Only lean simultaneously reduces cost and improves quality in healthcare. That was the resounding message from Dr John Toussaint, keynote speaker at this year’s Lean Healthcare Summit. And he should know. As the CEO of Catalysis (formerly ThedaCare Center for Healthcare Value), he’s been instrumental in leading a paradigm shift in healthcare around the world to measureable and phenomenal success.

Over a decade ago Dr Toussaint launched a management system based on lean principles and practices aimed at increasing healthcare quality while simultaneously decreasing healthcare spending. The system focused primarily on value-stream mapping of processes contributing to high-quality patient care; the application of PDSA (plan, do, study, act) problem-solving cycles; and widespread use of continuous improvement. As head of Catalysis, Dr Toussaint has since helped to develop educational programmes and resources based on his system that have been used by hundreds of global healthcare leaders to enable the transformation of healthcare value in their facilities.

During the Lean Healthcare Summit Dr Toussaint made note to the Catalysis philosophy that there are three critical elements required to achieve sustainable change: patient-centred care delivery; payment and incentives based on value and outcomes; and transparency of performance (quality and cost) throughout the healthcare system. And while they may sound like logical and obvious steps, without the proper lean protocols in place it’s near to impossible to achieve the desired healthcare reform.

Enabling change

Applying the lean methodology in a healthcare setting, or any setting for that matter, requires team members to establish what it is that they want to achieve and then determine how best to achieve those results. An important element of this is focusing on both key results and the best behaviour to achieve those results; and then actively leveraging existing systems to drive the best behaviour.

At the start and throughout the change process, according to Dr Toussaint, team members need to answer a number of key questions to ensure they are on the right track and have the same goals in place. The questions need to be broad, for example, what is the purpose of the reform and what are the problems that need to be solved? Questions also need to be asked about existing processes and systems, such as what are the values and principles underling the systems and processes and what’s needed for improvement and innovation? The human factor also needs to be questioned to determine how people can be developed and what changes leaders need to make personally to support the transformation journey.

Leading by example

For staff to be motivated to follow through in achieving the long-term goals it’s essential for leaders to create an enabling environment and champion the transformation process. During his presentation, Dr Toussaint made reference to the Institute of Enterprise Excellence’s enabling principles that a leader should abide to. According to the principles, leaders should lead with humility by seeking input and being open to new ideas; respect every individual and create an environment where individuals can actively engage in improvement; and to learn continuously and share their learning with others.

These principles are complementary to the five key behavioural traits that leaders should have to build a culture of continuous improvement. According to an article published by Dr Toussaint and CEO of the Zuckerberg San Francisco General Hospital, Dr Susan Ehrlich, the five traits are: willingness to reflect on one’s own behaviour on a regular basis and understand what’s working and not working; humility; curiosity; perseverance; and lastly self-discipline to make sure that the learning that the leader is doing is consistently being demonstrated.

Improving systems

The next step is applying key lean principles to facilitate the healthcare system’s improvement process. Again Dr Toussaint highlighted key principles from Institute for Enterprise Excellence that need to be applied to the improvement process.

The first step is to focus efforts on improving on the process, and not on fixing people. This can be achieved by applying a scientific mind-set, where team members are encouraged to continuously experiment to learn, improve and achieve desired outcomes systematically. The next principle is to challenge existing processes to create a flow of value that streamlines the patient’s journey in the healthcare facility. Along the way it’s important for team members to correct or eliminate any problems they encounter before moving onto the next process or department, this requires them to constantly seek ways to improve systems and processes and to challenge the status quo. The overall idea is to essentially create new work processes instead of making tweaks or adjustment to current, outdated processes.

Applying lean to real-world settings

While it’s one thing to learn and understand the theory behind lean, it’s another to apply lean methodology to a South African public healthcare setting. A number of Western Cape and Gauteng Department of Health representatives attended the Lean Healthcare Summit to share their experiences of applying lean to their provincial hospitals.

One such person in attendance was the CEO of Leratong Hospital, Grey Dube, who has been involved in a Catalysis healthcare leadership programme along with two other public hospitals in Gauteng. During his presentation, Dube admitted that his two biggest barriers as a healthcare leader were leading with humility and self-discipline to help his hospital overcome a number of issues all too common in the public space. According to Dube, before initiating lean in they received 20 complaints a day about waiting times and congestion in clinics, pharmacy and a number of other departments. Since applying lean they have now only received two complaints in two years about waiting times.

Lean Project Manager at the Gauteng Department of Health, Elon Mathipa, shared his experience of what he thought were the key elements of ensuring a successful lean transformation. One being that the best way to sustain a project and to get buy-in from staff was to get them to think of projects as having an end point. Meanwhile, the CEO of Charlotte Maxeke Hospital, Gladys Bogoshi, explained how since implementing lean her hospital has experienced improved efficiency across the board. For example, theatre efficiency has improved by 36%.

Ensuring continuous improvement

The Lean Healthcare Summit stayed true to its theme of empowering healthcare professionals through continuous improvement. Dr Toussaint and the other invited speakers demonstrated how healthcare leaders can apply lean practices to transform their facilities into Centres of Excellence. But as stressed again and again throughout the day, this can only be achieved if healthcare leaders work alongside their staff towards the same goal.

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