In this column, I’m addressing how to apply the principles of Lean in a medical practice.  

 I’ve heard about Lean principles being used in medical practices. What can you tell me about that? 

Physicians around the country are starting to utilize principles from Lean manufacturing in their medical practices to create more efficiency in delivering patient care and improving the bottom line. Lean design was developed by Toyota to build better vehicles at cheaper prices. Despite Toyota’s recent problems, their impressive rise as an organization and outstanding quality is due in large part to their use of Lean design.

Lean Basics

The foundational idea of Lean is to produce “what is needed, when it’s needed, with the minimum amount of materials, equipment, labor, and space.” The core principles of Lean are the following: 

• Clarify value in the eyes of the customer;
• Identify the value stream and eliminate waste;
• Make value flow at the pull of the customer;
• Involve and empower employees;
• Continuously improve in pursuit of perfection.

In a Lean process, workers are cross-trained, work stations are organized in order of the processes, and there is a compact layout.  In addition, all of the standard operations are defined. There is a focus on the needs of the customer (patient) and the processes are aligned to deliver value to the customer. When implementing a Lean process, you also want to make sure your processes are visual and that Lean thinking is rewarded in the organization.

Creating Value for Your Patients

Simply stated, Lean design helps you view your medical practice as a series of processes that are utilized to deliver your services to patients.  It’s like looking at your practice through a completely new lens. These systems that are all around you now become more “visible.”

Each part of these processes is either optimized to deliver value to the patient or it is “waste” and should be eliminated. In a medical practice context, every part of every process within the practice (check in, dispensing, et cetera) should add value for the patient. The first step is to truly understand the value that you’re bringing to the patient. Why do they come to you?  Surveys and patient interviews can help you answer this important question. Just like retailers use “mystery shoppers,” you can have people you know “experience” your practice and provide you valuable feedback. By taking the time to ask and truly listen, you will learn what matters most to your patients. 

Work on Your Processes

Now that you know what the value is for your patients, you can begin to work on the value streams (processes) and eliminate wasteful practices. To do this, you need to work as a team with those who are “hands on” involved in the actual process. Pick a process and literally map it out and examine whether there are wasteful or redundant steps in the process.

Common waste in medical practices includes unnecessary paperwork, idle time for patients or staff, incomplete information, duplication of processes, pharmacy errors, and having to redo labs.  Once you have identified each part of the current process and the waste, you and your team want to then design the new and improved process.  This is an iterative process so you want to build and test your new process to make sure it is maximally efficient.  Once you have worked on a particular process, then you systematically go through all of your processes.   

Keys to Success

Once adopted, Lean should become part of the fabric of your practice. You now regularly view your practice through this new lens with a relentless focus on adding value to patients and ruthlessly eliminating waste wherever it appears. To be successful at this, you need to be open to change and improvement–you have to care! It’s also critical to empower your staff in this process, and as a physician, you need to lead by example. Implementing Lean is a team sport that takes everyone working together to improve.

As employees identify waste and adopt this mindset, reward them and encourage them to continue to think that way. You’re trying to build a culture where this type of thinking becomes second nature. Your pursuit is perfection. That’s the motivator to become a continuous improvement organization. The byproduct of this focus is a more efficient and profitable practice and more satisfied patients.     

Martin Willoughby is a serial entrepreneur, author of the book, Zoom Entrepreneur,  and a business consultant. Direct questions to Martin at martin.willoughby@butlersnow.com

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