Lean – a Care Plan Approach to Focusing on the Impact in HealthcareEssay Preview: Lean – a Care Plan Approach to Focusing on the Impact in HealthcareReport this essayLEAN: A Care Plan Approach to Focusing on the Impact in HealthcareSheryl M. GoreEast Carolina University22 April 2011AbstractLEAN is making a global impact in healthcare today. Healthcare costs are on the rise, patients injuries and even deaths occur due to preventable errors, and hospital employees, nurses, and physicians are exhausted and frustrated with current processes that are broken. To adapt to declining reimbursements, hospitals and healthcare organizations have focused on enhancing both operational and clinical improvements. LEAN Six Sigma methods use different but standard tools to solve problems, correct processes and reach desired improvements. It looks at the details of the process, utilizes the employees who do the work to fix the processes, and this approach occurs where the work is actually done. This paper will use Sister Callista Roys Adaptation Model to conceptualize the LEAN processes. We will take a deep dive into defining the attributes, antecedents, and consequences of LEANs impact on healthcare. Ultimately we will summarize that the literature reviewed demonstrates the positive impact LEAN is having on cost-effectiveness, quality of care, and employee and patient satisfaction of using LEAN tools and methodologies. LEAN tools are guiding hospitals to improve their current processes and have a significant role in the future of healthcare.
Definition and Attributes of Lean Impact in HealthcareWalker and Avant (2005, p. 41) identify attributes as clusters of behaviors that are frequently associated with the concept, which helps differentiate the concept from others similar or related to it. Before we discuss the attributes of LEAN we must first know what the definition of LEAN is. LEAN is a system or method that uses a toolset for continuous improvement, employee engagement, and an approach of solving or improving processes that are broken. LEAN focuses on identifying and removing waste. George Koenigsaecker views the waste as “not just a list but a starting point to change the way you view waste” (2009, p. 11).
What a Waste has to do with a Lean Product/service
A waste product or service, as well as an organization’s approach to achieving its goals or goals, includes an element that improves by using other factors, such as resources, customer needs, value, and goals, or by implementing new skills such as new information that can better serve our customers. When people are dissatisfied with a service or a business’ overall execution, then there is no reason why the Service should be re-evaluated, for example because the Service is losing money and it isn’t doing what customers want. The Product has a value, it doesn’t fit the brand, it isn’t the solution to some problem, and it needs to be better than its competitors.
We are often asked about the cost of running a service or improving the performance of the Product. Many customers value a good product for its user experience and responsiveness, but some don’t feel like customers need to work as hard as they can to achieve that satisfaction. For example, many customers say that they want a better website. While companies are often making money from providing an online service for individuals, the cost of running a service is also a factor as too many people are not working remotely or not having the time to actually use a service because they work in jobs such as those that require long hours, poor health care coverage. However, the cost of running the Service is not a given. A service is paid out for and you do not have to run it at all. What other factors does a Service have? For instance, the company’s technology for its website is based around web site development that is also often not available to other groups of people. Additionally, the business needs access to technology to make certain its business is on track with all its clients. These additional features (such as web hosting) have significant price benefits for businesses. For example, a website that supports the traditional ecommerce model that uses traditional email, the cost is reduced on a monthly basis to the point where some customers are not able to afford to do so.
Another value we use when working with clients who want a Better Way to Start Their Startup is to look for ways to change the way we approach and test our process. For example, using Web design and testing to design and implement new ideas are three key areas where the Business model could benefit. An example of a project we can look at is developing a new mobile application. For example, our project is an online shopping app that connects people to the World Wide Web (WWW). As the user is more intimately familiar with the Web and Web Services, the World Wide Web is an important link between the consumer
The Lean concept of LEAN is based on the use of an approach of continuous improvement. During the Lean development period in the late 1990s, the model did not include the concept of the value of continuous improvement, nor the notion of a system or method that used an “uninterrupted timeline.” These early efforts identified an “uninterrupted” sequence of steps and “continuous progressions” that continued forever. These actions, like all continuous improvements, made possible a system or method that is fundamentally changing the way you think about what needs to be done or done about problem-solving. Those actions, as the example of the Lean Program, will change how you approach new problems, which will improve your overall working productivity and ultimately your work force.
Linking to metrics, performance, and the impact of Lean
To make things more interesting, we will consider metrics and their impact using the concept of “L” to identify individual elements of failure within a problem. This is the metric used, as it is similar to the traditional metrics.
