8 April 2008 by Sue Kozlowski

Lean Six Sigma for Healthcare

Quite a few Black Belts from manufacturing environments have told me, "I don't know anything about healthcare, but my industry is in a downturn so I'm looking for a Black Belt job in a hospital. I figure I can pick up the lingo once I'm there."

I've also been asked to speak to Industrial and Process Engineers who wanted to learn about healthcare so they could apply for jobs in that sector.

Now, I'm in full agreement that healthcare is a hotbed of opportunity for applying Lean and Six Sigma concepts! And I applaud people who are willing to step out of their comfort zones to try something in a new area. So here are some tips for Process Improvement Experts seeking to transition from another industry into healthcare.

Things you should NEVER say when discussing Lean Six Sigma with healthcare providers:

1. "Even though Lean and Six Sigma were developed in manufacturing environments, it's directly applicable to treating patients - after all, it's just like moving widgets down the assembly line!" (Trust me - this will be perceived as an insult.)

2. "Everyone will need to do standard work - there's no room for creativity in healthcare processes!" (Healthcare workers pride themselves on their ability to solve problems in a creative way - lead them gently into the concept of standard work for individual tasks, first.)

3. "We'll start by giving everyone three days of training in statistical analysis - let's begin with the nursing staff." (The most polite thing the nurses will do is roll their eyes - anything that takes them away from providing patient care will be suspect.)

4. "Patient Registration is an area that's non-value-added." (Don't tell the finance department, and the caregivers who depend on registration information such as emergency contact numbers, that putting accurate information into the computer system isn't a "vital x" for their functions!)

5. "Doctors are not customers - they're only providers." (Whoa! Physicians need to be treated as co-customers with patients - since doctors order tests and treatments, and interpret them on behalf of their patients - and decide which hospital to admit their patients to!)

So - there's your short course for Lean Six Sigma in Healthcare! Can you think of anything else that should NEVER be said, in healthcare or other industries???

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Leadership , Management

posted by Sue Kozlowski at 11:37 AM ET | comments [13]

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posted by david [ http://www.bigskyblog.com ]	8 April 2008 at 1:24 PM ET

I don't know about what should never be said, but one sacrosanct principle in healthcare that doesn't necessarily apply to other industries is safety. In healthcare, you can NEVER compromise patient safety, no matter the opportunities for Lean or Six Sigma savings.

posted by deepan	9 April 2008 at 3:43 AM ET

I know the below topic is beaten to death but still... Never say improve your turn around time for providing patient care :) after all we cannot put the person at risk by providing faster service...certain activities invariably takes so much time like time taken for a medication to work, time taken to do operation post anesthesia, time taken for a injury to heal etc...

posted by Ian Furst [ http://www.waittimes.blogspot.com ]	9 April 2008 at 8:47 AM ET

1. There's a tendancy to look at it from the care providers perspective. When you build any value stream map it should be from the patients' persepective. 2. Health care providers are generally bankrupt of time. They thrive on quality of care (and they consider wait time as part of that) but don't have a lot of time to sit and think about value stream mapping and the like. You'll generally have to build what you want to study/accomplish into their everyday activities. 3. There is an assumption that the current state is of high quality (otherwise it would have been changed). If you want to make a project work it's rarely not enough to just improve quality. It must either be neutral to their time or decrease the amount of time. It it doesn't accomplish both (quality and time) the project will likely fail. There are my pitfalls (could write a hundred more I think, I've stumbled a lot). Thanks Sue.

posted by Sue Kozlowski	11 April 2008 at 10:17 AM ET

Thanks David, for the reminder about safety. We have actually inserted it into the 5S, which we now call 6S, so our mantra goes sort-straighten-scrub-safety-standardize-sustain. And not just the safety of looking for frayed electric cords, but the safety of the patient as well. Deepan, you're right about making sure that in our zeal to promote faster cycle times, we shouldn't move the patient through the process faster than is required for quality of care... related to David's comment above! Ian's points are well taken, as always - reminding us of some of the many reasons we keeping hearing that lean six sigma "fails" in certain organizations - if we don't make it relevant to the associates involved, and patient-centric, it will not achieve its promise. I especially like the last comment - that it's not enough just to improve quality. For busy healthcare workers, anything that sounds like "more work for me" is bound to have a very steep change curve. Thanks to all for your perceptive posts. --Sue K.

