LEAN in Healthcare: What is it and how is it being used

LEAN, a business model that originated with Toyota production systems, was first utilized in car factories in Japan in the post WWII era. The goal of LEAN is to provide customers with an improved experience while decreasing waste and increasing value for both the business and the customer². The five principles of LEAN are defining value, value stream mapping, creating flow, establishing pull, and continuous improvement.³

LEAN methodologies have been utilized in healthcare systems to reduce admission and wait times, turnaround time of surgical suites, and ultimately, patient length of stay¹. LEAN processes have even demonstrated a “significant protective role in reducing HAIs, particularly CLABSIs.”⁴

The value of LEAN methodology is that by eliminating waste and wait time for the patient, it also increases value for staff and the patients. Health care workers can spend less time on nonproductive activities and more time with patients resulting in greater job and patient satisfaction.

A Lean Example

One of the most exciting ways LEAN processes are used in healthcare is with creating a “pull” system for patient flow. A pull system is a proactive process of admissions and transfers to facilitate flow throughout the hospital that results in decreased wait times and helps to plan discharges and decrease length of stay (LOS)¹. Penn State Milton S Hershey Medical Center, a 600-bed academic teaching hospital in Hershey, PA, has been using these concepts as they work with the care coordination and medicine departments to enhance patient flow with efficient admissions and discharges. (M. Werner, personal communication, 01/30/2024)

Monica Werner, Vice President of Care Transitions, and Amy Cutman, Manager of the Care Coordination department, credit a recent rapid improvement LEAN project with reducing LOS on Internal Medicine (IM) floors, the largest service in the hospital. The goal of the project was to reduce MD rounding time and improve communication between bedside nurses, doctors, and care transition staff while enhancing patient experience by reducing length of stay and increasing continuity of care. Representatives from care transitions, medicine, and nursing met intensively to review current practice and discover what was andwasn’t working. Members of the project team also interviewed the stakeholders who work on the IM floors – the doctors, nurses, social workers and care coordinators. The team then initiated the practice of cohorting providers and patients in the same geographic areas. Assigning patients to a geographic location, which then assigns them to a medical service, is a huge departure from the standard practice of IM doctors assigning the patient to a medicine team before assigning them to a bed. As a bridge to the new practice, physicians are assigned to a geographic area and patients are placed based on where the MD covering them is assigned. After a week of trialing this new practice, the LEAN project managers went back to the stakeholders for more input to refine the process.

Another aspect of the project was building on the already established multi-disciplinary rounds (MDRs) that occur each morning for medical providers, charge nurses, social workers, and RN care coordinators (RNCCs). Medical providers lead the morning rounds and provide a brief review of patients and their discharge plans. The LEAN project has now established a 2:30 PM MDR round, led by social workers or RNCCs, which focuses only on patients who are projected to discharge the following day. Monica Werner says that although the challenge has been to have all the stakeholders participate consistently, they have already seen benefits of the afternoon rounds. One benefit has been fewer Tiger Texts (the secure texting system) as the team knows they will be meeting at 2:30 and can discuss discharge issues then. RNCCs have also come to the 2:30 meeting with all discharge plans in place and the team can then DC the patient that day, instead of the following.

This LEAN initiative has led to PSH Hershey outperforming the top quartile of academic institutions against which they are measured. The goal for the top quartile is to be below an index of .95. Since implementing the project in October, PSH Hershey’s index score has dropped a statistically significant amount from .93 to .87. (A. Cutman, personal communication, 02/01/2024)

The experience of the LEAN project team at Penn State Health demonstrates how incorporating the principles of continuous improvement, pull and creating flow in a health care system has the potential to streamline patient admissions and discharges, reduce waste and LOS, and improve both patient and staff experience and outcomes.

Mölnlycke Healthcare is a world-leading medical and health care solutions company providing Advanced Wound Care, Surgical Gloves, and Patient Bathing and Decolonization solutions in the U.S. Market. Our expert team of Health Economic Specialist and Clinicians are committed to supporting your Lean initiatives related to outcomes, standardization, and utilization. Please contact your Mölnlycke Strategic Partner to learn more.