Characteristics of Lean Hospitals - Literature review Example

  Lean Hospitals Lean defines a process as well as a product. The concept of lean as applied in Graban’s “Lean Hospitals,” denotes a system of management aimed at streamlining the processes of value addition in production. The streamlining is aimed at cutting down input resources that may get wasted whilst maintaining high quality production. Lean, as a product of any system has become desirable in most industries after its success in Toyota (Graban 3). The auto-maker’s adoption and success in implementing lean management and processes has led to its success and more value production at a lesser cost. This has attracted its adoption in most industries in the manufacturing sector. Though initially seeming remote to healthcare, the management process has finally been adopted with success in various health institutions (Graban 4). Graban’s work explicitly details its adoption for the healthcare sector. The work on this managerial approach starts by identifying the factors that have prompted the adoption of a lean culture in healthcare service delivery (Graban 5). Like most other industries, the health sector is ever struggling with quality enhancement, client satisfaction and cash flow challenges. These elements of success have constantly been challenged by employee shortage and cost challenges that lead to poor performance and low value delivery. A large number of these challenges can be traced to wastefulness of resources in terms of cash, time and manpower. All the challenges result from the inefficient use of these resources. In order to combat this negative effect of wastefulness, it becomes necessary to implement a lean policy for all systemic processes within the hospitals (Graban p. 42-45). According to Graban (24), the ability of an organization to lean is determined by how well it is able to integrate lean management into its culture. The ability to lean relies on how well the medical organization is ready to engage leaning principles in all management systems, instead of using it as an occasional tool in some processes. In order to be effective it is recommended that the process of culturing lean management should be incorporated into work design processes and not sought as a reactionary remedial course. As per the recommendation, work should be planned as a sequence of experiments in which the revelation of problems and challenges occurs (Graban 24). The detected problems should then be addressed with immediate effect through a process of rapid experimentation that seeks to identify their cause and potential solutions. After the development of relevant solutions, there should be an adaptive process developed through experimentation that will ensure the solutions best fit the problems they are designed for. Graban (27) emphasizes the fact that any adoption of solutions should be adaptive, and people at levels of management should learn how to experiment with new ideas in assessing and bettering performance. Culturing the ability to lean does not suffice; instead there should be an explicit process in place that helps in defining value for various processes and identifying their related waste levels. The identification of the value of processes should go hand-in-hand with waste identification in order to determine the causes of waste that need elimination (Graban 22). The different types of waste as identified in the work include unnecessary waiting, defects, transportation and over production. After the identification of waste, value addition activities and non-value adding activities should be assessed too in order to determine which activities are necessary for retention. This process is accompanied by the elimination and retention of some activities depending on their perceived worth in the value addition process. In order to attain proper identification of waste and value addition processes, Graban (37) recommends the development of observational skills aimed at assessing processes and value streams. Value streaming is essential in identifying what is essential for procedures and what may be deemed as an unnecessary (Graban 50). In order to understand the intricacies of processes and identify waste, one needs to stand outside the scope of operations, but remain within their view in order to have a clear understanding of their occurrence (Graban 55). This process may involve tracking products (specimens, orders or patients) and employees so as to determine how much time is spent in each step of the service sequence. Additionally, the managing observer could use recorded data from process flows and turnaround times to identify the sources of wastage (Graban 59). The tracking and data use methods are especially important in determining time wastage in processes, which also the cause of other related wastes. Once the wasteful processes and their activities have been identified, Graban leads his readership to the development of systemic solutions that can be applied in curbing the wasteful nature. Standardization is identified as the core function to streamlining or leaning processes. According to Graban (70), standardization is the firm foundation upon which lean frameworks can be established. However, it has to be noted that the standardized work procedures have to meet some basic criteria. For example, the procedures have to be current and according to market standards, able to meet the stake holders’ needs, able to produce quality outcomes in a safe manner and with the use of optimal resources. In essence these standardized procedures have to be proper and less wasteful. However, it is important to note that standardized does not mean identical (Graban 72). Therefore, procedures should not be strictly rigid, but able to contain some changes which will allow for some flexibility when necessary to avoid making the whole process robotic and rigid to change which is necessary in any organization. The role of partakers in designing standards is also recognized in this work. Graban (71), states that procedures have to be developed by the involvement of those that engage in the tasks because they understand the procedures better. He cites this as a role definition process which is also essential in defining responsibilities, standards and lean methods applicable. Additionally, any role definition should be done with the use of concrete data to back it up. For example, staffing should not be randomly done, because of a perceived need; rather the need has to be proven by collected and analyzed data that shows a shortage and a need for extra hands. Graban (p. 89-96), proposes the 5S method as a means through which managers can help the work force internalize the leaning process. The 5S stands for sort, store, and shine, standardize and sustain. These S’s simply recommend procedural actions in internalizing lean procedures by: (1) sorting out procedures to determine the best; (2) retaining preferred procedures; (3) improving on the retained procedures; (4) standardizing the improved procedures and finally sustaining the application of these procedures and methods. In addition to the development of a lean culture and internalization of experimentation as a way to seek new and better procedures, Graban (112), recommends a proactive approach to solving problems by addressing their root causes even before they fully emerge. This is deemed as the most effective way to internalize leaning in any hospital set up. In conclusion “Lean Hospitals” is about identifying the essence of lean procedures in solving hospital problems such as delays, waste of resources and poor quality service delivery. The work identifies leaning as process and product not attainable through copying practices, but rather observing, experimenting, documenting and analyzing procedures. This should be coupled with value streaming to determine value adding processes and non-value adding processes that require streamlining for efficiency. It recommends the internalization of the experimentation and lean cultural procedures in order to enhance proactive leaning. In order to make procedures lean, constant empirical observation, role defining, procedural reviews, experimentation, error -proofing and standardization of procedures is recommended. Finally, lean does not mean ‘saving on costs’ or causing layoffs, and these misconceptions should be made clear by managers to staff, so as to prevent resistance to change which tends to crop up from these two misconceptions. Works Cited Graban, Mark. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, 2nd edition. Boca Raton, FL: CRC Press, 2011. Print. Read More