Applying Lean Thinking to Hospitals is a Band-Aid Solution

Victorian-era hospital, London

St. Thomas Hospital, London. A recent version of the Victorian hospital. There’s less of a difference than we think.

There’s no doubt that improving healthcare is an important, difficult challenge (to say the very least). Many organizations, or teams within organizations, are trying (and some casing succeeding) to apply lean principles to healthcare, such as empowered frontline teams conducting root cause problem solving, the use of visual management techniques, and developing multi-disciplinary teams to provide “patient-centric” care that brings the resources to the patient at the same time and place rather than shuttling the patient down an “assembly line” of discrete and disconnected procedures by one department after another.

But for the most part, the efforts to apply lean thinking in healthcare have focused largely on hospitals. The problem is that the very existence of hospitals as we know them is un-lean. Yes, in the short-term improvements to a hospital’s operations is a benefit, but if we are to realize the full benefits of lean flow thinking in healthcare then it starts with understanding that the concept of large-scale, centralized factories (a.k.a. hospitals) is the essence of un-lean thinking.

In traditional operations, the emphasis is on economies of scale. The results are large, centralized factories, warehouses or, in the case of healthcare, hospitals. Lean flow focuses on the economies of time. Resources are decentralized to better provide service where and when needed. The time that is most precious is that of the customer, or in this case, the patient. This is expressed both as a reduction of the time patients waste waiting as well as the total lead time for their consultation or treatments.

In lean flow, the focus is also on prevention rather than fixing things reactively. So too, lean healthcare would focus most of its resources on health maintenance and early preventative measures rather than heroic efforts to “find and repair” health defects.

Healthcare advocates who push for more decentralized models such as home care, the use of empowered, community-level health practitioners, as well as the use of preventative approaches such as better access to healthier food may not think they are preaching a “lean flow” message, but they are.

To be sure, moving away from the doctor-centric, hospital-centric model is itself an enormous change challenge. Whereas today billions of dollars from governments (and sometimes billionaires) go towards the building of more healthcare “factories” or their expansion by building a new wing, in this future-state the money would go towards decentralized, preventative processes. The public at large and not just the medical professions and the medical-pharma industrial complex would need to change expectations and habits. In some cases medical professionals and firms in the medical industry won’t want to change, given the dollars at stake. Voters will need to empower politicians to make policies in the face of intense lobbying for an unlean system.

The good news is that technological advances are on the cusp of providing the ability to move decisively from our 19th century mental model of healthcare to a truly lean healthcare system. Hospitals would evolve from a place for the batching and queuing of patients, to a place where scarce medical expertise advises local care-givers and patients through tools such as virtual reality, telepresence, smart wearables and other internet-enable capabilities. AI-driven robots could further enable the decentralization of care.

Improving hospitals is not a waste of time. We will have these monuments to traditional process thinking around for some time to come and if the people who work in them understand lean flow then this will help enable change. But if we can convince stakeholders that our current concept of hospitals is un-lean regardless of how well those hospitals run, it might help us to move to a vastly better healthcare model rather placing most of our efforts in trying to improve our centralized, assembly-line approach to healthcare.

5 Comments on “Applying Lean Thinking to Hospitals is a Band-Aid Solution”

  1. Rod Morgan says:

    Hi Bruce! Thank you for continuing to promote “new thinking”…. especially when it comes to healthcare. I have had the privilege over the years to work with some GREAT people on the front line… including telehealth, ED, inpatient-care, ambulatory care, CCAC, LHIN, Primary Care Clinics, nephrology and more… and witnessing the struggle to manage an often chaotic, more than occasionally incapable system and deliver quality care. The opportunities to improve and incorporate better practices leveraging stuff I know that is near and dear to your heart, Lean Six Sigma, is great but…

    I am left with this nagging feeling that we need a complete rethink of healthcare in Canada starting with “What does healthcare mean?”… What is the purpose? Is it extending of life at any cost? Quality of life? Where do we draw the line in terms of technology? If a pharma company comes out with a pill that can extend life by 10 years by simply slowing the aging process, do we embrace it?

    I know it is a pipe dream but “IF I was in charge”… (how scary would that be?)… I could bring the provinces together and instead of bickering over funding (never enough) and transfer mechanisms, I would start with trying to achieve consensus on the “vision” for Canadian healthcare (my preceding nagging questions) and go from there. Can we have a national health information system and a national pharmaceutical registry and management system instead of each province doing their own, redundant (and often unsuccessful) thing? Why NOT?

    Can we strip away the redundant administration and reallocate that to more value-added healthcare activities? PLEASE! Elinor Caplan told me “that will never happen” but I shall keep on dreaming.

    Until then, I guess we can continue to bail that boat but anyone knowledgeable in healthcare knows that we are beyond buckets at this point. Like the environment, there are choices that can be made. My fear is that we will very likely go down the same road as the protagonist in “Indiana Jones and the Last Crusade”… “He chose… poorly”.

    Thanks again for the insight and sharing, Bruce. cheers, Rod.

    • brucem says:

      Hi Rod – I certainly agree with your observation that tweaks and adjustments to the current healthcare approach will not fundamentally alter the trajectory. One example of the kind of change that might have more of an impact is deciding whether or not the current evidence supports the reduction of refined sugar in foods. Yet this topic remains stalled as various interests fight with each other rather than pursuing the science. Frustrating to say the least.

      • Rod Morgan says:

        Ah, yes… sugar (and other stuff)… Great observation Bruce. My goodness, where do we start (other than with the children and the politicians… one and the same?). My wife works part-time in a major grocery store and is saddened each day but the volume of “middle aisle” processed food purchases and gallons upon gallons of sweetened poison that families are buying. Thanks again for the insightful posts and great work (Miyashita Foundation). cheers, Rod.

  2. Wes Radulski says:

    We completed a lean exercise with the staff as a team building exercise so staff could see that they could have a positive impact on operations. Staff were surprised how small changes could make a difference in operations but more importantly they were surprised that they would be listened to (empowered) when they had ideas. Our health care environment is quite simple compared to a large acute care hospital but the lessons can apply on any care unit or department. Lean is a process improvement strategy but is also a management style/philosophy so workers and leaders benefit.

    • brucem says:

      Exactly! Lean is indeed primarily a management philosophy and a strategy to approach things. Also, the smaller size of your unit is perhaps another example of why large scale sites generally struggle — size can increase complexity and political inertia. Thanks for sharing your experience and success story.

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