Category: Thought Leadership
November 1 2017
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LEAN is a structured way to solve problems that cause waste in a system. It’s about listening to your customers, engaging them in what they value, and meeting their expectations. Today, industries around the globe have adopted “LEAN management” and “LEAN thinking” practices. Many industries have contributed to what we know as LEAN today, such as Toyota and several others in the automotive industry.  Using the Lean philosophy can improve quality of care and reduce errors within our complex healthcare systems. 

LEAN thinking is making its way into the healthcare industry. What does adopting a LEAN management practice mean for a healthcare system? In this blog, we’ll dive into a few of the key LEAN strategies that any healthcare organization can think about adding to their quality improvement program. 

What is LEAN thinking? 

At Neosho Memorial Regional Medical Center, we see LEAN as an acronym that stands for:

  1. Leadership
  2. Eliminate waste
  3. Act now 
  4. Never ending

These elements have become the foundation for improving processes within our healthcare system. The idea is that every required step is adding value, and that value should ultimately translate to an improved patient experience. Using the LEAN principles in our healthcare system means observing how valuable processes are and really drilling into that process to see if we can eliminate waste for our patients. We recognize that processes are ever changing and we need to observe key processes that deliver value to our patients.  In the end, LEAN is about providing a structured way to eliminate waste and increase value to our patients.

Choosing LEAN for process improvement 

In healthcare, we know how important the voice of the customer – our patient – is. What are the needs and the wants of our customer? What expectations do they have in the delivery of care? 

Largely, our customers want and expect us to use our time – and theirs – efficiently. LEAN teaches us to focus on the areas of waste that is not value added for our patients.  Using LEAN tools, we can try to eliminate those forms of waste in our system.

Simple LEAN strategies

LEAN tools assist organizations in identifying waste and offer ways to standardize process thus adding value for our customers.  Let’s take a closer look at some of the LEAN tools.

Tool #1: Gemba

One of the tools that LEAN offers is called a “gemba walk.” Gemba walks occur when a member of the healthcare team goes to the place that the actual work is being performed to see the work occurring in real time.   Some might refer to it as “going to the scene” so you can see the people and how the work is being delivered and received.  In other words, the gemba is where the work of value-creating happens.  

When done right, gemba is a full-contact activity. It means going to the department, asking thoughtful questions and being willing to get involved with whatever is going on. 

Tool #2: Observation

Observation goes hand-in-hand with gemba, but it’s a little more advanced. When we’re going for an observation, we’re going for a reason. 

Observation must be conducted first hand, not from an office or by calling someone for an update. Observation occurs at the gemba – we go to the place where the work happens, and we look at each element – each nurse, each patient – one at a time. This is a structured process with an observation tool sheet, where we document what we see as we see it. We want to document the work that's being performed so that we can fully understand the impact of an activity on the patient experience and safety. This is observing the current state and looking at what is versus what should be.

The revelations that can come from this structured observation process may be surprising. From a leadership perspective, it can be hard for you to realize that the processes in place to maintain patient safety aren’t working as they should – and that’s exactly why documenting the work that is being done is so critical. It's also a great way to see things from the patient’s perspective and expose the hidden cost of inefficient processes. When we understand the root cause of a problem and make efforts to rectify the situation, we’re creating a culture of continuous improvement.

Tool #3: 5S workplace organization

The 5S methodology is a tool to keep the workplace organized, using a list of five Japanese words: seiri, seiton, seiso, seiketsu and shitsuke. For many of us, it might seem like the simple way to incorporate the 5S methodology is to “keep stations tidy.” But there’s a little more to it than that. Translated into English, 5S instructs us to do as follows:

  1. Sort – Remove unneeded items. This helps to eliminate clutter from the work environment and reduces the cost of purchasing redundant equipment. 
  2. Straighten – Organize and label the location for each item so that there is no confusion about where it belongs and where to place the equipment after its use. This helps make the workflow smooth and easy. 
  3. Shine – Regularly clean and straighten equipment; this ensures that it is being properly maintained and is safe to continue using. 
  4. Standardize – Once a process for meeting the first three “S” bullets is established, make that process the standard for maintaining organization in the workplace. Everything should have a right place, and it should always make it back to that place. 
  5. Sustain – Audits on the work space should be regularly performed to maintain order and ensure that the established process is being followed. 

In a hospital setting, the 5S methodology is a little more comprehensive than simply organizing a desk surface. At Neosho Memorial Regional Medical Center, we have a designated place for our EKG machine and our oxygen tanks – these places are visually outlined and labeled, and our staff has been instructed in the proper way to replace this equipment when it’s not in use. We have these visual controls for things like crash carts, too, and other items throughout the system. The 5S methodology helps us stay organized, certainly, but more than that, it’s helped us do our jobs more efficiently – ultimately, empowering us to improve the care our patients receive. 

The LEAN philosophy fits easily into the culture at Neosho Memorial. Our managers embrace the tools that are offered by using LEAN. We continue to grow and learn more about the LEAN principles and how we can use them to add value to our customers. While only a few of the LEAN philosophy ideas were discussed in this blog you can see how they make an impact and aid us in providing the “BEST” care for our patients.

We are dedicated to increasing value for your organization and excellence in care for patients. Learn more about how Cerner is leading the industry in performance excellence. 

Jennifer Newton,Chief Nursing Officer

Jennifer Newton Chief Nursing Officer Neosho Memorial Regional Medical Center

@Cerner

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