posted by Bob Yokl [ http://www.strategicva.com ]	15 April 2008 at 8:52 AM ET

I am a trainer and consultant in the healthcare world that works in the supply chain and I do believe that if you intend to go to a healthcare environment that you better do your homework and get yourself up to speed pretty darn fast. The Department Heads and Mangers, Nurses and Docs will chew you up and spit you out pretty fast if you do not understand what they are talking about and inevitably it will slow your process down dramatically (and may lessen your end results). What I see in the supply chain is that most Lean Six Sigma Practitioners/Consultants that come into the healthcare supply chain world go right for the obvious - Inventory in a hospital. Remember they all apply supply chain and materials management principles for over 30 years now, how much can you wring out of that area when labor costs are fixed and space is a premium. Many hospitals do have perpetual inventory systems which can account for the majority of their inventories. Remember the majority of the costs in healthcare are in two areas, Labor and Non-Labor so in the case of the supply chain you need to learn the products which are the big drivers of cost not inventory (what's in inventory anyhow - products) which if you are lucky you can hit on a small savings win. Healthcare is a different world entirely and my advice is that it may not be as quick of an easy switch over as you may think. Very dynamic.

posted by Sue Kozlowski	17 April 2008 at 2:29 PM ET

Thanks Bob for your insight. We actually did have one Black Belt candidate from the automotive world, who said in his interview, "Well I'll just tell 'em that it makes no difference - healthcare or manufacturing - after all, patients moving through a process are just like widgets moving down a line!" Of course, that may be true in theory, but we couldn't imagine putting that person up in front of doctors and nurses. I agree that there are savings to be gleaned from the supply chain - among the most challenging are the products physicians use in surgery, because each doctor is quite sure his/her choice is the best, and they don't see the value in standardizing. In another situation, I found that the surgical department had no standard process for replacing lost or damaged equipment - they simply let the levels run down until they were flash-sterilizing twice a day. We were able to show how standard work could reduce the loss, and equally important, how to maintain par levels in a way that the expense could be anticipated and budgeted for, rather than let go until only an emergency order could keep the OR in business. Plenty of opportunity for Lean and Six Sigma in healthcare, indeed!

posted by Rajat Dhameja, MBBS, MHA [ http://www.linkedin.com/in/rajatdhameja ]	21 April 2008 at 1:07 PM ET

Creativity in healthhcare is limited when the services in questions are of the tangible provider-patient type. The farther one is from the actual care giving process, room for creativity increases. In other words, health administration professionals who are involved in improving operational efficiency, business development, strategy, quality improvement, contracting, project management etc. make the wheel of healthcare spin like other businesses.......Regulations and Compliance however are most stringent in healthcare than any other industry. On the contrary, a surgeon performing a cardiac bypass has less play and room for creativity. Healthcare tends to be too broad a term for the purpose of several discussions.

posted by Marek Kozlowski	25 May 2008 at 6:37 AM ET

I am in the industry which sell the product first and then finds how the product is made. Could you guess what industry am I in ? Telco Sales visit customer and sells the communication services with promised delivery date. The delivery process has to identify physical elements needed to deliver.. like 350m fibre connection which may be crossing busy road,may go via heritage building etc. Negotiation with building owner is part of the delivery chain with the clock ticking against the promised delivery date. The manufacturing is outsourced but no contracts are in place. Each job is a separate tender. Network records are a mess and most jobs are redesigned and redone. Relate this to making widgets and reducing WIP !!

posted by Anonymous	16 July 2008 at 3:19 PM ET

You can never compromise patient safety with Lean? Hospitals do that every day WITHOUT lean.

posted by Sue Kozlowski	18 July 2008 at 8:13 AM ET

Dear Anonymous, let's not imply that hospitals "do that every day" as if all hospitals compromise patient safety on purpose. All the hospitals I've worked with have dedicated professionals who are trying to work around poor processes that originated in the 50's and 60's. In Jim Womack's phrase, they're "heroes, not farmers." [Lean Enterpise Institute at www.lean.org, Jim Womack's E-Letter, 5-12-2006.] There's a great need for Lean and Six Sigma principles to be learned and applied in all healthcare organizations. Let's focus on sharing our knowledge and supporting these organizations to improve their processes - to the benefit of all of us who will be needing healthcare sooner - or later. --Sue K.

posted by Laura [ http://www.sybeq.com ]	19 July 2008 at 6:19 PM ET

Very interesting article and comments.Thank you all for sharing !

posted by Michael Sellers	13 September 2009 at 8:37 PM ET

As a nurse who has been in leadership for 15 years I have a hard time understanding how person from other industries can come into the health care field and truly understand the balance between the need for quality care and operational performance. I am a believer that if a hospital put its focus on quality the rest of the operation will come together. Core measures and HCAPs allow the public to compair hospitals quality to each other. As the public figures this out the hospitals with the best quality will end up on top. CEO from other industry coming into heath care and trying to run it as "just another industry" as in for an awaking.

posted by Sue Kozlowski	9 October 2009 at 8:50 AM ET

Thanks Laura for contributing your feedback. Michael has been "in the trenches" for a while and the focus on quality - not just as numbers that are studied after the fact, but as guides to improving care in all its aspects - is becoming more important in many healthcare areas. I think we can all agree - there are plenty of opportunities for improvement in healthcare! Kudos to those of you who are working in this important area. Sue K.

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