Lean Sigma In Healthcare

Posted on December 7, 2008 - Filed Under Business | Leave a Comment

Bringing Lean Sigma in Healthcare to Life!

Without a doubt, Lean Sigma is set to make a big impact on the Healthcare sector over the next few years. Although many of the tools of Lean are familiar to Service Improvement Teams working within public and private Healthcare providers, what is different is the application of Lean following a more structured methodology that reviews entire pathways (value streams) from end to end and then converts this thinking rapidly into action.

Healthcare differs from manufacturing. Its product is not a series of identical items (or range of items). It is about delivering healthy patients, all of whom are different. This fundamental difference, if not addressed correctly in a Lean Sigma improvement programme, can lead to an increased risk to patients.

Consider, for example the important issues related to ‘care pathways’:

 Pathways often interact and overlap in a way that manufacturing value streams do not

 Patients frequently switch between pathways and specialities dependent on their specific needs and treatment plans

Further complications exist within and between organisations in the Healthcare sector. Relationships are rarely the same as the pure ‘customer/supplier’ relationships experienced in manufacturing. In the Healthcare environment, it is rarely possible to have the hands-off procurement relationship available to commodity buyers, or the openness of (say) Internet eAuctions as these do not necessarily enable the provision of medical best practice or provide adequate patient confidentiality.

The Key Message
Lean is capable of bringing about the changes needed within Healthcare, BUT the different risks and ways of managing them effectively mean a pure manufacturing based approach:

 Will be difficult to apply
 Could have a negative impact on patient safety

Some examples of how these risks could manifest themselves when applying a Lean Sixma approach which does not consider patient safety explicitly and continuously include:

 Applying Lean Sigma to make isolated improvements in one pathway and missing how the improvements (changes) impact on the others, i.e. the improvements introducing or increasing the risk for a patient either upstream and downstream
 Not addressing a patient safety risk in a pathway design resulting in (for example) increasing the risk of infection or of patients receiving the wrong medication

As traditional Lean Sigma practitioners often do not take into account an assessment of overall risks (except perhaps a Health & Safety check prior to the start of a Lean event) there is a strong probability of introducing unknown risks into a process with potentially disastrous results.

These, and other challenges with the application of Lean Sigma in Healthcare, promote the need for a combined approach that utilises the best of Lean Sigma with the effective approaches to managing risk to deliver enhances performance and patient safety within Healthcare. This does not mean slowing the implementation of Lean Sigma to a snail’s pace through endless surveys and risk assessments. Rather an integrated “Lean Sigma Risk Management” approach with the structured application of effective risk management activities during the pathway redesign process, something not unfamiliar to many Lean Sigma practitioners through the use of FMEA, ‘What If?’ analysis or even in the use of SMED.

Perhaps one change to the use of a Lean Sigma tool that could have a BIG short term impact on Healthcare risk is the addition of a +1 to 5S to make it 5S+1. The addition is a consideration of the ‘Safety’ (i.e. Risk / Patient Safety) impact during each of the normal 5S steps – for example, whilst a defibrillator may only be used once every year (and therefore using traditional 5S might warrant being moved away from the area) a 5S+1 solution would say that when it is needed, it is needed quickly – so keep it close by!

When we opened this short article, we mentioned that Lean Sigma is set to have a big impact on Healthcare as it can address the needs for improved efficiency and effectiveness there by helping deliver reduced lead-times and costs. A closing thought for Lean Sigma practitioners in Healthcare is:

Whatever the operational benefits possible, they must not be achieved at the expense of patient safety!

This article has been prepared by Mark Eaton of Amnis (http://www.amnis-uk.com)

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