Lean Concepts Applied To Healthcare With Positive Results
By Christine Kern, contributing writer
Adopting Lean methodology significantly reduced discharge time and raised satisfaction levels.
According to the Lean Enterprise Institute, the premise of lean manufacturing is to produce an item based on customer specifications in the fastest, most efficient way, for the best possible price, while maximizing customer value while minimizing waste. And now, researchers at Penn State Hershey Children’s Hospital have conducted a study applying lean technology to streamline healthcare and reduce the number of patients that must be turned away.
According to a press release, the approach also enables doctors to spend more time with their patients and doctors in training without affecting readmission rates. It could ultimately serve as a model for hospitals around the country to open up existing beds to more patients and reduce emergency department crowding and lost referrals without investing significant capital.
“We spend more time in the patient’s rooms, engaging them in discussions and teaching the residents and med students,” Dr. Michael Beck, physician at Children’s Hospital and associate professor at Penn State College of Medicine, explained. “So not only does this newer model appear to be effective and more efficient, it appears to be a staff and customer satisfier, which are key elements in sustainability.”
When hospitals are at or over bed capacity, a common practice is to “board” admitted patients in the ED until beds free up elsewhere in the hospital. This practice is causing a nationwide challenge of overcrowding and safety concerns across healthcare organizations, and particularly in emergency departments.
The study was designed to investigate how to discharge patients more efficiently, without negatively impacting readmission rates. To carry out the investigation, researchers turned to Lean Six Sigma, a methodology commonly used in other industries that is starting to make its way into healthcare. Lean Six aims to improve effectiveness and efficiency by eliminating waste in the overall process.
“Lean Six is designed to reduce delays, defects, and deviations through waste elimination and creation of standard practices,” Beck said. “It emphasizes creativity over capital by finding the most efficient sequence of steps in a process to improve quality without adding significant costs.”
Over the six-month study, Lean Six interventions significantly sped up discharges in the intervention group, when compared to historical controls. The median time of discharge was 93 minutes earlier in the intervention group than in the control group. The researchers published their results in the Journal of Hospital Medicine.
“We successfully eliminated an hour-and-a-half off all of our discharge times – consistently, predictably, and reliably – for the busiest months of the year,” Beck said. “We were discharging 45 percent more patients per day, faster than the control groups, without increasing length of stay or increasing 7-, 14-, or 30-day readmission rates.”
As discharge delays decreased, patient satisfaction increased. Surveys found that 75 percent of patients said they would recommend the hospital to others, compared to 53 percent before the study. And physician satisfaction also rose significantly, with unanimous consent to continue with the new model, despite that doctors worked more hours during the intervention period.