How Lean Health Care Improves Quality, Values Staff and Reduces Cost

Erica Cumbee

The best health care ensures that every aspect of every process is in the best interest of patients. At Virginia Mason, we know that by empowering teams to remove the waste from our processes, we are providing higher-quality care, reducing the burden of work on our staff and lowering costs.

Looking at quality in a new way

We provide higher-quality care for our patients by removing the waste out of our processes. In our lean management system, we define waste as any non-value-added activity or task when viewed from the patient’s perspective. To remove waste from our processes, teams partner together — from frontline staff to leaders — to analyze our processes, generate new ideas to improve them and test those ideas using the science of process improvement.

For example, in one of our ambulatory clinics, our team realized that during many of their patient interactions, their patients were having their blood pressure taken twice. The medical assistant took a patient’s blood pressure at the beginning of the exam, and then shortly afterward, the physician entered the room and took the patient’s blood pressure again. The team asked, Did the patient need two blood pressure readings to receive appropriate care, or would it have been better for the patient to experience one accurate blood pressure reading and then spend valuable time interacting with the physician?

The team then used root-cause analysis to discover why so many patients had two blood pressure readings in the same visit, brainstormed ideas to solve the problem and created new standard work and training for care providers after testing those ideas through the PDSA (plan-do-study-act) cycle. The result was an accurate blood pressure reading the first time, every time. Most important, the team established a seamless, reliable, high-quality experience for the patient.

“The single greatest waste in health care is the waste of our talent. Lean tools and methods help us identify wasteful work for our staff and determine how to eliminate that waste and therefore reduce the burden of work.”

– Erica Cumbee

Taking the burden out of work

The single greatest waste in health care is the waste of our talent. Lean tools and methods help us identify wasteful work for our staff and determine how to eliminate that waste and therefore reduce the burden of work. We understand, for example, that nurses don’t go to school to be on the phone all day or to spend a majority of their time chasing down supplies. Yet in many health care systems, that is exactly what nurses are doing. It’s the same for medical assistants, who find themselves searching for a free provider to answer a question from a patient’s phone call, and surgeons, who are calling supply technicians to explain precisely which instrument they need right away. The list goes on and on. How do we help nurses, medical assistants and physicians spend more time engaging with their patients, which is what they want to focus on — and what their patients want, too?

At Virginia Mason, our teams have found ways to use lean processes to engage with each other and find out how to build in best practices so that they can reduce the burden of work. Today we have teams in which medical assistants aren’t continually apologizing to patients on the phone because they can’t find a provider to help. We have teams in which nurses aren’t hoarding supplies in their pockets because their supply rooms aren’t properly stocked. We have teams in which surgeons aren’t kept waiting in surgery suites because the right instruments haven’t been delivered.

By eliminating the wasteful practices, our patients are getting the care they need and our employees are spending more time with patients.

Making the connection to lower cost

We’ve found that in embedding quality in our care — for our patients and staff — we are also reducing cost. When we don’t have providers retaking a patient’s blood pressure to get the correct reading, our providers can spend more time with patients and see those that they need to see that day, which helps the bottom line. When supplies are stocked correctly, so that our nurses can depend on having exactly the supplies they need — just when they need them — we reduce the enormous cost of inventory and eliminate expired supplies. And when our surgeons have all the instruments ready for them in the surgery suites, they can perform more procedures in less time, which helps with an organization’s overall margin.

The crucial role of respect

At Virginia Mason, our lean production system is all about showing respect for people — for our patients and our staff. In fact, every team member is invaluable to achieving the best possible care for our patients. When we show respect to our employees and empower our teams to focus on the relentless pursuit of eliminating waste, we improve quality for our patients, and the cost savings follow.

Erica Cumbee, MPA, Transformation Sensei

Erica Cumbee, MPA, Transformation Sensei

Erica Cumbee, MPA, is a transformation sensei at Virginia Mason Institute. Erica trains clients from all over the world to effectively practice lean tools and methods, develops operational leadership emphasizing the importance of acting and thinking in a lean framework, and embeds lean management methodology into healthcare cultures. Erica is certified in the Virginia Mason Production System®, experience-based design (EBD), training within industry (TWI) and focus group leadership.

Erica Cumbee, MPA, is a transformation sensei at Virginia Mason Institute. Erica trains clients from all over the world to effectively practice lean tools and methods, develops operational leadership emphasizing the importance of acting and thinking in a lean framework, and embeds lean management methodology into healthcare cultures. Erica is certified in the Virginia Mason Production System®, experience-based design (EBD), training within industry (TWI) and focus group leadership.

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