Patricia Santiago

LEAN and Operational Readiness in Healthcare

General | Operational Readiness

May 2017 – In our operational readiness consulting practice, organizations will ask us if The Readiness Group uses LEAN methods as part of our consulting framework. The answer is “Yes!” However, it is important to point out the difference between the methods used in a formal LEAN approach to those typically needed as part of an operational readiness project in healthcare.

LEAN management principles were first introduced in the auto manufacturing sector, specifically Japan, but have since made their way to Healthcare where the principles and methods of LEAN are being used to improve efficiency, lower costs, while increasing the quality of care being provided.  There is no one definition of LEAN but the principles generally focus on the elimination waste so that generally adds value and serves the customer’s needs. Identifying ‘value-added’ and ‘non-value-added’ steps in every process to improve the flow and create standardized work to improve quality.   LEAN is a cultural shift and implementing LEAN thinking requires change management throughout an entire organization and incorporated into the values of the organization.  LEAN must be lead by the top executives and adopted by front-line staff as all staff are essential to changing processes, improving flow and reducing waste (Source: Going LEAN in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2005”).

A LEAN organization strives to continuously improve upon processes by undertaking ‘events’ in which a leader will champion a specific group of individuals through a process to make change – Kaizen.  This process includes value stream mapping, laying out the current state of a process, identifying the value-add steps and waste steps and ultimately identify the future state eliminating waste steps where able.  In Healthcare, value-add steps would include performing procedures, diagnostic tests, nurse/physician consultations.  Where waste steps include waiting between procedures, redundant documentation, looking for supplies/equipment.  The improvement team will use tools such as “5 whys” or fishbone diagram to do a root cause analysis of the issues leading to waste. Plan-Do-Study-Act (PDSA) cycles are effective in producing quick strategies. With the PDSA approach, you work to identify the issue and how success will be measured (P), conduct small tests of change (D), analyze the change, collect data to support whether the outcome is as anticipated (S) and determine whether to adopt the change or what can be approved upon (A). (Source: Documents/qi/rf-document-pdsa-cycles1-en.pdf).

The Readiness Group provides a structured approach to our operational readiness consulting practice. This includes an assessment of current state operations to gather information on how the organization practices and delivers patient care in their existing space. In preparation for operations in the new building, The Readiness Group will ask user groups questions about future state “flow” – 7 kinds: patient, care provider, visitors/family, medications, supplies, equipment, information. We facilitate each discussion asking who is the best person to be doing the work and ask if the work is essential to patient care. In our experience, these questions will tend to identify gaps in resources or clarity related to process, roles and responsibilities. Reviewing each of these flows individually within a department and how these flows interact with one another, helps to reduce the risks associated with a new opening by proactively identifying areas for improvement, boosting staff familiarity and confidence with new processes and equipment. What follows are practice implications for each of these major flows.

Mapping the major flows using a flow chart or spaghetti diagram helps identify the work flow implications for practice; it will also help identify what is “waste”, which could be reduced or eliminated as part of process improvement. This is where the LEAN strategies come in to play.  Organizations that are equipped with resources to support LEAN-work, take this as an opportunity to do a rapid process improvement workshop “RPIW”, a “5S” (sort, set-in order, shine, standardize, sustain), or a “PDSA,” depending on the extent of the improvement required. The Readiness Group values PDSA as a LEAN method used to action improvement strategies for the future state; it provides a thorough review of the process, from current state to future state, with root cause analysis, measures, and intended plans to trial and sustain the new process.

The process improvement initiative occurs independently of the operational readiness initiative. The initiatives merge when the change in practice requires operational action prior to move-in. For example, future state may require new equipment, which will need to be procured prior to occupancy. The new equipment may require less resources or a change in the staffing mix. Since an organization is a network of systems and services, a process improvement in one department inevitably impacts operations of another. Operational readiness ensures workflow is integrated across services to assess organization-wide impact. Strategic uses of LEAN tools contribute to work plan development around operationalizing in the new space. With the user group, the work plan is further developed and monitored. When the construction project reaches completion, operational processes are then validated on-site with training and orientation as an effective means to test how processes will work and where inherent risks to safety and quality may lie.

Operational readiness, as a spectrum of work within the capital development project, is an opportunity to leverage LEAN initiatives to ensure that “bad” practices are not transferred to the new building.  The Readiness Group works with organizations to identify and adopt practices that will help operations address needed changes to their work, standardize approach where possible, and be more streamlined and efficient at operational occupancy. Preparing an organization to take current practices to future-state practices given new space, new technology, new systems, and new people is what operational readiness is about.

About The Readiness Group Inc.

The Readiness Group Inc. is a leading firm in hospital activations, relocations and equipment decommissioning when healthcare organizations are engaged in capital development projects. The firm represents the next generation of leadership for operational readiness and transition services in Canada.

The Readiness Group continues to expand and acquire projects throughout Canada.

For more information about The Readiness Group Inc: