In the True LeanTM program, we believe that the principles of the Toyota Production System (TPS) apply not only to manufacturing but to any “Complex System.” Healthcare facilities are critical systems in our society that like any system where people are doing work, contain significant amounts of waste. Some can be avoided completely, while others, though unavoidable, can be actively managed to reduce their impact on patients and caregivers alike. Within these systems, every activity can be considered a process, and, as we say within TPS thinking, a good process provides a good result. Continuously improving the processes and the people in healthcare systems can lead to improved clinical outcomes, enhanced patient and caregiver experiences, and optimized business results.
What are “Wastes” in Healthcare Facilities
Before diving into examples of waste in healthcare facilities, it’s essential to first define the 7 Wastes from a Lean Systems perspective. In TPS, waste is considered as “anything that the customer is not willing to pay for.” This would include Motion, Quality Defects, Waiting, Over Processing, Transportation, Inventory, and Overproduction.
As within any complex system, these wastes occur at all levels within healthcare operations.
- For healthcare providers: unnecessary movement and overproduction (ex., unnecessary testing) can disrupt the flow, increasing patient wait times and reducing efficiency.
- For patients: Waiting and transportation are among the most visible wastes, but the most critical waste is the quality issues caused by medical errors.
- For facility management: Excess inventory is a leading contributor to increased costs and inefficient processes for managing resources at risk of expiration.
- For staff: Over-processing or quality issues during the sanitization of surgical areas, as well as idle (waiting) time before, during, and after, lead to inefficiencies.
Together, these wastes impact healthcare delivery in terms of performance; diminished patient well-being and satisfaction, as well as increased costs.
Where is the Starting Point
A successful implementation of TPS within healthcare begins by addressing the needs of patients and caregivers; understanding how the key principles of TPS —Customer First, Respect for Humanity, and Elimination of Waste —can foster and develop an organizational culture that supports a sustainable, continuously improving, Lean Healthcare environment for the benefits of both Patients and Providers.
What is Next: The Elements of a Lean Healthcare Model
- A Supportive Leadership Culture: A successful cultural transformation to create a sustainable Lean Healthcare environment requires a committed Leadership team that both values and understands their own active role in supporting the implementation of each of the “elements” of a Lean Healthcare Model.
- Clearly Defined Roles: Established and developed to separate the performance of normal “standard of care” processes from the handling of abnormal situations and problem solving.
- Engaged Staff: Cultivate a culture where people understand and recognize the importance of their contributions to improving the quality of care by following these standards and identifying problems as they arise, thereby enhancing care processes, skills, and the work environment.
- Standard Processes: All activities are carried out consistently by all staff and reflect an understanding of the currently known “best practice” for performing any process from an evidence-based care perspective.
- Abnormality Management System: enables staff to recognize, in real-time, deviations from standard processes and “workarounds.” This system should capture and analyze data on abnormalities, allowing quick resolution of acute problems and providing insights for long-term improvements.
- Operational Problem Solving (8-Step Problem Solving): Led by people doing the work to both maintain and continuously improve the current “best practice” standards of care in their work areas by systematically addressing the root causes of problems to prevent them from recurring.