Lean and Mean
Does the title apply to your healthcare organization? Maybe it should. Check out the current issue of Quality Progress for “Make Healthcare Lean” by A.Manos, M.Sattler, and G.Alukal. Another application of techniques from industry. Good ideas under “Tools and Techniques.” Many obvious, but we still don’t use them: Organize the workplace, so you can find tools and supplies. (Without looking, where is a pencil on your desk?) Standardize work. Do the same thing every day, and learn to do it well. Quick changeover. This speaks to me! The OR doesn’t make money while it’s empty. We used to schedule all the left eye cataracts in the AM, right eyes in the PM to minimize time in moving the microscope. Same for knee arthroscopy. Interesting quote from Henry Ford: “The longer an article is in the process of manufacture and the more it is moved about, the greater its ultimate cost.” We calculated the $ cost per minute a patient was in our facility. The trick was to move them out without their feeling rushed. Nausea was not allowed, and good pain control was mandatory. All of this is possible, but it doesn’t happen by accident. Discussion of causes of waste in healthcare: Overproduction. (e.g. paperwork). Our patient chart was six pages. Total. Everything. We counted (and minimized) penstrokes. Inventory. Next time you do an inventory, put a $ value on each cubby hole. Take all the cupboards out of the ORs. Bring in only what you need and return the extra to inventory when you’re through. How about the anesthesia cart! Finally, waiting. “In any form, waiting is a waste.” Is there ever a time when the patient is on the OR table, but nothing’s happening? My ORs used to cost $20 per minute. Do the arithmetic.
Comments
Either I am misunderstanding your comment about supplies (inventory)in the OR, or I generally disagree with it. Maybe its in your definition of "what you need", so hopefully you can shed some light on this.
A significant waste comes in trying to find something when you need it. In the OR, taking time to search also increases the risk of an undesireable outcome. And yes, I understand that you can't possibly stock each OR room for every possible outcome. My comment is also based on my impression that most ORs are not arranged today to have a truly efficient central stocking location. The tradeoff is having a larger inventory at hand (in the OR) versus wasting time finding the right equipment while you are trying to contain a situation, at $20/minute. This is even more of an issued in the ED.
My inexperience may be showing....Tell me what I'm missing in this picture.
Posted by: Matt Meyers | July 14, 2006 09:30 AM
The trick is to get all surgeons to agree on what is necessary to do each standard procedure. Then, you don't need to go fetch anything. And you don't need cupboards full of stuff you might need.
Posted by: Robert | July 21, 2006 10:16 AM
What exactly is "mean" about lean? I don't think it is particularly to put those words together if you're in favor of lean. Some people will criticize the process as "lean and mean", particularly if lean is being used to drive layoffs (which shouldn't be the case). I always have to convince people in healthcare that lean is NOT mean -- it is good for patients, good for employees, and good for the hospital. "Lean and mean" isn't a cute saying, it's something that gets in the way of lean progress and it's a phrase that has to be debunked, rather than using it as the headline in a pro-lean blog post.
Posted by: Mark Graban | August 8, 2006 09:51 PM
Sorry, Mark. Nothing negative intended. "Mean" only in the sense of "Ready for Action." Lean is a valuable concept for healthcare--as long as the supply chain is not broken. I deleted all the cupboards from the blueprints for a surgery center to make the supply system there leaner. We ordered drugs every day. Counted penstrokes needed to complet a record. Etc.
Posted by: Robert Burney MD | August 15, 2006 09:02 PM
"Mean" has never meant "ready for action." It means miserly, base, ignoble, and grabby-spirited.
And Henry Ford was a fascist, not a role model. And human beings are not PRODUCTS.
Posted by: Stella | August 31, 2008 10:54 AM
I guess it's a male thing. "Mean" was intended in the sense of aggressive, aware, in control, no excuses, top performance. "Show me a better way, and we'll be doing it tomorrow if not today." True, it does have another menaing. I would regard the U.S. Marines as "mean" in a positive sense. The Blackwater mercenaries are "mean" in a negative sense.
Posted by: RGBurney MD | September 2, 2008 07:58 AM