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Management focus - Lean machines

Hospitals worldwide are using ‘Lean’ management principles to streamline processes, reduce costs and improve quality and services

Lean improvements have been initiated in hospitals worldwide for the benefit of patients, employees and healthcare organisations. Hospitals, including the Mater Hospital in Dublin, are successfully using Lean thinking to streamline processes, reduce costs and improve quality and timely delivery of products and services.

Lean management principles are being successfully applied to the delivery of healthcare and even though the principles of Lean are not typically associated with the sector, they do work in healthcare organisations.

Lean thinking begins with driving out waste so that all work adds value and serves customer needs. Identifying valueadded and non-value added steps in every process is the beginning of the journey toward Lean operations.

Lean is a proven methodology that answers the question: how is a healthcare organisation going to do more with fewer resources? It is important for the healthcare organisation to have a formal Lean infrastructure that can help build the adaptive capacities needed to respond to the internal and external challenges that occur. This infrastructure provides a governance framework to oversee Lean projects that result in patient benefits and operational efficiencies.

A Lean healthcare organisation will be better able to embed strategic principles in every department and measure results with a metric system that allows managers to understand the link between its actions and the corresponding effects on organisational goals.

Lean at the Mater
In 2011, the Mater hospital established a Strategic Lean Group to prepare for the relocation of services to the new Whitty Building. This involved training for staff in Lean Six Sigma principles to improve patient outcomes while generating economies by reducing waste.

Although Lean Six Sigma had been running in the hospital since 2011, the Mater Lean Academy launch in 2013 was the final step in the consolidation of a Lean infrastructure with systems to support change management initiatives. The academy’s mission is to improve healthcare quality, patient safety and efficiency by applying the principles of Lean engineering, management and science. To meet the HSE’s demand for quality healthcare at affordable prices, the academy works on the latest strategies and competencies to improve care, manage margins and facilitate compliance with national guidelines. Mater Lean Academy programmes are accredited by its academic partner, UCD.

The academy believes that quality improvement initiatives that result in better patient care and improved provider margins directly correlate with, and are sustained by, the skills and knowledge possessed by all levels of healthcare professionals and support staff.

Lean Six Sigma in healthcare:

  • Provides better patient care
  • Improves the patient experience
  • Offers better value for money processes
  • Ensures quicker access to diagnostics
  • Provides earlier effective treatment
  • Maximises business and income generation capacity
  • Minimises queues and waiting times
  • Optimises payment by results.

Although healthcare differs in many ways from manufacturing, there are also surprising similarities: workers must rely on multiple complex processes to accomplish their tasks and provide value to the customer or patient. Waste of money, time, supplies or goodwill decreases value. However, when applied rigorously and throughout an entire organisation, Lean principles can have a positive impact on productivity, cost, quality and the timely delivery of service.

Medical care is delivered in extraordinarily complex organisations with thousands of interacting processes, much like the manufacturing industry. Studies have shown that Lean has a wide range of applications to hospital operations which include: reducing inappropriate hospital stays; improving the quality and financial efficiency of trauma care; reducing the cost of temporary staff; improving operating room and emergency department efficiency; improving radiology processes; and reaching better strategic decisions affecting marketing and capacity management, among other strategies that lead to improved hospital profitability.

In the Mater, there is a weekly ‘White Belt’ introduction to Lean programmes, given by experienced ‘Black Belts’ and ‘Master Black Belts’ in the hospital setting. Participants who successfully complete the White Belt Programme can progress to the Green Belt Programme, which is accredited by the UCD School of Nursing, Midwifery and Health Systems. In addition to awarding 10 European Credit Transfer and Accumulation System (ECTS) credits, the programme also offers a route into the interdisciplinary professional certificates and a Masters in practice innovation.

Seán Paul Teeling, Lean Six Sigma programme co-ordinator

Studies suggest that leadership management support and a continuous learning environment are important facilitators of Lean implementation.

To increase the successful outcomes of leadership actions, interdisciplinary training is supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes, rather than simply ‘implementing’ actions. Research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts.

By engaging in this shared, experiential learning process, the ownership of Lean implementation can also increase. Interdisciplinary projects to date in the Mater include:

  • Patient nutrition
  • ED to wards pathway
  • Community referrals
  • Ultrasound workflow
  • Echo workflow and processes
  • Porter services
  • Patient way finding
  • Theatre turn around time
  • Stroke thrombolysis time
  • Phlebotomy
  • Drug rounds
  • Ward cleaning
  • Interruption reduction.

All projects are made possible only by the time, professionalism, dedication and interdisciplinary collegiality of the nursing, medical, allied health and other professional and support services within the hospital.

An example of this interdisciplinary work ethic was the ‘Our Daily Bread’ project, which was set up by a team of nursing, dietetics, speech and language therapy, and catering staff to ensure that patients requiring assistance with eating and nutrition, received their meals on time and with the help necessary to ensure nutrition, hydration and patient wellbeing were maintained.

The project was piloted in 2012, following a reference site visit to the Pembury Hospital in Tunbridge Wells. A ‘coloured tray initiative’, based on the Pembury experience was introduced and is now running in seven of the 13 Mater hospital wards with consolidation and roll-out to all wards continuing incrementally. The participants in the ‘Our Daily Bread’ project worked on this as part of their progress towards a LEAN Six Sigma Green Belt Special Purpose Award, which they received in December 2013.

In addition to training staff in Lean methodologies and applications, the Mater Lean Academy offers quality improvement projects that incorporate consulting, coaching, and training services for Mater hospital healthcare professionals, support services and staff in all capacities. The primary goal of all projects, rapid improvement events and consultations is to achieve direct patient benefit and outcome as well as cost savings.

Seán Paul Teeling is a Lean Six Sigma programme co-ordinator

For further information on undertaking university accredited, hospital-based, Lean Six Sigma training at the Mater Hospital, please contact Michelle McGuirk. Email: mmcguirk@mater.ie, Tel: 01 8097463 or consult the Mater Lean Academy at http://www.mater.ie/education/materleanacademy/

Management focus - Lean machines


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Irish Nurses & Midwives Organisation (Cumann Altrai agus Ban Cabhrach na hEireann). The Whitworth Building, North Brunswick Street, Dublin 7. T:+353 1 664 0600 E:inmo@inmo.ie