Fresh perspective for success in healthcare

A Doctor’s Perspective on Lean in Healthcare: Top 5 Observations

“An anesthesiologist, surgeon, pathologist, and psychiatrist were driving in a rental car together in Utah….” It sounds like the beginning of a corny medical joke, but it actually happened.

My hospital, like many others in the United States, has been on a “Lean Journey” which means learning to apply management principles honed in the auto industry to healthcare. I, along with other managers from various functional areas in our hospital, had the opportunity to visit the Autoliv airbag factory in Ogden, Utah, and see how this organization applies Lean.

Making the most of this trip took some translational thinking. Obviously making airbags is not the same as taking care of patients. Interestingly it did not take long for me to look past this difference and learn some valuable lessons. Although I have read some good articles about Lean management in healthcare, seeing it firsthand filled in a lot of gaps for me. I am by no means a Lean expert. I come from the perspective of a doctor who wants to take the best possible care of his patients. These were my top 5 observations:

  1. Employee engagement and recognition. One of the most important principles of lean is respect for people. A sign posted on the factory floor asks, “What will I do today to save more lives?” Finding a defect in a part or a potential hazard is celebrated openly, and any employee who reports a finding receives a small reward as well as a posting with his or her picture displayed in the central visual management area. Each work unit has a suggestion box for employees to submit ideas to improve processes, and the company has full-time employees dedicated to turning these ideas into reality whenever possible.
  2. Standard work. Each process from the making of a part in a work unit to the manager’s daily schedule has a set sequence of standardized steps. This makes a lot of sense from the standpoint of training, cross-training for coverage, and consistency in performance. In addition, standardizing processes with frontline staff in charge can help decrease unnecessary steps, waiting, or “re-work” that lead to frustration and dissatisfaction.
  3. Visual management. Each workspace unit responsible for a part at Autoliv has a standup display showing the unit’s performance and goals. In a central location on the plant floor, there are walls displaying the organization’s strategic priorities and charts showing recent performance statistics and benchmarks. Huddles or verbal status reports take place at the same time each day at various levels of the organization, starting early at the frontline work units and progressing upward through larger functional areas.
  4. Rapid tiered escalation. When an acute problem in a unit arises, the team lead is called immediately, and the team members try to solve it together. If the problem persists beyond a set time limit, the next level supervisor is called, and so on. This escalation ultimately ends with the plant manager who is the managerial equivalent of a hospital director. This process ensures that problems at the frontline get addressed in a timely fashion.
  5. Managerial presence. At the work units, each team lead is on the factory floor helping team members, teaching, and troubleshooting problems. For Lean to work, leaders have to be actively involved and present and not just issue orders from their offices. At Autoliv, higher level managers visit the factory floor multiple times a day to observe teams at work, field questions and comments from employees, or audit processes.

Implementing Lean management in healthcare requires a cultural transformation with an investment of time, effort, and resources that does not happen overnight.Tweet: Implementing Lean management requires a cultural transformation with an investment of time&effort @BHGStat Autoliv’s Lean journey began two decades ago with onsite teaching from a Toyota Lean sensei and still continues today. Both management and leadership are necessary for success. Although “management” is often used interchangeably with “leadership,” they are not the same. Leadership should be visionary, inspiring, and motivating in my opinion. Management is about accomplishing the mission or getting the daily work done. Good leaders need to be able to plan strategically for the future, keeping long-term goals in mind, while still accomplishing the daily mission. Using Lean principles, goals can be made visible, and leaders can empower employees to take ownership of their own problems and solutions.

Edward R. Mariano, MD, MAS

After graduating from Georgetown University School of Medicine, Dr. Mariano completed his anesthesiology residency at Stanford University Medical Center and pediatric anesthesiology fellowship at Stanford University Medical Center/Lucile Packard Children’s Hospital. View full bio on authors page