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Friday, 8 August 2014

Applying Lean Manufacturing Principles in Healthcare

The Spring 2014 issue of Healthcare Management Forum has an excellent article by Chattergoon, Darling, Devitt and Klassen on taking Lean Six Sigma principles developed by Toyota and others for the manufacturing industry and applying them with great success to Healthcare, in this case the Toronto East General Hospital (TEGH) and, especially, its Emergency Department (ED). From such a leap, it surely must be a relatively small step to applying these same Principles in other Healthcare arenas such as Long-Term Care Homes.

You can read or download the article here:
Creating and sustaining value: Building a culture of continuous improvement

The central message can be summed up in this quotation from the article's abstract: "enabling continuous improvement in an organization is about an entire cultural shift—not just a series of rapid improvement events."

A culture of continuous improvement evolved organically at TEGH in three key phases:

Phase 1: Setting the stage. 
The organization made a commitment to quality and value explicit in its vision and through its strategy, creating a department dedicated to improvement and innovation - the TEGH Improvement System (TIS).

Phase 2: Team-driven performance management. 
The leadership team promoted and modelled a "huddle philosophy",  which allowed units, departments, and programs to identify new improvement opportunities, monitor performance on improvement projects, and sustain gains. The voice of the patient, obtained through interviews and videos, was made a cornerstone of the huddle philosophy.

Phase 3: The daily management system and cross-appointment model.
A daily management system, called Management Made Easy (MME),  was created to allow units, programs, and portfolios to identify and proactively address improvement opportunities before they blew up into large-scale problems. A cross-appointment model was adopted where staff members outside of the TIS team were given weekly-portion appointments to the TIS team to be  coached and acquire experience with the TIS team through involvement on improvement projects. Conversely, TIS team members are also given 'portion' appointments to work on improvement projects in departments such as surgery or medicine, thereby giving coaching exposure to entire teams.

TEGH can boast about a number of successes as a result of this culture of continuous improvement, most notably that of having the lowest Emergency Department wait times for admitted patients in Toronto Central LHIN (from being one of the worst) and reduced length of stay for patients with chronic obstructive pulmonary disease by 46% through improved quality-based procedures (QBPs); all this while seeing improved staff satisfaction ratings.

The organization has documented a list of telling "lessons learned". At the top of the list is the need to adapt and translate LEAN improvement principles from their original industrial and manufacturing context to the local situation at TEGH.

You can read or download the entire article here: 

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