As chair of a national awards committee for electronic health records (HER) adoption in hospitals and physician practices, I recently read winning applications dating back several years. They all spoke of the importance of leadership and staff involvement in the drive to “go paperless,” but I discovered one dramatic, recurring theme, which is best summed up by this phrase from one of the applications: “We were able to see how inefficient and sometimes dangerous our current processes were.” Inefficient: (aka: waste of money and resources); dangerous (aka: risky for patients and staff ) – the effects of poor and formerly unexamined processes. These processes had become comfortable, and their inherent potential for harm and waste was simply not on anyone’s radar screen. Yet that potential was clearly on the minds of the leaders of these organizations.
It is the committed, wise, and proactive leader who is willing to admit to dangerous processes in the clinical setting. Only after that admission can real corrections begin. In the cases mentioned above, the decision to “go paperless” was a catalyst for important process improvements. These led to increased efficiency and financial returns for the providers and better quality and outcomes for their patients.
Lean management is a powerful tool when poor processes are leading to waste and loss. Providers implementing Lean have consistently reported improved financial performance, reduction in waste, and fewer costly and painful medical errors. Despite those reports, there is still some skepticism about Lean and other tools for improvement. Remembering the quality improvement programs of the ‘80s and ‘90s, many fear that Lean is just the “flavor of the day” in quality improvement.
If you are in that group, read on. The authors in this issue report significant benefits from using a Lean approach to process improvement. They have enhanced patient safety and driven waste out of their systems. They have saved money and improved revenue streams.
The key factor in achieving those results with Lean was the active commitment of top leadership. David Mann advises that 80 percent of the impact of Lean initiatives comes from leaders who provide full commitment to the process. Stuenkel and Faulkner tell us that the first important lesson they learned in their initiative to improve operations and reduce waste was that the initiative must be driven from the top down. They write, “The organization-wide learning of such an effort is deep and intense, and to remain focused and successful it must be a priority of top management.” Developing a culture of continuous improvement by changing the way we, as leaders, practice and behave is critically important, according to Bliss. Toussaint advises “change the leadership philosophy to support continuous improvement.” Grunden is equally emphatic: “Without commitment from top management, efforts stall” she says.
In a 2003 article in Industry Week, Cindy Jimmerson reported on studies indicating that the national numbers for waste in healthcare are between 30 percent and 40 percent, but, she says, in “doing minute-by-minute observation over the last three years (the percentage) is closer to 60 percent.” If we were to reduce waste in healthcare even by 30 percent, our financial fortunes (and that of our patients and our country) would be significantly impacted. Lean is one important tool to accomplish this.