Section 1: Simple Steps to a More Agile Hospital
With all the hoopla about healthcare reform, there’s one huge missing piece—healthcare is going to have to get dramatically faster, better, and cheaper to help pay for the changes. Each of the nation’s 5,700+ hospitals must find ways to cut millions of dollars in unnecessary costs over the next decade. This may sound difficult considering that half of all hospitals lose money. Most hospitals exist on a 4 to 5 percent margin. But Lean can help hospitals start getting faster, better, and cheaper in just a few days.
One of the key principles of Lean thinking is to eliminate delays that consume up to 95 percent of the total cycle time (57 minutes per hour). If you’ve ever been a patient in a hospital emergency room (ER) or nursing unit bed, you know that there are lots of delays. Over the years, healthcare has made tremendous strides in reducing cycle time in various aspects of care. Outpatient surgeries are one example: Arrive in the morning, and leave in the afternoon. No bed required. But there is still lots of room for improvement.
Goal: Accelerate the Patient’s Experience of Healthcare
In any given “factory,” there are two kinds of time: work time during a process when actual work is occurring and elapsed time—the total time a process takes (work time plus any time spent on handoffs, waiting, batches, backlog, and so on).
– Ken Miller
Over the last decade, I’ve consulted with many hospitals on all kinds of projects. Perhaps the most powerful tool that can be applied immediately to start slashing cycle times, medical mistakes, and cost is Lean. And it doesn’t have to take weeks, months, or years. With the right focus and the right people in the room, it only takes a few days to find ways to speed up any healthcare process, which, in turn, will reduce errors and boost profits.
Every hospital seems to have the same problem: patient flow. This shows up in many ways:
Patient dissatisfaction and physician dissatisfaction
Emergency Department (ED) divert hours (ambulances diverted because of overcrowding), patient boarding in the ED, LWOBS (leaving without being seen), and four-hour turnaround times
Operating room (OR) delays, cancellations, and long turnaround times
Imaging delays, long turnaround times
Lab delays, long turnaround times
Bed management delays
Late discharges
Long patient lengths of stay (LOSs)
Lost revenue
What one element is critical to both patient flow and satisfaction?
Time—patient wait time leading to poor turnaround times and poor patient outcomes. Patient wait times are non-value-added (NVA). This non-value-added wait time is “baked into” existing procedures and facility design, but that doesn’t mean that it can’t be changed.
Healthcare delivery often involves complex processes that have evolved over time and that are neither patient-focused nor clinician-friendly. When systems do not work well, healthcare workers resort to creating “workarounds,” adding additional layers of “patches” and “fixes” to poorly functioning systems.
– Christopher S. Kim, M.D.
