I have always been drawn to Lean business concepts and how they seem to cut to the chase, literally going after the waste in process and looking at facts rather than feelings. Coming from a behavioral health background, I understand how change can create feelings that may be confused with facts, and I wanted to know how Lean can work with EHR adoption.
The holiday time provided a perfect opportunity for me to talk with an expert, Bill Booth, who also happens to be a colleague and a friend. Here is his take on Lean in EHR adoption as a solution for disruption:
How do you begin on a Lean project? There seems to be so many places to begin in healthcare.
Mr. Booth: When we spoke to a large hospital network, their question was: When is my organization ready to do Lean?
Taiichi Ohno, who is considered the father of the Toyota Production System, or Lean, was asked that question many years ago. His answer was: Start where there is need – if you have a need you are ready to start.
At the same time, if there are key factors in place, it’s easier to be successful if top management understands the process and there is a business culture that understands and supports change.
It is typical that the work culture is not where it should be to support transformation. Disengaged staff, hard-to-reach physicians, and middle management scrambling are common business traits in many facilities and systems. Yet, if leadership is willing to encourage risk taking and continuous improvement – and discourage silos – then it does not have to have a perfect culture for a Lean project to be successful.
Last year at the IHI Annual Conference, Don Berwick identified what he considered the greatest risks in healthcare. Two of his top five included the failure to coordinate and deliver care and the costs of care. I believe these are still spot on and are problems that could benefit from a Lean approach. Ohno’s advice would be: start from need and move from there.
I have seen great success using Lean principles in revenue cycle, patient flow, quality metrics, Meaningful Use, EHR adoption, care coordination and readmissions. Actually, any number of places within an organization that has a great need can benefit.
Can you say more about EHR adoption and Lean processes?
Mr. Booth: There are many disruptive factors in healthcare. We are seeing technology replace paper almost overnight and workflows struggle to support the demands of the EHR.
Where EHRs are already in place, new systems that are better designed to meet ARRA/HITECH requirements are replacing older ones. This disruption affects efficiency of the practice significantly.
The practice has attested Stage 1 Meaningful Use, yet the practice is in chaos and efficiency and workflows are upside-down. This is precisely where Lean and kaizen are perfect remedies. Kaizen can literally mean: “to take apart and put back together in a better way.”
Systems have been taken apart by technology, now we have an opportunity to put them back together in a better way. Of course it is always good when the workflow design is done on the front end of these projects, but with the charge to Meaningful Use we are finding that there are several organizations that are now doing the clean-up.
Does everyone need to become a Lean expert?
Mr. Booth: It helps to have a person leading the team who understands the tools, the techniques and the philosophy. It is important to understand that Lean is a set of management science tools yet more than the tools. At its core, it’s a respect for people because it helps them learn how to do their jobs better.
I know there are cases where Lean has gotten a black eye, because those in charge did not remember the core Lean philosophy – people, and investment in their success.
A Lean leader is always learning. It is helpful for everyone on the team to have an understanding of the language of Lean, just like we have a language of EHR, and a clinical language. We do not all need to become experts, yet it is helpful to have a guide to get you started.
What does 2013 hold for Lean? How can it help us in health IT?
Mr. Booth: Where there is change there is a great place to apply Lean tools and philosophy. In 10 to 15 years we will look back on what hospitals and physicians went through and say, “How did we do it?” Lean as a process, as a technique to manage this time of transformation provides a great framework for thinking through the challenge before us.