Lean in Health Care
Case for Change
Waste, redundancies, errors, and escalating costs are pervasive in many industries. The Japan-based Toyota Corporation developed the Toyota Production System (TPS) to tackle these problems within its organization. The tools and principles of the TPS helped increase efficiency, decrease resource waste, and improve quality. Eventually, American manufacturers began to utilize TPS to improve their own organizations. TPS, today better known as Lean, revolutionized the way manufacturers did business. Lean also reduces overhead costs, eliminates waste, and increases patient and staff satisfaction, by improving the processes by which an organization carries out its activities.
Others industries took notice of these rapid improvements in manufacturing and considered implementation within their sectors. Health care, in particular, lent itself well to Lean techniques. Implementation of Lean allowed providers to lower cost and improve the quality of care delivered to patients. One of the early adopters, Virginia Mason Medical Center in Seattle, reaped Lean benefits immediately after its 2002 implementation. The 350-bed hospital saved $6 million in planned capital investment, freed 13,000 square feet of space, cut inventory costs by over $350,000, reduced staff travel time around the hospital, and decreased infection rates. At the same time, the hospital greatly improved patient satisfaction.
The Iowa Healthcare Collaborative (IHC) recognizes that many health care providers in Iowa have successfully implemented Lean process improvement within their organizations. These providers have many success stories of more efficient care delivery and better resource allocation. IHC hopes to encourage more Iowa health care providers to implement Lean, and has a goal of expanding the number of hospitals using Lean for improvement.
IHC would like its efforts to create greater awareness of Lean in the Iowa health care community. Additionally, IHC hopes that these process improvement tools will spark meaningful, lasting dialogue among the state's providers. This communication should successfully link those new to Lean and other process improvement techniques and those who have successfully implemented them within their organizations. IHC hopes this sharing of ideas will stretch beyond this project and into other meaningful arenas.
This toolkit will:
- Provide numerous educational materials about Lean
- Provide a list of Iowa contacts who have implemented Lean in their organizations
- Provide success stories from Iowa hospitals who have applied Lean tools for improved outcomes
Sources:
- Connolly, C. "Toyota Assembly Line Inspired Improvements at Hospital." Washington Post, June 3, 2005, p A01.
- Institute for Healthcare Improvement. "Going Lean in Health Care." 2005. Available at www.ihi.org.
Tool Kit
Education and Tools
Lean Presentations
- Dean Bliss, St. Luke's Hospital, Cedar Rapids, IA
Lean Overview
- Sarah Pavelka, Quality Management/Organizational
Development Specialist
Lean Paradigm- 5S tool- used to develop the most efficient workspace and eliminate waste in day-to-day operations.
2007 Annual Lean Conference Speaker Handouts
- Creating a Culture of Improvement at Mercy Medical Center-Des Moines
Dan Varnum, MBA, Vice President of Performance Improvement, Mercy Medical Center – Des Moines
This presentation will walk you through how Mercy Medical Center – Des Moines had continued to develop its culture of process improvement, and share successes and lessons learned.
- Improving Processes to Decrease Cost and Improve Service
Jay Christensen, Administrator; and Les Martin, Director of Continuous Improvement, Mahaska Health Partnership, Oskaloosa
This presentation illustrates how the Mahaska Health Partnership decreased costs and improved customer service through simple organizational changes.
- Lean Basics
Dean Bliss, Director of Lean Improvement, St. Luke's Hospital, Cedar Rapids
This presentation provides a basic understanding of the Lean methodology, including terminology and acronyms.
- Non Healthcare Approach to Lean
Teresa Hay McMahon, Performance Results Director, Iowa Department of Management, Des Moines
Jeff Ruiter, Director of Demand Distribution, EDS, Des Moines
These two presentations describe how Lean methodology has been successful in non-health care environments in reducing costs, increasing productivity and achieving greater customer and employee satisfaction.
- Reinventing Health Care: Improving Quality as a Determinant for Reducing Cost
Karen Wolk Feinstein, PhD, President/CEO, Jewish Healthcare Foundation and Pitts burgh Regional Health Initiative, Pittsburgh, PA
This presentation examines the way in which quality improvement leads to cost reduction and the innovative way in which health care institutions in Pennsylvania are using process engineering to achieve improvements.
Lean Overview
Development Specialist
Lean Paradigm- 5S tool- used to develop the most efficient workspace and eliminate waste in day-to-day operations.