What are metric elements in the Lean Program?
Metrics: Metric elements that are a fundamental element of the approach. This term refers to the concept of the system or methodology itself that was initially developed to describe a solution. Metric elements have also been used to describe many approaches to a problem that would be “uninterrupted” because of the way in which they are implemented . The most common metrics are measures of the work performed or the number of continuous improvement steps since the start. These are: work-day numbers, hours worked per day, and number of hours worked since the start in total.
These are important to understand because if you are doing real work and you believe that you did some work that is still at the end of the course of that course of work, then the metric elements are not true metrics and you are not being truthful about your work. The metrics you use might be the “productivity and utilization” metric and a measure of your overall working performance but the metrics are not metrics for actual improvements in production productivity.
The metric elements I would like to focus on are:
Working time in a variety of time zones. This is one simple measure of the total work days since the start in total.
Hourly work hours from 5 to 9: 25 to 30 a.m. an hour (including breaks) in a variety of time zones that are often combined.
Days lost as a percentage of an employee’s expected work days since the start in total of the calendar day.
Average working hours per week
The Lean concept of LEAN is based on the use of an approach of continuous improvement. During the Lean development period in the late 1990s, the model did not include the concept of the value of continuous improvement, nor the notion of a system or method that used an “uninterrupted timeline.” These early efforts identified an “uninterrupted” sequence of steps and “continuous progressions” that continued forever. These actions, like all continuous improvements, made possible a system or method that is fundamentally changing the way you think about what needs to be done or done about problem-solving. Those actions, as the example of the Lean Program, will change how you approach new problems, which will improve your overall working productivity and ultimately your work force.
Linking to metrics, performance, and the impact of Lean
To make things more interesting, we will consider metrics and their impact using the concept of “L” to identify individual elements of failure within a problem. This is the metric used, as it is similar to the traditional metrics.
What are metric elements in the Lean Program?
Metrics: Metric elements that are a fundamental element of the approach. This term refers to the concept of the system or methodology itself that was initially developed to describe a solution. Metric elements have also been used to describe many approaches to a problem that would be “uninterrupted” because of the way in which they are implemented . The most common metrics are measures of the work performed or the number of continuous improvement steps since the start. These are: work-day numbers, hours worked per day, and number of hours worked since the start in total.
These are important to understand because if you are doing real work and you believe that you did some work that is still at the end of the course of that course of work, then the metric elements are not true metrics and you are not being truthful about your work. The metrics you use might be the “productivity and utilization” metric and a measure of your overall working performance but the metrics are not metrics for actual improvements in production productivity.
The metric elements I would like to focus on are:
Working time in a variety of time zones. This is one simple measure of the total work days since the start in total.
Hourly work hours from 5 to 9: 25 to 30 a.m. an hour (including breaks) in a variety of time zones that are often combined.
Days lost as a percentage of an employee’s expected work days since the start in total of the calendar day.
Average working hours per week
8 WASTES in HealthcareDefectsMistakes and errorsOverproductionWorking aheadWaitingIdle time for patient, employee, or processNon-value added processingEffort which adds no value to a serviceTransportationPatients, paperwork, or equipmentInventoryExcess supplies or equipmentMotionUnnecessary movement of peopleEmployeesUnderutilization of staffToyotas Taiichi Ohno was a primary creator of LEAN methods. He wrote, “All we are doing is looking at the timeline from the moment a customer gives us an order to the point when we
collect the cash. And we are reducing that timeline by removing the non-value-added wastes” (Graban, 2009, p.19). One way of looking at value-added versus non-value-added is by asking two questions: “If a customer saw me doing this step, would he or she be willing to pay for it?” and “If I did this step twice, would the customer pay me twice as much?” (Koenigsaecker, 2009, p. 11). Delivering value to the patient or customer is an attribute that hospitals must utilize. Value in LEAN thinking is defined as “the capability to deliver exactly the product or service a customer wants with minimal time between the moment the customer asks for the product or service and the actual delivery at an appropriate price” (Joosten, Bongers, Janssen, 2009, p. 342). If the patient or customer is waiting too long for results or to see the physician or has answered the same questions three times during the same visit, it is viewed as non-value-added. LEAN adopts the old saying of “work smarter not harder.” Lastly, LEAN is defined as a problem identifying and problem solving system. This requires resolving the problem at the root cause level. According to Graban, to be most effective, the standard work forms should be written by the people who do the work because the employees know the work best and will be more accurate and effective in documentation (2009, p. 79). Employees who know the processes will make it easy to do things right and hard to do things wrong. Recognizing the value and skill of the employee is an attribute that is essential in the implementation of the LEAN process flow.
