Monday, January 24, 2011

Benefits of Lean similar at hospitals around the world

Bangkok Blog#2 – Written on Monday, January 24, 2011
Michele Jordan
VP Quality Improvement and Transformation

Today was the official start to the Seminar on Regional Sharing on Lean in Health Care.  There are about 25 participants sponsored by the Asian Productivity Organization (APO).  I am in awe of the rich diversity.  Participants represent 15 Asian countries:  Cambodia, China, India, Indonesia, Iran, Japan, Korea Malaysia, Mongolia, Nepal, Pakistan, Philippines, Singapore, Thailand and Vietnam.  Each country had to submit a ‘country paper’ describing their health care system and the status of Lean in the health care sector.  I have to read all 15 of them before the end of the week.

Most countries are in their infancy where Lean is concerned but they all see the potential for Lean to improve their health care systems and are anxious to learn more.  The health care challenges faced in Asia are similar to what we face in Canada – quality concerns (i.e. wanting to use more evidence-based practice; need to minimize adverse events), lack of standardization, patient satisfaction, meeting growing public expectations, trying to reduce length of stay and insufficient money to do all the things we want to do.

In Asia, many hospitals are run by doctors who serve as both practicing physicians and CEOs.  Most of the participants at the conference are doctors and all of the speakers today were doctors.

The first presenter was Dr. Anuwat Supachutikul, Chief Executive Officer, Healthcare Accreditation Institute who set the tone for the day by providing an Overview Application of Lean Thinking to Healthcare.  I think it is absolutely brilliant that Thailand’s Healthcare Accreditation Institute had the foresight to invest in Lean and sponsor demonstration projects in several hospitals.  They clearly see the link between Lean and quality!

Next  Dr. Cherdchai Nopmaneejumruslers, Assistant Dean in Quality Development, Siriraj Hospital gave an introduction to the theory of Lean touching on topics such as value vs waste,  the ‘House of Lean’ (similar to our ‘House of Rouge’), common  Lean tools, operational excellence, value stream mapping and visual management.  He also talked about error rates and adverse events.  Did you know that the rate of preventable deaths in hospitals is comparable to the error rate for airline baggage handlers? Dr. Cherdchai is a respirologist who trained in Canada at (U of T, McMaster and UHN). He is the only one I came across so far who can relate to the frigid temperatures in Canada in January.

The third speaker was Asst. Prof. Dr. Roengsak Leetanaporn, Director, Songklanagarind Hospital. He gave a series of small lectures on specific aspects of Lean thinking including: Benefits of Continuous Flow, Cycle Time, Takt Time, Cell Concept, Batching, Workload Leveling, Error Proofing and A3 problem solving. For each topic, he gave an example from his hospital.  His hospital currently has 300 Lean projects on the go of varying size and complexity!

One of the most interactive and enjoyable parts of the day was a Patient Simulation Exercise organized by Dr. Cherdchai and his team from Siriraj Hospital.  It was a fun exercise similar to ones we have used at RVHS but using Lego.  At the end of the exercise we showed how improving processes (without increasing staff or space) could lead to more patients being seen, better quality (reduced defects), improved cost-effectiveness and improved morale.  The results made true believers out of everyone in the room, especially the doctors.  (Look for this exercise at Rouge Valley in the coming months!!)

Two things struck me about Day 1 of the conference. First, the similarities in Lean implementation between the Thailand hospitals and Rouge Valley.  Like us, they are using 6S, A3 thinking, surgical safety checklists, standard order sets, value stream analysis and kaizen events. Their discharge planning whiteboards, complete with “EDD” look exactly like ours! They have even surpassed us in some areas. For example, they have implemented Kanban systems for inventory management.

The other thing that impressed me immensely is that we sat in a room for an entire day and talked about the benefits of Lean.  Yet no one ever mentioned cost-cutting – only improving quality and ‘making patients happier’. No matter what part of the world you live in, that is what Lean is all about.