Can Lean Thinking save our healthcare system?
Can Lean Thinking save our healthcare system?
That is a very good question.
I am not sure any one thing will ‘save’ healthcare. We are in a time of ‘white water’ change in medicine. New discoveries and new treatments race to the bedside. There will instead be a constellation of things that will improve our healthcare systems. The future of medicine is in the provision of personalized medicine. This is typically discussed in relationship to the Humane Genome project and molecular medicine. However, it is much more than that.
Personalized medicine is providing the ‘right care at the right time’. Often in the management of chronic conditions care is arranged ‘just in case’. Appointments are scheduled into the future ‘just in case’ you need to be seen. This is a symptom of the tradition of medicine that dictated care to the patient rather than negotiated care with the patient. Personalized medicine will change our healthcare processes dramatically in the future. Personalized medicine will require our systems to provide ‘customized’ solutions for patients. Medications are chosen based on a genetic analysis of the patient. Other patient needs will also become important to meet. After hours clinics already seek to personalize care. Patients will be able to request or pull services without long queues. Some systems already allow patients to go online and select their appointment time without ever speaking to a clerk. The services they pull will be those that have value for them. Lean will provide the basis for understanding the value added activities that will compose personalized medicine.
Lean Thinking is directed at reducing waste. This will allow a greater productivity for those value added services. For this reason management science will be as important as basic sciences in the healthcare of the future. So called ‘implementation science’ or ‘translational science’ is little more than systematically applying management theory in the delivery of evidenced based practices. Currently it has been estimated that approximately 50% of a clinician’s time is not necessary and not value added in the eyes of the patient. If this waste is eliminated then clinician’s will be able to spend more of their time caring for patients. This will reduce frustration for both clinician and patient.
Currently most facilities are organized around functional department such as laboratory testing, radiology, and medical clinics. Patients travel from one site, queue up and after being ‘processed’ in that department are sent to another department. Thus for a 2 minute blood test, 5 minute radiograph of the chest and a 10 minute doctor’s visit the patient may have spent all day go to and from these functional villages. The clinics of the near future should be organized into a “cellular” model which will allow all the services to take place within the clinic, rather than this functional “village’ model where patients travel between functions such as lab, clinic and radiology. In the future those functions will be provided at the point of care. Personalized medicine will become the ‘right care, at the right time, in the right place’.
Lean Thinking in healthcare is not just about how to reduce the administrative burden or waiting times of the patient. It is also important to consider the costs that patients undergo in accessing services. Even if the patient does not pay personally for their care, there is a cost. Much of that cost is hidden and does not occur in the clinic or hospital. It occurs as a result of the time and effort to get to the hospital or clinic. An easy illustration is trouble a patient undergoes in traveling to the office, finding a parking place, then walking to the office and then repeating at the other ‘villages’. The travel costs represent a barrier to many of our patients. Technology solutions will allow an amendment to the mantra of ‘right care at the right time’ by providing care at a distance. Telemedicine and telehealth combined with point of care testing will be a norm. This will move medicine away from the bricks and mortar of the clinic and hospital. The mantra will become ‘the right care, at the right time, in the right place, using the right technology.’
Lean thinking actually challenges healthcare administrators to develop systems that provide ‘the right care, at the right time, in the right place using the right technology.’ By applying Lean Thinking as new services and buildings are considered all of this is possible today. The future is here. But it will take administrators and physician executives prepared to think lean to fully capitalize on the changes. So you could say that Lean Thinking will be as important to ‘saving’ healthcare as any advance in the biological sciences might be.
Dr. Jeffrey Clothier
Associate Chief of Staff of Mental Health Service
Chief of Psychiatric Consultation and Emergency Psychiatry
Central Arkansas Veterans Healthcare System
Little Rock, AR 72205
That is a very good question.
I am not sure any one thing will ‘save’ healthcare. We are in a time of ‘white water’ change in medicine. New discoveries and new treatments race to the bedside. There will instead be a constellation of things that will improve our healthcare systems. The future of medicine is in the provision of personalized medicine. This is typically discussed in relationship to the Humane Genome project and molecular medicine. However, it is much more than that.
Personalized medicine is providing the ‘right care at the right time’. Often in the management of chronic conditions care is arranged ‘just in case’. Appointments are scheduled into the future ‘just in case’ you need to be seen. This is a symptom of the tradition of medicine that dictated care to the patient rather than negotiated care with the patient. Personalized medicine will change our healthcare processes dramatically in the future. Personalized medicine will require our systems to provide ‘customized’ solutions for patients. Medications are chosen based on a genetic analysis of the patient. Other patient needs will also become important to meet. After hours clinics already seek to personalize care. Patients will be able to request or pull services without long queues. Some systems already allow patients to go online and select their appointment time without ever speaking to a clerk. The services they pull will be those that have value for them. Lean will provide the basis for understanding the value added activities that will compose personalized medicine.
Lean Thinking is directed at reducing waste. This will allow a greater productivity for those value added services. For this reason management science will be as important as basic sciences in the healthcare of the future. So called ‘implementation science’ or ‘translational science’ is little more than systematically applying management theory in the delivery of evidenced based practices. Currently it has been estimated that approximately 50% of a clinician’s time is not necessary and not value added in the eyes of the patient. If this waste is eliminated then clinician’s will be able to spend more of their time caring for patients. This will reduce frustration for both clinician and patient.
