For example, a team might explore the steps their patients go through each time they come in to see a provider. This helps the team identify and remove roadblocks for patients, such as:
Improving wait time doesn’t necessarily reduce costs, but it has other worthwhile benefits. A patient who completes paperwork at home may be more likely to arrive on time, which helps all patients receive the timely care they expect. The patient may also be more thorough and accurate when entering information about current medications, which helps providers make informed treatment decisions and avoid harmful drug interactions.
Lean management mobilizes the entire workforce to improve the work that matters most to the organization. Leaders set clear goals, while teams and even individual team members adopt their own targets that support those goals. For example, if an organization aims to reduce central line infections by 80%, then all teams who handle central lines subscribe to the same goal, iterating on solutions and tracking progress.
This alignment does more than drive results for the organization’s priorities. It also improves staff satisfaction and engagement, by inviting them to be vital and valued contributors to the organization’s mission and success.
Quality and safety can never be “reached.” They must be sustained. A Lean healthcare organization provides the structure and culture that workers need to sustain quality and safety as part of their daily work.
This runs counter to the practice of quality “initiatives,” where the job of improving quality falls to a dedicated team or office, often for a specific amount of time. How can one team affect quality throughout an organization? And what happens when the initiative is done?
Lean organizations don’t need to worry about these questions, because every team works on improving quality, every single day.
Constant improvement is possible only when frontline workers are empowered to lead it. A central tenet of Lean is respecting the expertise of the individuals who do the work.
Leaders show respect by stepping away from the role of problem-solver and instead take on the role of problem-framer. In healthcare, this means leaders:
In the role of problem framers, leaders give frontline team members the time and tools to find inefficiencies and then devise and implement new, more effective methods. Ultimately, the entire team is engaged and valued, and both patient care and team satisfaction improve.
A key habit in the practice of constant improvement is root cause analysis: going beyond factors on the surface to find the true source of a problem. Root causes are often mundane, such as where equipment is stored or how samples are labeled. But these mundane factors can lead to annoying or even harmful outcomes and errors. So adjusting them can make work significantly safer and more efficient.
Seeking root causes is another way of showing respect for workers. Rather than blame the person who made a mistake, leaders partner with the person to explore why the error was made. What conditions allowed the mistake to occur? How can we change them to prevent future mistakes and promote the safe, high-quality actions we want? By focusing on why the process — and not the person — may be flawed, leaders cultivate an environment where frontline staff are more eager and willing to speak up and share their ideas for improvement.
Patient care is inherently dynamic. Lean organizations, like any other, will often try solutions that don’t end up working as intended. This proves that the willingness to try new solutions is even more important than the initial impulse to improve.
With quality improvement, strategic alignment, staff empowerment and other core competencies baked into their DNA and daily operation, Lean organizations have the tools and mindset to iterate, flex, evolve and innovate.
A patient-centered system can be a powerful management method for healthcare organizations. It can promote better stewardship of resources and provide improved care to patients, faster and more affordably.
Lean management practices have helped numerous organizations achieve these and other benefits, such as:
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