We have been hearing a lot of talk lately about the state of healthcare. With an aging population, it is becoming a very expensive process to provide adequate healthcare to all who need it. Once you get past the political rhetoric, there are a few simple facts that are beyond dispute.
According to the U.S. Census Bureau, in 2010 12.8% of the U.S. population is 65 years and over. This number is expected to double in size over the next 25 years. By 2030 almost 1 out of 5 Americans, some 72 million people – will be 65 years or older. In fact, the fastest growing segment of the U.S. population is the age group 85 and older.
This might not seem like a big deal to most people, but it really is when you look at it from a supply and demand perspective. According to a survey conducted by Press Ganey Associates in 2007, U.S. emergency patients spent an average of 4 hours and 5 minutes in the emergency department. The question is: Are patients harmed by long wait times? In 2006, the Institute of Medicine released a report, which found there was “a growing concern” that a patient having to wait is affecting their level of care. It also stated that waiting could “result in a patient experiencing protracted pain and suffering and delays in diagnosis and treatment.” The aging population is and will continue to overwhelm the U.S. healthcare system and is creating a fragmented care process.
According to OECD data, American health care is a prime example of the consequences of fragmented care: high costs (40% higher than the next most expensive nation), injuries to patients (between 44,000 and 98,000 Americans dying in hospitals each year due to errors in their care), unscientific care (500 percent variation in rates of some surgical procedures from city to city), and poor service. Patients with chronic diseases — who account for 75 percent of all health care expenditures — are most vulnerable.
What is the answer to this growing problem? Is it a matter of throwing more money at the problem? How can we save the next patient from being harmed as a consequence of the next medical error? The answer will astonish many because we need to go to the automobile industry for the solution. In fact, the Toyota Production System (TPS) is where we find the methods to help improve the healthcare system. How do I know this? Well, there are many examples throughout the U.S. and the world where healthcare facilities have implemented programs using Lean principles from the Toyota Production System to help identify and eliminate waste.
What is demonstrated by using Lean principles is that most hospitals are not designed for sick people. The medical facilities are designed to fulfill functional requirements of the healthcare process and staff needs. The result of this type of hospital design is patients have to be moved or transported from one process to the next.
A typical process will start with a patient going to registration in one part of the building. Next, the patient will check-in with someone in another department to take their vital signs, and maybe they need to give specimens (urine, blood, etc.) in another department somewhere else. After several lengthy waiting periods, and visits to different floor levels and multiple elevator rides the patient will arrive at their main destination. This is the actual reason for them being at the hospital, which is to see a physician for a diagnosis and treatment. For a cancer patient, this is chemotherapy, for an emergency patient this is to have their condition examined and stabilized. After their treatment, they may be discharged to go home, or there could be more tests required, which means more travel time to other departments.
In a Lean Enterprise, the customer is the primary focus. Every improvement is the result of seeing the production and delivery process from the customer’s perspective. Hospitals are now starting to implement the same approach in the delivery of healthcare. I often work with the staff in hospitals, and I find them to be hard working and dedicated people. The problem is they are overworked and overwhelmed because of the bureaucracy and organizational structures they work with. However, working harder is not going to change the process, it will only exacerbate the problem. So, what is the solution?
We need to get everyone to work smarter, not harder! This means getting everyone involved in the healthcare process to become a problem solver. The people who live and breathe the daily challenges are the medical staff and patients. Training hospital staff to understand Lean principles and how to implement them to identify and eliminate waste is the first step. Organizing them into improvement (kaizen) teams to find solutions to improve their service to the patient is the second step. Implementing both steps will dramatically improve the patient’s experience.
If you are interested in learning about Lean Principles check out the Lean Healthcare Online website. All of their Lean training is online and available 24/7. To see more information about the Level 1 – Lean Awareness in Healthcare training…click here
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