Dan Varnum, MBA, Vice President of Performance Improvement, Mercy Medical Center – Des Moines
This presentation will walk you through how Mercy Medical Center – Des Moines had continued to develop its culture of process improvement, and share successes and lessons learned.
Jay Christensen, Administrator; and Les Martin, Director of Continuous Improvement, Mahaska Health Partnership, Oskaloosa
This presentation illustrates how the Mahaska Health Partnership decreased costs and improved customer service through simple organizational changes.
Dean Bliss, Director of Lean Improvement, St. Luke's Hospital, Cedar Rapids
This presentation provides a basic understanding of the Lean methodology, including terminology and acronyms.
Teresa Hay McMahon, Performance Results Director, Iowa Department of Management, Des Moines
Jeff Ruiter, Director of Demand Distribution, EDS, Des Moines
These two presentations describe how Lean methodology has been successful in non-health care environments in reducing costs, increasing productivity and achieving greater customer and employee satisfaction.
Karen Wolk Feinstein, PhD, President/CEO, Jewish Healthcare Foundation and Pitts burgh Regional Health Initiative, Pittsburgh, PA
This presentation examines the way in which quality improvement leads to cost reduction and the innovative way in which health care institutions in Pennsylvania are using process engineering to achieve improvements.
Articles
New Articles
- "Creating an Environment for Caring Using Lean Principles of the Virginia Mason Production System." Dana L. Nelson-Peterson & Carol J. Leppa. The Journal of Nursing Administration, Volume 37 Number 6 2007.
- "Dentist Drills Down to the Root Causes of Office Waste." Lean Enterprise Institute.
- "Lean in Healthcare." Elizabeth Saunders. IAbiz Online, February 5, 2008.
- "Mistake-Proofing the Design of Health Care Processes." John Grout. Agency for Healthcare Research and Quality, Publication No. 07-0020 May 2007.
- "Pulling Lean Through a Hospital." George Taninecz. Lean Enterprise Institute.
Old Articles
- "Apply 'Lean' Principles in the Health-Care Industry." Donna Daniel. Puget Sound Business Journal, October 28, 2005.
- "Decoding the DNA of the Toyota Production System." Steven Spear & H. Kent Bowen. Harvard Business Review, September-October 1999.
- "Fixing Healthcare from the Inside, Today." Steven Spear. Harvard Business Review, September 2005.
- "Going Lean in Health Care." Institute for Healthcare Improvement, 2005.
- "Lean Sigma – Will It Work for Healthcare?" James Bahensky, Janet Roe, & Romy Bolton. Journal of Healthcare Infection Management, Winter 2005. 19(1): 39-44.
- "Lean Thinking for the NHS" Daniel Jones and Alan Mitchell. NHS Confederation, 2006.
- "Learning to Lead at Toyota." Steven Spear. Harvard Business Review, May 1, 2004.
- "Maximizing Hospital Outcomes with Tips from Toyota: Using Less to Do More." Gary S. Kaplan. Physician's Weekly, October 3, 2005.
- "Power of Lean in the Laboratory: A Clinical Application." Jennifer Blaha & MariJane White. GE Healthcare White Paper, 2006.
- "Reducing Waste and Errors: Piloting Lean Principles at Intermountain Healthcare." Cindy Jimmerson, Dorothy Weber & Durward K. Sobek II. Journal on Quality and Patient Safety. 31(5): May 2005.
Websites
- American Society for Quality is a membership organization devoted to quality. "We have the knowledge, tools, expertise and resources to inspire you and your organization."
- Association for Manufacturing Excellence is a not-for-profit organization dedicated to cultivating understanding, analysis and exchange of productivity methods and their successful application in the pursuit of excellence.
- Gemba Research produced a useful Lean Manufacturing Toolkit.
- I Six Sigma is a site that provides information on Six Sigma process improvement.
- Lean Blog is a blog about Lean in factories, hospitals, and the world around us.
- Lean Enterprise Academy is a source of Lean information for those in the United Kingdom.
- Lean Enterprise Institute is a nonprofit education and research organization founded in 1997 to promote and advance the principles of lean thinking in every aspect of business and across a wide range of industries.
- Lean Healthcare West is a group of experienced healthcare professionals that serve as implementation consultants for Lean in health care.
- Productivity Press is a publisher of Lean improvement books.
