From The Editor | May 2, 2012

Kaizen: The Key To Lean Healthcare?

Ken Congdon, Editor In Chief of Health IT Outcomes

By Ken Congdon, editor in chief, Health IT Outcomes

Now, more than ever, hospitals are being expected to do more with less. The pressure to operate more efficiently will only increase when (or if) healthcare reform goes into effect. Reimbursement changes and cuts will place a significant strain on hospital budgets and challenge the industry to streamline operations. This reality is forcing some hospitals to lay off staff and close clinics or other associated facilities. Others have focused on deploying health IT solutions as a means to maximize efficiencies. There’s no question that several of today’s health IT solutions can go a long way toward helping a hospital optimize workflow, increase productivity, and reduce costs. However, as the old adage states — even the best technology will do you little good if the underlying processes are broken. That’s where lean methodologies come in.

Lean methodologies are geared toward continuous process improvement, and there are two predominant lean schools of thought — Six Sigma and Kaizen. Both philosophies are focused on improving processes by eliminating waste and reducing defects. Both have also been credited for saving corporations billions of dollars over the years.  However, each takes a slightly different approach to achieving this outcome. For example, Six Sigma incorporates more statistical analysis than Kaizen, focusing on eliminating defects so that a final product is as close to perfection as possible. Kaizen, on the other hand, looks to improve all aspects of a business by standardizing processes and eliminating waste. The Kaizen philosophy also strives to include every employee — from corporate executives to entry-level workers — into the process improvement initiative.

Applying Kaizen To Healthcare

Kaizen stresses that the real experts in any organization are the people that actually do the work each day, and these employees should be intimately involved in improving their own workflows. In healthcare, this could be a nurse in the emergency department, someone working in finance, a surgeon in the operating room, or an IT executive. Each of these folks face their own unique challenges and frustrations, and each have their own ideas for how their specific workflows could be more efficient. Kaizen aims to empower these workers to implement these changes, rather than waiting for a fix to be handed down from upper management.

Mark Graban, lean expert and co-author of an upcoming book titled Healthcare Kaizen, often compares Kaizen to the suggestion box methodology. “Traditionally, suggestion boxes have employees submit anonymous ideas,” says Graban. “Those ideas are then reviewed by a committee on a monthly or quarterly basis and are either implemented or dismissed. The individual who submitted the idea rarely gets any feedback on their idea. Kaizen, on the other hand, is a local process that moves much faster than the suggestion box approach. Someone in a work group will talk to their supervisor about a change they feel should be implemented. These ideas are either collected on a bulletin board or entered into a web-tracking system. Rather than running these ideas up to a committee, the employee that made the suggestion and their supervisor are empowered to implement these changes on their own.  The idea of Kaizen is that a lot of little ideas evaluated and implemented at a local level can have a huge impact on an organization and can generally be implemented much more quickly and easily than a single million-dollar idea handed down from corporate.”

According to Graban, there are several ways Kaizen can be applied in healthcare settings. For example, an ER nurse may notice that one of the reasons for discharge delays is that physicians batch the orders they send to the lab. This often forces the first patient seen to wait around for another four or five patients to be evaluated before any of their paperwork is processed. In a Kaizen environment, this nurse could point out this problem and, together with their supervisor, suggest and implement an alternate workflow where physicians chart each individual patient immediately following their visit. The entire ER team would then evaluate whether or not the new workflow helped reduce discharge delays.

Making workflows more efficient through Kaizen can do more than just decrease patient wait times, it can also save lives. For example, inefficient workflows can often be the cause of hospital acquired infections (HAIs). A classic example is incorrectly inserting an IV or central line. There are a set of supplies that clinicians need to gather to correctly insert an IV. This process can often be time-consuming and burdensome for a clinician. As a result, a nurse may cut corners and insert an IV without all the prescribed draping or other supplies. These shortcuts can lead to infection. A simple, low-cost Kaizen idea would be to eliminate the wasted time associated with tracking down supplies by gathering everything that is needed to start an IV and place it all in the same shelf in every room. This eliminates the need for staff members to run from room to room to locate the supplies, and decreases the risk for HAIs.

As you can tell from the examples outlined above, Kaizen isn’t rocket science. To the contrary, it is rooted in common sense. However, many employees don’t feel empowered to implement changes in their organizations, even if they are common sense solutions. Kaizen puts a structure in place that provides employees with this power. Kaizen changes are often small, but when instituted in masse they can make a huge difference. For example, Joseph E. Swartz, Director of Business Transformation at Franciscan St. Francis Health of Indianapolis and co-author of Healthcare Kaizen, estimates that his facility implemented nearly 4,000 Kaizen ideas last year that resulted in a multi-million dollar impact to the hospital’s bottom line. If you aren’t already leveraging Kaizen or other lean methodologies in your healthcare facility, perhaps it’s time you gave them a try. Going lean could provide you with the added efficiencies and budget you need to make the best use of the IT solutions you choose to implement.