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The Lean method from not “not running a hospital”

January 4, 2012

It’s a bit confusing. Paul Levy, who used to run Beth Israel Deaconess Medical Center in Boston, was well known for his blog “running a hospital.” Since he resigned from that position he’s been calling the same blog, with the same URL “not running a hospital.”

Levy obtained the URL to the address in case readers got confused, but now he’s using THAT address for another purpose- documenting Beth Israel Deaconess’s efforts to improve transparency and implement a program called the Lean process. Here’s what he says about the resource-

What you see documented on that blog is a consistent and decided institutional commitment to transformational change at BIDMC and several other places.  It takes a long time and with constant reinforcement from the top folks to fight inertia and entropy and build sustained momentum for this kind of change.  Personal involvement and interest of the CEO and clinical leaders is essential.
I’m particularly interested in what Levy has to say about the Lean method because it’s a project my mother talks about all the time.  Yes, I’m not the only health care “expert” in the family. My mother has worked on the human resources/organizational development side of hospitals for decades. Right now she’s at Salem Hospital in Oregon, helping the medical center implement its own version of the Lean method.
I’m not an expert on the concept, but here’s the gist- hospitals are taking some cues from lessons learned at the Toyota plant in Japan about empowering employees to make systematic changes that make everyone more effective.  Kent Hospital used some of these principles in the redesign of its emergency room.
My knowledge of the program and its pluses and minuses ends there. All I know is my mother is always throwing out buzz words from Lean. Recently, she looked at our messy garage and said “you could 5S that pretty easily. ”  Five what?  Here’s Paul Levy’s example, of 5S taken from a presentation by the University of Michigan Health System. UMHS used 5S to reorganize its carts for blood draws.
Here’s the cart before “5S”

Image taken from Paul Levy's "This is Not 'Not Running a Hospital'"

And the cart after “5S”

Image taken from Paul Levy's "This is Not 'Not Running a Hospital'"

At first glance, it looks like 5S just means “get organized.” But it’s a little more involved than that. According to Lean Innovations, a group that implements Lean in the manufacturing industry, each S stands “for 5 Japanese words that constitute good housekeeping.”

Roughly translated they are-

  • Sort (Seiri)
  • Set in order (Seiton)
  • Shine (Seiso)
  • Standardize (Seiketsu)
  • Sustain (Shitsuke)

My mom explains it this way- first you “sort” through everything you have, throwing out what you don’t need, then you organize or “set in order” the objects.  My mother hasn’t talked as much about “shine,” but it seems it evolves cleaning the area.

When you “standardize” you decide what this work place should normally look like, and design ways to easily identify and fix the area if something’s awry. Picture those garages where people hang their tools on nails and then trace their outlines on the wall. You just have to see that blank space where the hammer should be to know it’s missing. The final S, “sustain” stands for being diligent about the other S steps. Keep up the vigilance around your “good housekeeping.”

Levy writes here about ways he implemented 5S at the hospital. Here are a few of his examples-

Of course 5S is just one aspect of the Lean method, and Levy can tell you more about it than I can, so check out his resources.

In the meantime, hospital folks out there- do you think this system might be useful for you? What do you know about the Lean method? Is it an effective set of concepts or the latest fad? Or both?

21 Comments leave one →
  1. January 4, 2012 11:46 am

    Thanks, Megan! There are several places that are doing this, to great results. Please ask your mom to send me more about Salem.

    • January 4, 2012 11:48 am

      Will do Paul! She just got back from a trip to Japan to study at the Toyota plant. I’m sure you’d have lots to talk about.

  2. alicia permalink
    January 5, 2012 7:00 am

    I was at the Kent Hospital ER recently. One problem with their setup is that the admitting person took my medical history while my neighbor who had driven me to the ER was sitting next to me. That was embarrassing and I lied about an aspect of my history for privacy reasons and told them the truth when I was in the more private area. That setup could lead to inaccurate assessments, I assume, but the idea of everyone in the neighborhood including relatives knowing the details of my personal life overwhelmed my usual behavior of being honest with a doctor.

    • January 5, 2012 7:38 am

      That’s interesting Alicia. Thanks for letting me know about your experience with Kent’s new system. I didn’t know they took your history in a public place. What would you do instead if you could design the system? What’s your opinion of the rest of the set-up?

      • alicia permalink
        January 5, 2012 9:39 am

        At South County ER they either (a) interview you in a separate small partitioned area with just yourself and the admitting person there, or (b) if they have taken you back immediately, an admitting person comes around with a portable computer setup on a cart. (Yes, I have been in an ER several times in the past couple of years.)