- Quality Press is a publisher of books on subjects such as quality improvement and Lean.
- Star Thrower provides innovative training materials.
- Superfactory offers resources supporting lean manufacturing and lean enterprise best practices.
- University of Michigan College of Engineering Center for Professional Development offers a one-week Lean Healthcare Certificate Program.
Books
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5S for Service Organizations and Offices: A Lean Look at Improvements |
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A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste |
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A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinics, and Other Healthcare Organizations |
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Becoming Lean: Inside Stories of U.S. Manufacturers |
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Leading Change |
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Lean For Dummies |
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The Lean Healthcare Pocket Guide |
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Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction |
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Lean - Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost and Throughput |
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Lean Six Sigma for Service: How to Use Lean Speed and Six Sigma Quality to Improve Services and Transactions |
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Lean Six Sigma: Combining Six Sigma Quality with Lean Speed |
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Lean Solutions: How Companies and Customers Can Create Value and Wealth Together |
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Learning to See: Version 1.3 |
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Lean Thinking: Banish Waste and Create Wealth in Your Corporation |
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The Machine that Changed the World: The Story of Lean Production |
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The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota Based Methods |
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Stop Rising Healthcare Costs Using Toyota Lean Production Methods: 38 Steps for Improvement |
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The Toyota Way: 14 Management Principles from the World's Greatest Manufacturer |
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The Toyota Way Fieldbook |
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Winning Score: How to Design and Implement Organizational Scorecards |
Iowa Contact Information
| Iowa Healthcare Contacts | ||
Spencer Hospital |
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Mercy Medical Center |
University of Iowa Healthcare |
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Iowa Health - Des Moines |
Skiff Medical Center – Newton |
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Jennie Edmundson Hospital |
Iowa Health System |
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Pella Regional Health Center – Pella |
Mercy Medical Center |
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Mahaska County Health Partnership |
Mercy Medical Center |
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Jefferson County Hospital – Fairfield |
| Iowa Industry Contacts | ||
Alliant Energy |
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John Deere Public Affairs |
Pella Corporation |
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Rockwell-Collins |
Vermeer Manufacturing Co |
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| Iowa Government Contact | ||
| Iowa Department of Natural Resources | ||
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Teresa Hay McMahon Executive Officer 515-281-0110 |
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Iowa Community College Contacts
The reVIEW© training program, originating from Lean Healthcare West, "teaches simple, proven tools for Lean implementation that are immediately practiced on real issues in your workplace." The following individuals have been trained to bring the reVIEW© program to organizations.
For general information contact:
Collette Saylor
Executive Director
515-964-6267
casaylor@dmacc.edu
www.iacct.com
www.leanhealthcarewest.com
Lean Consultants
Breakthrough Management Group |
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Kenagy & Associates |
Gemba Research, LLC |
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Lean Advisors, Inc. |
Guidon Performance Solutions |
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Simpler |
HPK Group, LLC |
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TBM Consulting Group |
Success Stories
Below are Process Improvement Success Stories from St. Luke's Hospital – Cedar Rapids, Mercy Medical Centers in Cedar Rapids and Des Moines, and the University of Iowa Hospitals and Clinics.
Spencer Hospital – Spencer
St. Luke's – Cedar Rapids
St. Luke's Hospital – Cedar Rapids
Mercy Medical Center – Cedar Rapids
Mercy Medical Center – Cedar Rapids
Mercy Medical Center – Des Moines
University of Iowa Hospitals and Clinics
Pella Regional Health Center - Pella
Allen Hospital - Waterloo
Mentor Hospitals
We would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors. Please contact IHC if your organization would like to contribute materials to this toolkit.
IHC would like to thank the Lean Steering Committee:
| Vicki Baum | Indian Hills Community College |
| Kathy Berry | Mercy Medical Center, Cedar Rapids |
| Dean Bliss | Iowa Health System, Des Moines |
| Tom Evans, MD | Iowa Healthcare Collaborative |
| Randy Fry | University of Iowa Hospitals and Clinics, Iowa City |
| Jeff Jutting | Mercy Medical Center, Des Moines |
| Kyla Kiester | Iowa Healthcare Collaborative |
| Perry Meyer | Iowa Hospital Association |
| Sarah Pavelka | Iowa Quality Center, Marion |
| Mike Rohlf | Iowa Department of Management |