Creating a leaner healthcare system

Healthcare systems could learn lessons from the lean manufacturing techniques used by japanese car maker Toyota. 

Sixty per cent of activities done during each patient visit within healthcare systems are a waste of time and manpower, according to a pioneer in delivering “lean” healthcare who recently spoke at a national healthcare conference in Cayman. 

Cindy Jimmerson, founder and president of Lean Healthcare West said studies of health facilities in the United States, Canada, Denmark and Australia have shown that only 40 per cent or less of activities performed every day in hospitals add value to a patient’s visit. 

Ms Jimmerson gave the example of her own visit to the Cayman Islands Hospital the day before she gave a presentation at the 20/20 Healthcare Conference in November. She spent five and a half hours at the hospital, underwent four tests, had what she described as “20 minutes of patient-involved time” and spent 19 minutes paying her bill. 

She said she had calculated that the amount she would consider to have been valuable to her as a patient during that visit was just 6 per cent, which she said was “typical” of experiences in US hospitals. 

Ms Jimmerson, who set up her organisation with a grant from the National Science Foundation from 2001 to 2004, said the time and manpower wasted in hospitals worldwide were, in fact, opportunities for improvement. 

Lean’s goal is to partner with medical facilities to educate and for them to recognise opportunities to improve healthcare delivery in every environment, anywhere in the world, at an affordable pace and price.  

The organisation has borrowed its approach on how to identify and cut waste from Japanese car manufacturer Toyota, which has used “lean manufacturing” for decades to produce high quality, reliable vehicles. 

As the baby boomer generation ages – there are 76 million baby boomers in the US and only 42 million Gen X, Gen Y or Millennial babies to replace them, Ms Jimmerson said – demand for healthcare will grow and something needs to be done to make healthcare more available, more affordable and accessible to that aging generation. 

To do this, major cuts can be made within healthcare organisations by identifying the wasteful processes and eliminating them, Ms Jimmerson said. 

With about 1,500 people working in or affiliated with healthcare in Cayman, there is a big opportunity here to teach each one of those workers to find ways to cut such waste, she told delegates of the three-day conference. 

“Sixty per cent waste to me is 60 per cent opportunity,” she said.  

“We’ve determined we can’t have more babies to fill that gap of healthcare workers coming up behind us.  

“We know we’re going to have to quit working at some point. We’re not going to change the demographic, but we don’t have to…  

“In the US, we spend almost US$3 trillion dollars on healthcare, 60 per cent of that is almost US$2 trillion. Imagine if we cut this in half, we’d save another trillion dollars in the United States to spend on healthcare and that’s enough to take care of everyone because we’d have the money to do that,” she said. 

“There’s a simple formula for us to improve healthcare and that’s to improve the quality.  

“Superior quality equates to better fiscal results,” Ms Jimmerson said. 

She explained that Lean’s simple formula involves liberating the people who do the work to make decisions and make suggestions to improve how work is done, making incremental small changes along the way, rather than depending on senior management in boardrooms to make decisions on work they don’t know how to do themselves. 

“We need to go to the people who do the work, the resident experts, and let them design the work,” she said. 

Involving the frontline staff in such decisions also increases their motivation for changing how they work, rather than simply ordering them to work differently, she said. “We will support the changes we are part of creating,” she explained. 

Toyota’s philosophy is “everything we do from this moment forward, ask yourselves before you make any improvement or choice, is it going to move us closer to the ideal,” said Ms Jimmerson, who added that healthcare systems needed to take that same approach. 

Toyota’s definition of “ideal” is give the customer exactly what he or she wants, no more, no less. Translating this to healthcare, it would mean, for example, instead of supplying a big, comfortable waiting room with big-screen TV and gourmet coffee, cut down on waiting times. 

It also means ensuring there are no defects, that service is available on demand, that there is no waste of time for the worker or the patient and that a safe physical, emotional and professional environment is provided, Ms Jimmerson said. 

“I think we have enough money but we’re inadvertently, with our best efforts to do a good job, not making the most of the opportunities to reduce waste and make the most of what we have,” she said. 

Cindy Jimmerson, Lean

Cindy Jimmerson, Lean Healthcare West, speaking at the 20/20 Healthcare Conference in Cayman in November.