Businesses across the spectrum have created better products and services at lower costs with the lean process. But is it possible to follow the lean production mindset in healthcare for meaningful value change?
"The first thing we need to realize is we do have similarities to other industries," said Lloyd A. Hey, MD, a spine surgeon at Hey Clinic Scoliosis & Spine Surgery in Raleigh, N.C., in a presentation titled "Surgeon Leadership for Improving Quality and Decreasing Cost in Clinic and Operating Room" at the North American Spine Society Annual Meeting in October.
The automotive industry is a prime example. Toyota revolutionized automobile production in the 1950s to create a better product for lower cost. That resulted in material flow going one way and information flow coming back to improve the process.
The healthcare industry has a service flow and feedback from patients to perfect the appointment and healthcare delivery process. But to implement lean, physicians often need to change their mindset. He recommended the following books for surgeons interested in learning more about leadership and the lean process:
• "Out of the Crisis" by Edward Deming
• "The Machine That Changed the World" by James P. Womack, Daniel T. Jones and Daniel Roos
• "The Fifth Discipline" by Peter Senge
"We are all very comfortable with the patient/doctor relationship and how we do whatever we can to help the patient but we are less aware of how our actions actually impact society through hospitals, vendors, insurance companies, government agencies and employers and eventually to the next generation," said Dr. Hey. "This is what systems thinking is all about because the choices we make now have a ripple affect in the long run."
Dr. Hey implemented ELIs — error, learn, improve — in his practice. Every day, surgeons see errors in their practice and instead of blaming others Dr. Hey proposes using those errors as opportunities to learn and improve.
"This leads to an upward cycle of improved quality over time," said Dr. Hey. The ELI approach is important at the individual level as well as the clinical level. Dr. Hey has weekly meetings with the staff and hospital administration to discuss opportunities for improvement.
"What we really need is process control information systems because that's your conveyor belt for your practice. You can take the things you're learning from your ELIs and actually integrate that into your information system to help prevent that from happening again."
Teamwork and quality metrics for clinic flow and outcomes are important as well. For each area, providers can prefect which patient to send to which services for optimized outcomes. In surgical care, it's even more important to understand how the preoperative process affects the intraoperative process. Key elements surgeons can control in the OR include:
• Trained surgical teams
• Infection prevention
• Minimized surgical time
• Best implant insertion equipment
• Use of proper number of biologics and devices
• Minimize the cost for implants
Postoperative patient education on expectations and when to call providers with issues are critical to maximizing patient outcomes.
"Lean production also helps us think about how we get our teams work together so they aren't just one group passing data to another group but actually groups within your practice and hospital helping each other to move patients through the process," said Dr. Hey.
Dr. Hey was also involved in an international study looking at implant costs. Surgeons around the world are concerned about cost and sustainability and they focused on the OR as the main cost driver.
"There are ways in which we as surgeons can actually have impact on that cost by directly working with the vendor. I found that's better for the vendor because they are able to stay there and work there, but it's also better for the patient and society," said Dr. Hey. His study found pedicle screws had a variation of $20,000 depending on the screws, and that's something surgeons can affect.