Southeast Planning Region
Lean Health Care

Health care facilities are taking their cues from the manufacturing sector to find ways to reduce waste and eliminate bottlenecks.

By Jennifer Ridgeway 

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Health care employment has been growing nationwide, but there also has been a movement to make health care work better and smarter, with the end goal of reduced costs and improved outcomes. The Southeast Planning Region in Minnesota is home to some of the country’s most progressive medical institutions on that front.

Health care sector keeps hiring

Clearly, health care employment has been growing since the 2001 recession (see Figure 1). Between 2000 and third quarter 2008, the sector added more than 11,000 jobs (28 percent growth) and increased its presence from one in every five private-sector jobs to one in four.

Despite the current recession, health care employment should continue to grow, especially when the economy rebounds. In this patient-centered industry, greater demand for services means more people hired. Between 2006 and 2016, health care employment is projected to grow 25 percent in Minnesota, or by 12,000 jobs.

But those numbers rest on assumptions that health care operations largely stay the course, something that needs to change, according to Dr. Douglas Wood, head of the Rochester-based Mayo Clinic's Quality Academy, the clinic’s internal quality improvement unit.

“It is time for health care to completely redesign its educational and delivery systems with an emphasis on creation of value,” Wood said.

That is where total quality management tools come into play.

What is lean?

Based on principles developed by the Toyota Motor Co. and widely used in manufacturing industries for nearly 20 years, the lean concept focuses on reducing waste and eliminating bottlenecks. While lean is best known for assembly-line manufacturing, the basic principles can be applied in health care, too.

The Cambridge, Mass., based Institute for Healthcare Improvement puts it this way: “Whether building a car or providing health care for a patient, workers must rely on multiple, complex processes to accomplish their tasks and provide value to the customer or patient. Waste — of money, time, supplies or good will — decreases value.” [ 1]

Imagine bottlenecks at appointment check-ins that increase patient wait times or duplicative patient forms that increase staff workload, annoy patients, and potentially increase risks to safety and patient care. Those are common problems tackled in lean-flow projects, including Kaizen events (four- or five-day sessions focused on analyzing a current process to identify areas for improvements).

The application of quality management and lean in health care has slowly but surely started to take hold in southeastern Minnesota. Medical facilities like the Mayo Clinic have been implementing quality solutions for the past several years. In 2005, a quality improvement curriculum was implemented for all 115 accredited residency and fellowship programs of the Mayo Clinic School of Graduate Medical Education. [2]

Two years ago Mayo established its own Quality Academy as part of a strategy to make quality one of the clinic’s major objectives. The Quality Academy provides training for all Mayo staff in the various quality methods, statistical analysis and support for specific projects to improve quality.

Several other regional care providers started lean initiatives with the help of grants from the Minnesota Job Skills Partnership (MJSP) — a DEED-funded program that helps pay for employee training. In the past five years, 15 grants have been awarded for lean health care training.

Two MJSP projects were in the southeastern region. One was a partnership of Winona State University and Winona Health, while the other was a partnership between Lake City Medical Center, Cannon Falls Medical Center, Minnesota State College-Southeast Technical and Riverland Community College.

The reasons for practicing lean or quality management vary. For Winona Health, lean was a natural extension of an earlier project – the Electronic Medical Record (EMR) information system – that was designed to improve efficiencies and lower costs. By combining lean strategies with the EMR, officials hoped to improve the satisfaction and effectiveness of employees. The ultimate goal was to lower health care costs, which regional businesses had identified as a barrier to growth.

Lake City Medical Center-Mayo Health System (LCMC) faces several challenges, including a shortage of health care workers, larger competitors, and an increasingly complex and costly regulatory environment. The hospital hopes to create efficiencies, enhance quality, reduce costs and address worker shortages through lean training.

Productivity improvements may mean that some open positions won’t always need to be filled. But lean strategies are not strictly about staff reduction. In fact, workers are at the heart of the process.

Jamie Groth, business solutions coordinator at Winona State University, said lean health care is a part of everyone's job.

“It involves changing the culture of the organization so that everyone has an eye for waste, and workers are happier when they're able to be involved with helping fix a problem rather than just inheriting the way it is,” Groth said.

Thanks to the training offered at LCMC, lean has easily spread throughout the organization and has helped build a culture of change. Staff members participate in both small- and large-scale projects aimed at reducing waste and increasing efficiency. Increased job satisfaction also can lead to reduced employee turnover (a perennial issue in some health care industries) and higher patient satisfaction.

“Patients are happier when employees are happy,” said Jane Foote, executive director of HealthForce Minnesota, a partnership within the Minnesota State Colleges and Universities system.

Getting results

Outcomes have been positive at institutions that have launched lean projects or developed total quality management systems. Mayo Clinic, for instance, has calculated a conservative return on investment of more than $3 million for its Quality Academy team’s activity.

One lean project recently completed at LCMC was a Kaizen event on the hospital acute care floor. Called the "Acute Care Shuffle," the effort focused on the supply stockroom. As a result, inventory was reduced by about $1,100, storage locations were cut by 50 percent, motion and travel distances were reduced, supplies were retrieved more quickly and accurately, and space utilization was increased by 20 percent in the stockroom.

Thanks to the new efficiencies, nursing staff spent one-third less time searching for supplies. By reducing the search time, which is considered non-value-added time, nursing staff was able to spend more time on patient care.

Although costs are increasingly driving conversations about health care reform in America, quality management strategies, including lean health care, have the potential to make an impact in many areas.

Doug Parr, of Riverland Community College in Austin, said lean is an entry point for what will become broader strategies in quality management. That shift toward outcomes is what Mayo Clinic has embraced.

Dr. Wood added, “Health care is a very process-oriented industry. There are many opportunities for quality improvement and quality design. I estimate we could improve the effectiveness and efficiency of health care by at least 20 percent.”

Regional employers and colleges have made great strides in getting these strategies on the radar in southeastern Minnesota, but the concept is still new to many. Next steps include distributing standardized training courses to a larger audience.

Another MJSP-funded lean health care project established the Coalition for Continuous Improvement in Healthcare in 2006. [3] The coalition’s goals are to build membership and to improve the quality of care, cut costs and develop better processes.

The poor economy has made it difficult for some health care providers to think about new projects or strategies, but future challenges related to health care costs may bring them back to quality improvement strategies in the end.

“The great news is that health care is turning to things like lean and Six Sigma,” Parr said. “There are lots of opportunities to discover their systems as a place to put their improvement efforts.”

End Notes

 [1]Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, Mass.: Institute for Healthcare Improvement. 2005. Available on www.IHI.org .
[2]Rothman Schonfeld, Amy, PhD. “Teaching Quality Improvement and Patient Safety Skills Gets High Priority at the Mayo Clinic.” Academic Physician & Scientist (March 2008): 2-5.
[3]Online at www.ccihlean.net .