Currently most facilities are organized around functional department such as laboratory testing, radiology, and medical clinics. Patients travel from one site, queue up and after being ‘processed’ in that department are sent to another department. Thus for a 2 minute blood test, 5 minute radiograph of the chest and a 10 minute doctor’s visit the patient may have spent all day go to and from these functional villages. The clinics of the near future should be organized into a “cellular” model which will allow all the services to take place within the clinic, rather than this functional “village’ model where patients travel between functions such as lab, clinic and radiology. In the future those functions will be provided at the point of care. Personalized medicine will become the ‘right care, at the right time, in the right place’.
Lean Thinking in healthcare is not just about how to reduce the administrative burden or waiting times of the patient. It is also important to consider the costs that patients undergo in accessing services. Even if the patient does not pay personally for their care, there is a cost. Much of that cost is hidden and does not occur in the clinic or hospital. It occurs as a result of the time and effort to get to the hospital or clinic. An easy illustration is trouble a patient undergoes in traveling to the office, finding a parking place, then walking to the office and then repeating at the other ‘villages’. The travel costs represent a barrier to many of our patients. Technology solutions will allow an amendment to the mantra of ‘right care at the right time’ by providing care at a distance. Telemedicine and telehealth combined with point of care testing will be a norm. This will move medicine away from the bricks and mortar of the clinic and hospital. The mantra will become ‘the right care, at the right time, in the right place, using the right technology.’
Lean thinking actually challenges healthcare administrators to develop systems that provide ‘the right care, at the right time, in the right place using the right technology.’ By applying Lean Thinking as new services and buildings are considered all of this is possible today. The future is here. But it will take administrators and physician executives prepared to think lean to fully capitalize on the changes. So you could say that Lean Thinking will be as important to ‘saving’ healthcare as any advance in the biological sciences might be.
Dr. Jeffrey Clothier
Associate Chief of Staff of Mental Health Service
Chief of Psychiatric Consultation and Emergency Psychiatry
Central Arkansas Veterans Healthcare System
Little Rock, AR 72205
posted by Joe Aherne at
15:24
2 Comments:
Not sure I truely agree. If you try to ensure that all tests, investigations and "pre-treatment" processes are carried out within one clinical setting - isn't that what we call a hospital? Yes it might be possible to "lean" some processes - eg having reception staff able to take simple blood tests, but where do you site an MRI scanner - next to the drinks dispenser? Lean in health should be the concept of reducing waste, ensuring experts do the expert tasks, and make sure the patient is fully informed rather than holding onto information and preventing good self-care. The notion that many laboratory tests will be done through telemedicine is just plain wrong. It has taken years to just do blood sugars - biochemically one of the simplest tests we can do. Adding tumour markers, blood counts and hormone levels is currently way off. So articles like yours raise false expectations. It is the processes which requires "lean" thinking - ie ensuring all tests are done BEFORE attending the doctors appointmnet, so he/she is armed with the results and can make decisions, rather than deferring to yet another appointment. Empowering front-line staff to make decsions about treatment and discharge is essential in removing patients who follow basic simlpe pathways, freeing up medical time to deal with the complex ones. There will remain a need to centralise many departments - lots of evidence shows that small clinical teams do not see enough complex cases/patient volume, they fail to grow in expertise and there is duplicated waste. I'd be happy to discuss further across the pond. Sean.barnett@northeast.nhs.uk Sean Barnett, Manager and Clinical Scientist in the National Health Service, England
By
Anonymous, At
09 January 2007 10:32
The role lean can play in saving the system is by helping provide 'the right care at the right time in the right place using the right technology'.
I agree that the future is unknowable and that much of the potential for remote testing is in the remote future.
In terms of remote care and telemedicine. We currently utilize care coordination and disease management using telemedicine and telehealth processes that include several. routine tests that used to require a visit by the patient.
Again the argument that somehow tumor markers would be undoable through more remote testing is may not be correct. Gene chips have been approved by the FDA to obtain a genotype for drug metabolism pathways. Currently the cample is obtained locally an the chip is sent to a centrally lab. But as the equipment becomes better, smaller and more widespread it is possible that the samples can be processed locally in the future.
There are designs and prototypes for labs on a card that have shown the feasibility to have testing remote from the office for a wide range of tests.
What the future holds can only be speculated about. Whatever the capability of the future technologies, the best implementations will be lean and will relate to the right care at the right time in the right place using the right technology.
I think that using the extreme example of where do you place an MRI to minimize incremental improvements that can be accomplished by considering more effcient space utilization is a bit of a red herring.
The issue of where to place an MRI does bring up some issues that touch on lean thinking. Too often equipment placement is done by asking where do we have space and then routing patients and supplies to that site. Consequently you have travel and waiting areas in multiple places in the facility. For instance I have seen facilities where the cardiac cath labs were located on different floors from the recovery areas.
I think we can do better. For instance consider radiographs. Now that many facilities are digital the need for film readings is obviated. Thus locating all radiographic procedures in a central area close to film processing units is not necessary. Instead some radiographic test could be done in the clinic closer to the examination rooms.
I still believe that it is not just the technology that will be important in medicine but the way the technology is implemented that will be important. In that regard lean managment and lean thinking will be valuable concepts to master for future administrators.
By
Jeff Clothier, At
10 January 2007 16:48
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