Going Lean Can Reduce Risk, Improve Care

By Susan Kanvik

Incorrect dosages. Undiagnosed health conditions. Surgical complications. Computer breakdowns. Every year, thousands of patient lives are lost due to medical errors such as these. A recent study by Johns Hopkins estimates that in the United States, more than 250,000 deaths are due to medical error, making it the third highest cause of death in the U.S. behind heart disease and cancer, according to data from the CDC.

Johns Hopkins researchers found that most errors stem from systemic problems such as poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols.

Healthcare organizations have begun to give such risks the attention they deserve—and some are using Lean principles to do so. In the past, Lean was practically nonexistent in healthcare; it was often thought of as a manufacturing methodology. Today, more healthcare organizations are embracing Lean principles to reduce the risk of errors, streamline processes, and increase patient satisfaction.

What is Lean?

Lean is a process improvement methodology that combines tools, management systems, and accountability to create value for customers—in this case, patients, physicians, nurses, and other healthcare workers. In healthcare, the “Lean approach” is more than quality improvement and cost reduction; it’s about continuously striving for the best patient outcome and experience using the fewest wasted resources.

Healthcare organizations first used Lean to improve productivity, reduce inventory, improve testing accuracy, and reduce purchasing and food service costs. Can Lean really improve patient safety by reducing risk, errors, and wait times? Those who have put it into action unequivocally say yes.

Recognizing what’s wrong with a process is the first step toward improving it. Lean gets managers out of their offices and into various departments to see problems in real time and firsthand, rather than relying on reports or hearsay. It allows physicians to “feel the pain” that patients, nurses, and administrators feel daily.

Improving patient care and safety with Lean

What are some Lean methodologies that your organization might consider?

• 5S workplace organization removes all unnecessary materials by sorting and standardizing only the necessary ones. For example, when an operating room has only the minimal required equipment and materials, the risk of surgical error is reduced.
• “Point-of-use” or “just-in-time” delivery of surgical tools and medications to the physician at the right time and amount eliminates waiting time during procedures. In critical operations such as heart surgery, this can make a life-or-death difference to the patient.
• Standard work helps ensure that critical medical procedures and protocols are followed, making it easier to detect abnormalities if problems arise. Standard work procedures can be more effective if photos are included to display each task for easier understanding. An example of standard work could be “how to properly insert peripherally inserted central catheter (PICC) lines into patients.”
• Visual controls can be used to quickly identify defects or abnormalities. Such controls include floor markings that indicate restricted personnel zones, color-coded bins to identify new vs. used syringes, and hospital room doors that indicate when a patient has an infectious disease, such as MRSA.
• Quality checks are critical in preventing or minimizing human error. These checks ensure that, prior to passing material or information downstream, a self-check is performed against the standard work for accuracy and completeness. For example, in a blood transfer, staff would check to make sure they collected the proper sample; that the labeling was accurate, complete, and matched the donor; and that the sample was properly delivered to the collection location with proper control documentation.
• “Mistake-proofing” is a technique to ensure that human error cannot occur. For example, medical instruments may have color-coded parts that fit together in only one way, thus preventing the wrong piece of equipment from being used.

Lean in action

Healthcare organizations across the country are putting Lean principles into practice—and getting results. One hospital wanted to reduce the turnaround time for inserting PICCs so patients could be discharged to home IV therapy more quickly. Lean methods reduced the average PICC wait time from 26 hours to 16 hours, with concomitant savings in time, money, and safety.

The ability to provide effective patient care continues to be challenging for healthcare organizations. However, implementing process improvements enables them to improve patient care through the application of Lean principles.

Susan Kanvik is a healthcare consultant with Point B, an integrated management consulting, venture investment, and real estate development firm. Kanvik has more than 40 years of experience in the healthcare industry with a focus on information technology and data/analytics to improve outcomes and operations.