    • January 11, 2012 5:34 pm

      Alicia please take time to contact the hospital. I had an issue at an ED and sent them a break down of what issues I had seen while there. Can read more details on my blog
      I work as a Lean Coordinator at a factory so I have a habit of seeing waste everywhere I go.
      After contacting the hospital and meeting with the ED Director I have joined the family / patient council to work on improvements at the hospital. Take time to let them know. Its one small way to help them improve

      • January 11, 2012 5:36 pm

        Dwain- sounds like you’re doing interesting work at Kent. How does your experience implementing lean at the factory compare to using it at Kent? Do you notice any unique challenges for health care?

      • January 11, 2012 5:39 pm

        Apologies Anthony for getting your name wrong! Also, for misunderstanding your comment. Looks like you’re not based in Rhode Island and you’re not helping out at Kent. Was your hospital already using lean or did you introduce it to the administrators over there?

  3. January 9, 2012 10:36 am

    Thanks for highlighting Paul’s work and blog and Lean healthcare principles (as described in my book “Lean Hospitals”).

    In the case of E.D. process redesign, one of the goals is to have a clinical discussion (often triage) as soon as possible, instead of the first interaction being about insurance or financial information. More E.D.s are doing “registration at the bedside” after triage or an initial assessment has been done. This is very patient-centered and leads to faster medical decision making and better care.

    That said, care needs to be taken to provide privacy and confidentiality (with screens, barriers, etc.). It sounds like Kent still needs to make some incremental improvements in this area. But, if they are a “lean hospital,” they will be open to this feedback and they will make improvements to their process.

    • January 9, 2012 11:03 am

      Thanks for the perspective Mark. I’m not sure if Kent would call themselves a “Lean hospital.” The consultants that worked with Kent say they used a lot of different methods, including Lean Six Sigma concepts. Either way, I’m sure they’d be open to feedback like this. Have you worked with any hospitals in Rhode Island or nearby?

      • January 9, 2012 11:14 am

        Yes, the definition of “lean hospital” is difficult to pin down, as it ranges from organizations that are just dabbling with lean methods to those who run their entire organization using lean management (such as ThedaCare in Wisconsin and others who have been using lean for about 10 years). So maybe Kent is just getting started, but I hope they keep at it. Nobody “becomes lean” overnight.

        I haven’t worked with any R.I. hospitals in depth, but when I was based in Boston with the Lean Enterprise Institute, I had a chance to participate when a large group of R.I. hospital leaders visited a great little manufacturing company called VIBCO, located in Wyoming, R.I.). The hospital leaders saw how the lean culture at VIBCO engaged every employee in continuous improvement and they were really impressed.

        Here’s a video interview I did with VIBCO president Karl Wadensten:

        If you don’t know Karl, you should look him up. He’s doing a lot to try to improve healthcare in Rhode Island.

      • January 9, 2012 3:57 pm

        Cool. Thanks for the link. I’ll take a look.

  4. January 11, 2012 1:34 pm

    I wish that UK hospitals would consider lean methodology. We were recently talking to a surgeon about lean and he said it sounded brilliant and we would have a great effect if only the managers would listen.

    • January 11, 2012 2:21 pm

      Thanks for writing Chris. Why do you think your managers are disinterested? There must be some hospital in the UK that’s thinking about lean.

      • January 11, 2012 3:13 pm

        Royal Bolton Hospital NHS Foundation Trust in the UK is widely considered a leader in lean healthcare:

        Lots can be found about them and lean via google.

        There’s a nationwide initiative through the NHS called “Releasing Time to Care” that is based on Lean (for nursing and inpatient wards), but that’s more local in the hospital than an organization-wide lean mindset and approach.

      • January 11, 2012 3:41 pm

        Mark, maybe you and Chris should talk! Thanks for the background. PS- my mother says they’re reading your book at Salem Hospital.

  5. January 11, 2012 3:52 pm

    Thanks for your comment Mark. I’m really glad to hear that Royal Bolton NHS Foundation trust are embracing Lean. Unfortunately in my experience that is the tip of the iceberg. This is not the fault of the nurses, many of them are angels, but the processes are often a shambles and the managers are so focussed on budgets most other initiatives are overlooked. For an experienced surgeon to say what he did tells us that we could help, locally at first. We live in hope!

  6. March 1, 2012 10:12 am

    Thanks for the shout out Mark!


  1. More on Lean, from my mom and VIBCO « The Pulse: health care in RI
  2. Industrial vibrators and health care « The Pulse: health care in RI
  3. Public Radio Story on VIBCO Helping Rhode Island Healthcare — Lean Blog

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