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Improving the quality and efficiency of health care services

Lean solutions reduce waste, improve delivery, create capacity and cut costs

As Canada’s health care organizations work to deliver quality care, transform service delivery and meet evolving patient needs, they face significant challenges. For example, they must:

  • address a growing demand for services with limited resources;
  • seamlessly flow patients within and across organizations;
  • invest in new technologies that support the move towards a system-wide electronic health record;
  • reduce wait times to align with government policy and meet the expectations of increasingly informed citizens; and
  • accomplish all of this in an environment of rising costs and shrinking budgets.

To be sure, health care organizations have adopted various approaches and tools to respond to these challenges, including continuous quality improvement and business process redesign. And while they have met with some success, in general they continue to grapple with endemic challenges, such as extended patient visits, long wait times and rising service delivery costs.

Clearly, health care organizations need a new approach. Notably, one may already exist: the application of Lean.

What is Lean?

Based on the Toyota production system, Lean has evolved beyond its roots to deliver success in sectors other than manufacturing. Lean solutions involve identifying the tasks associated with organizational processes to determine how to improve quality and processes by eliminating non-value added activities or waste. The ultimate aim is to improve quality and productivity, optimize human resources, augment service delivery capacity and realize savings while improving overall service levels – goals that strongly resonate with health care organizations.

“Five years ago, some people argued that Lean tools weren’t appropriate for the public sector or health care, but that view has now shifted,” explains Young Lee, senior manager responsible for leading Deloitte’s practice in the application of Lean in health care. “As public sector and health care organizations across North America adopt Lean initiatives, they have improved quality, enhanced their focus on patient-centred care, created service capacity and reduced costs. As a result, organizations can reinvest savings into other strategic initiatives.”

Real-world examples – Lean solutions in hospitals

To date, hospitals in Boston, Pittsburgh and Seattle have piloted Lean initiatives that have limited hospital-acquired infections and medication errors. Canadian hospitals are also recognizing the value of Lean principles. For example, University Health Network, the Ottawa Hospital and the Provincial Health Services Authority in British Columbia have started to explore – and apply – Lean solutions to reduce wait times and improve patient flow. In Val-d’Or, Quebec, one health facility used Lean to reduce its budget by over 10% and cut day-surgery wait times by two hours.

Government leaders and policy makers are closely tracking these successes. In July 2008, Quebec’s Health Minister Yves Bolduc announced his intention to apply Lean ideas to elements of the provincial health care system. “It’s an approach that, despite its name, is not geared only to the production of cars,” Minister Bolduc told the Canadian Press. “It involves working with people to eliminate delays and unnecessary procedures.”

How health care organizations can benefit

Lean initiatives can streamline hospital visits, improve the productivity of health care providers, reduce the time it takes to complete specific procedures, create service delivery capacity and deliver savings that can be reinvested or reallocated to support additional services or programs.

“Lean relies on a customer-oriented approach, which reflects the health care industry’s focus on delivering patient-centred services,” explains Lisa Purdy, leader of Deloitte’s Health Services practice. Lean principles give health care professionals an opportunity to both improve operations and transform their internal culture. By enhancing their focus on continuous improvement, organizations can begin to adopt a truly patient-centred view of service delivery.”

As an added benefit, Lean initiatives can help inject accountability and improve transparency by providing metrics that demonstrate the value realized from health care investments. “Corporations aren’t the only entities that face falling revenues, higher expectations and a demand to do more with less while keeping customers happy. The public sector, particularly health care, is facing similar budget constraints and citizen demands,” Lee asserts.

“By adopting Lean for certain elements of the health care system, governments and provider organizations can improve the quality of care and patient safety, reduce wait times, enhance patient flow, streamline operational processes and realize savings.”

Contact the Health Services group for more information about this topic.

Navigating the Lean landscape

One innovative approach for health care organizations grappling with the need to deliver quality services is the implementation of Lean initiatives. In addition to enhancing quality and realizing efficiencies, Lean can help organizations establish a culture committed to continuous and sustainable improvement.

There are three stages of Lean for public sector organizations to consider: assessment, training and implementation. Activities covered by each of these stages include:

  • Assessing your current operations and the potential benefits and savings you can realize through Lean initiatives
  • Transitioning to a Lean culture with hands-on training programs
  • Cost-justifying your process improvements with simulation modeling
  • Developing an implementation methodology best-suited to your organization’s needs
  • Integrating your Lean initiatives with any existing improvement processes, such as Six Sigma and Total Quality Management

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