Eliminate work that is not adding value

Jim Collins spoke about the dramatic improvement in patient services which can be achieved through implementing LEAN principles at the HMI Waterford Forum. Maureen Browne reports.

LEAN thinking can be defined as a dynamic, knowledge driven and customer focussed process through which people in a defined enterprise continuously eliminate waste with the goal of creating value, Jim Collins, a LEAN Adviser/Consultant and Industry Lecturer in LEAN Systems at the University of Limerick told the HMI Forum in Waterford Regional Hospital.

Jim Collins
Jim Collins

He said that because the LEAN concept had originated with Toyota in Japan, there was a misperception that it was “a factory thing”, that it wouldn’t work in healthcare agencies, that they were different or that they had already tried things like that.

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LEAN was underpinned by very solid management principles.  It was not an off-the-shelf solution but a way of doing business which could be adapted to the culture of different organisations and systems.  As well as containing a tool box, it dealt with culture and employee relationships. It was focussed on managing processes in a holistic way and most organisations, outside of manufacturing, tended to be quite poor at understanding their full processes from beginning to end.

So many of you are at present unable to spend your time adding value to this process

“You look for ways to eliminate work that is not adding value.  People who work in healthcare generally don’t just come to work for the money, there is a commitment to health and people, yet so many of you are at present unable to spend your time adding value to this process.  You define value added work by asking what is of value to your patient.  When you understand what the patient values you can map your process and see how much time and money are being invested in activities which add no value to patients. If processes do not add value they are waste.”

Collins said that it was also important to ensure a continuous and even flow which, he said, is not something which happens very regularly in hospitals or in many other businesses and to trigger this flow using pull (the pull of the patient) rather than push.

“Start implementing change and always pursue perfection, but don’t look for the perfect solution or answer.  Rather look for something which makes today better than yesterday and then in the following few weeks go back and see if there is something else which can be improved.

“When you are looking at LEAN there are a number of questions which you should ask yourself:

  • Are you doing things which are not adding value?
  • Is what you are doing transformation or are you just moving patients and/or data around?
  • You might get big discounts for bulk buying, but are you using all this stock?
  • Are staff or patients waiting around – for example, waiting for a doctor or for a test result?
  • How much money and time are being spent on mistakes?”

Collins said that it was important to get to the root cause of problems and not be satisfied with finding the symptom or part of the cause and plugging it.

“You must also allow yourself the space to fail, what is unacceptable is not mistakes but the failure to learn from them and the continuation of the status quo.

Rather look for something which makes today better than yesterday and then in the following few weeks go back and see if there is something else which can be improved

“LEAN had originally been called the Respect for Humanity system in Toyota.  It’s not into bashing people.  We don’t look to identify individuals but rather to find weaknesses in a process that allows mistakes or waste to happen.  We must also accept that employees are experts, and outside experts and advisers should facilitate utilising that expertise which already exists in the workplace.”

He had the following advice for people planning to introduce LEAN. “Firstly build your knowledge of LEAN and identify your LEAN support, then establish senior management commitment to LEAN. Educate your people and encourage them to go and see LEAN in action. Trust your experts – the people who do the job every day and dedicate internal resource to ensure sustainability. Guarantee no job losses resulting from improvements, and don’t embark on a LEAN journey until you are committed to seeing it through.”

He said that various healthcare institutions deploying LEAN in the US had achieved dramatic improvements; including reduced turnaround time for clinical lab results by 60 per cent, reduced patient waiting time for orthopaedic surgery from first call to surgery from 14 weeks to 31 hours, and reduced patient deaths related to central line associated blood stream infections by 95 per cent.

Collins concluded with a challenge to those attending the Forum to take more time for reflection, to think about how much of their time is really spent on value-add work and how this might be increased while making their work more satisfying and enjoyable.

This HMI forum was run by HMI South as part of the new HMI regional structure.