Lean Healthcare Continued…..It’s About Time

This post comes courtesy of Sharon Ruth of MDSIS (a DMGMA Sponsor) and Jim Jones of DEMEP. It’s the second in a continuing series of articles on LEAN managment.
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How can Lean be measured in Healthcare? It’s About TIME!
Lean is not a social program. It’s a process improvement system that improves all aspects of the business case simultaneously when Waste is eliminated. In healthcare, business case (outcome) metrics can be categorized into: Satisfaction, Quality, Time, and Financial Time. These categories also includes patient access to services, the time to complete those services, and employee time to deliver them.
Did you know that when Waste is eliminated, time is “freed up” for staff and leadership? Here is an example you can relate to; your office staff do not have to search for supplies or perform rework due to a recurring defect/error. Leadership (YOU the practice administrator) do not have to deal with a recurring problem (among other problems you are dealing with on a daily basis). However we do not see that time is freed up in 1 full-time equivalent (FTE) increments. And while continuing the Lean journey and seeing productivity improvement, you cannot lay people off because of gains due to Lean. If you do, employees will no longer sign up for the next improvement activity. So, what should leaders do to see the financial gain seen in a Lean Healthcare environment without it being perceived as another cost reduction program?
First, make your office productivity visible
Productivity is a measure of cost, not production. It measures how much input (personnel) is required to deliver a certain amount of output (your patients seen daily). When looking at labor productivity, possible productivity calculations are patients/labor-hour and service-units/FTE. Once the appropriate productivity metric for a given office process is determined, track it daily and post it in a visible location for all staff to see. Discuss it at least weekly. Let people know that productivity must be continually improved and that eliminating Waste is the only way to achieve it without overburdening staff. This creates a great opportunity for dialogue amongst the office staff, physician and management. It allows leadership to communicate the reality that you are operating a business, while letting staff know that you are not going to continue adding work or reducing FTEs without improving processes to free up a proportionate amount of time.
Second, track all time saved and place a dollar amount on its potential
Think of time freed up from a Lean event as being stored in a “time bank”, it will help you to see its value to the patient and the practice. The freed time passes through three phases. First, it is identified (phase 1) during Lean improvement activities, as time that will be freed up once tested solutions are fully implemented (phase 2). It is at this point that leadership must decide how to monetize (phase 3) the time savings. You can use the freed up time by either investing, cashed, or both. Here is an example; freed up nursing time can be “invested” in more direct patient care (time with the patients) in order to improve other outcomes like satisfaction, infection rates or fall rates. Or it can be “cashed” by actions such as increasing volume with existing staff (revenue increase), reducing overtime (cost reduction), not filling a planned position (cost avoidance), or reducing budgeted FTEs. REMEMBER!…If you reduce budgeted FTEs, your staff must feel confident that a proportionate amount of Waste has been eliminated and that no one will lose their jobs as a result. Attrition and internal transfer are examples of ways to achieve your commitment to no one losing their jobs due to Lean. In Lean thinking, it is important that leadership track and dollarize the time savings in all three phases in order to see its value. In many cases it will be difficult to quantify the exact impact to the practice but if we don’t quantify freed up people’s time, we cannot see its potential or actual financial value to the organization.
Reducing wait time and defects for patients frees them up to do the things they want to be doing, which increases their satisfaction with healthcare services. Eliminating Waste for staff frees up time to improve productivity without overburdening them. When it comes down to it, “It’s About Time.”
To learn more about lean please contact Jim Jones @ DEMEP (jjones@demep.org) 302-283-3135 or Sharon Ruth @ MSDIS (sruth@zutzgroup.com) 302-397-0173

Tags: Delaware Healthcare, DEMEP, Healthcare practice improvement, LEAN, MSDIS, waste reduction in healthcare