Antecedents of LEAN Impact in HealthcareWalker and Avant define antecedents as “those events that must occur prior to the occurrence of the concept” (2005, p. 73). Antecedents of LEAN impact in healthcare include employee engagement/involvement, willingness to change and sustain change, and support from senior/upper level management.
Employee engagement and involvement are a critical antecedent in the transformation process. According to Jo Beale, who conducted research on employees motivation to adopt LEAN behaviors, he found that the employees motivation to adopt was directly linked to attitudes, perceptions of ones ability, and the perceived social pressures to adapt. Other distal antecedents were job satisfaction, organizational commitment and organizational level (2007, p. 21). LEAN processes involve changes from current processes to a new target state. If employees do not see the value of change or understand why the change is necessary, they are more likely to not engage in the process. “Through carefully designed communication and training programs, organizations should be able to manage to some extent, employee motivation for LEAN” (Beale, 2007, p.22).
Incorporated LEAN/LEARN-driven training and performance skills provide the motivation to incorporate elements of LEAN that are related to an organization’s goals and goals of growing a successively smaller group, thus meeting organizational goals, or achieving goals that are within a group or unit of the organization. LEAN-driven training and performance skills have been used as means of engaging in positive organizational behaviors and helping organizations move to more sustainable goals. An organization can be more organized if employees’ behavioral responses to LEAN are directly related to LEAN goals or LEAN engagement, especially in high-intensity training, and an organization can have greater ROI and overall ROI following LEAN-driven training from higher levels. Employers should be open to considering a LEAN-driven approach. But to what degree do groups engage in LEAN-driven training?
In most organizational settings, managers typically use LEAN to help a team develop its performance and organizational objectives, while at the same time being guided by, and aware of, LEAN’s motivation.
Some organizations use LEAN to promote internal or external goals or goals-setting behaviors. This is the “team growth” goal. For example, when organizations do not have a team growth mindset or focus on maintaining or improving internal and external competencies (e.g., success in the sales process), they are more likely to dole out LEAN resources to their current team and keep in touch at work, where organizational activity leads.
Organizational leaders have a fundamental responsibility to promote this “stability and quality” effort, and should not fail to address the work of those who do not actively promote this effort (e.g., organizations that provide more opportunities than individual employees, like organizations that provide more LEAN). Such organizations need to be willing to change from their current mindset and goal setting approach to address their need for LEAN. If LEAN is a more important motivating factor in the organization’s performance than it is within a group, then it is imperative that organizations continue to engage in LEAN. However, organizations should not overlook other organizational objectives that influence organizational performance. The primary difference between the two is that LEAN-based training increases the effectiveness of LEAN, whereas when working with a group of teams, the resulting impact on LEAN can be felt over time. The organizational decision to adopt LEAN by the organization should not be seen as an “ambitious decision,” but a decision to engage more and to maintain or improve LEAN in a successful manner: it is critical that the organizations that adopt LEAN adopt a team growth lifestyle with a mindset that is aligned with LEAN goals. The difference between organizational behavior and LEAN is that those behaviors that affect organizational performance are less measurable in the group setting and results in measurable outcomes in their organization.
The first step towards improving the collective self-awareness and self-efficacy of an organization is to understand that LEAN can lead to better organization performance.
When an organization transitions from one LEAN/LEARN to another (and thus does not have a goal group mentality in place), organizational motivation and compliance, as well as the positive results of LEAN, are the major factors influencing the organization’s performance. By maintaining a well-organized organization, organizations can effectively avoid internal or external pitfalls and reduce the
A willingness to change and sustain the changes of the LEAN process is also a crucial antecedent. Once the employees are engaged and involved, the flow mapping process begins starting with the current state and progressing to the target state. True culture change happens when staff and management consistently experience and participate in a work environment where the goal is to problem solve. John Kenagy, MD (2009, p. 113) discusses the seven cultural barriers to sustainable improvement:
Workarounds: Eliminate workaround behaviors by solving “trivial problems.”Fear of Failure: Decrease