The Lean Hospital

What does being lean have to do with operating a hospital? Well, when you’re talking about the lean method known as the Toyota Production System, it just may be what puts hospitals back in the driver’s seat of their bottom lines.

Six years ago, few hospital administrators had ever heard the term. Today, what began as an experiment at Seattle’s Virginia Mason Medical Center is sweeping through cash-strapped hospitals across the country.

Originally envisioned by the Japanese automaker as a way of doing more with less, the much-copied management system is becoming the gold standard for U.S. hospitals. They are betting that going Toyota lean will streamline processes, increase employee satisfaction, improve their finances, and most importantly, enhance patient care.

What does being lean entail?

“At its core, lean is a process-improvement methodology and management improvement system,” says Mark Graban, a senior consultant with Ortho-Clinical Diagnostics’ ValuMetrix Services in Rochester, N.Y. Graban teaches the Toyota system to hospitals throughout the country. One of the system’s most basic tenets is respect for the work force. Another is that it does not assign blame. Instead, Graban explains, “Lean engages the work force to improve the work they are involved in—improving process and quality, and reducing delays for patients.”

Can Hospitalists Go Lean?

Hospitals have used lean to improve productivity in areas as diverse as inventory, testing, purchasing, and food service. What about their most critical function — patient care? Can lean help hospitalists to perform their jobs, too?

“Yes,” asserts Christopher Kim, MD, MBA, of the Departments of Internal Medicine and Pediatrics at the University of Michigan. Dr. Kim studied lean and applied it at his hospital in Ann Arbor. “To really do lean projects well, you need the buy-in of the physicians—the hospitalists. I believe hospitalists have a huge role in how successful lean projects can be. It behooves them to participate in these process improvement projects and take a lead role.”

Managers must sign on, as well.

“Lean gets managers out of their offices and into various departments to see what the problems are,” says Graban, whose book Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction is due out this summer. “Lean allows you to see it firsthand rather than relying on budget reports. We take executives to the nursing unit, and you see the light bulb go off. They say, ‘We need to help our employees provide care.’ ’’

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