Lean Management in Primary Care

What is Lean Management and what are the benefits in general practice?

Lean is very new to medical practices in Australia and is more recognised in hospitals, services, and manufacturing businesses. The principles of Lean can be applied in just about any industry. Lean is a philosophy that puts the patient front and centre.

Lean is a set of concepts, principles and tools used to create and delivery the most value from the patients’ perspective whilst consuming the fewest resources and fully utilising the knowledge and skills of the people performing the work. Now, doesn’t that sound like an ideal environment!

Traditional healthcare systems are designed around functions or services rather than the patient’s experience within healthcare. The focus on continuous improvement in healthcare is therefore on improving flow among activities that add value to the individual patient’s journey and to the medical centre operations.

Some benefits of Lean Healthcare include:

1. Improved patient services
2. Improved workplace organisation, cleanliness and safety
3. Empowerment and engagement of practitioners & staff
4. Reduction of waste (e.g., waiting times, non-utilised talent, resources, motion, inventory, etc)
5. More timely delivery of patient care

The Principles of Lean

The five principles are considered a recipe for improving workplace efficiency and include:

1. Defining Value: define the value based on what the patient needs are and what they are willing to pay for.
2. Mapping the value stream: identify all the activities that contribute to the process focused on the patient
3. Creating flow: to avoid interruptions or delays
4. Establishing a pull system: creating a workflow where work is done as demand is needed.
5. Pursuing perfection: constantly seeing out ways to perfect the system/process – QI.

How do we approach Lean Management?

As with any good project, we need to identify what it is we want to achieve and the scope of what is to be included/excluded. The PDCA (plan-do-check-act) model supports both the principles and practice of continuous improvement and Kaizen. Kaizen means change for the good.  Kaizen focuses on applying small, daily changes that result in major improvements over time for the better. The PDCA Cycle provides a framework and structure for identifying improvement opportunities and evaluating them objectively. PCDA is a tool used in Lean for carrying out change, see below.

Plan

“Plan” is really a three-step process. 

1. The first step is the identification of the problem
2. The second step is an analysis of this problem
3. The third step is the development of an experiment to test it. 

Some of the things to consider during this process includes:

Problem Identification

• Is this the right problem to work on?
• Is this problem important and impactful for the organisation?
• Who does the problem affect and what is the potential impact of solving it?

Problem Analysis

• What is the requisite information needed to fully understand the problem and its root cause?
• What data do we already have related to the problem? What data do we need to collect?
• Who should be enlisted or interviewed to better understand the problem?
• After understanding the problem, is it feasible to solve it? Will the solution be economical and practical?

Do

The “Do” stage is where we test the proposed solutions or changes. Ideally, this should be carried out on small-scale studies. Small-scale experiments allow us to learn quickly, adjust as needed, and are typically less expensive to undertake. Make sure that you measure the performance and collect the data necessary to make an evaluation later on.

Check

In this stage, review the experiment, analyse the results, and identify what you’ve learned. Consider the following questions:

• Did the implementation of the change achieve the desired results?
• What did not work?
• What was learned from the implementation?
• Is there enough data to show that the change was effective?
• Do you need to run another experiment?
• How does the small scale experiment measure up to the larger picture?
• Is the proposed solution still viable and practical?

Act

In this stage, take action based on what you learned in the study. If the change did not work, go through the cycle again with a different plan. If you were successful, incorporate what you have learned from the test into wider changes. Use what you have learned to plan new improvements and start the cycle again. If your plan worked, you will need to standardize the process and implement it across the business. During this phase of the PDCA cycle, you should ask the following questions:

• What resources are needed to implement the solution company-wide?
• What kind of training is needed for full implementation of the improvement?
• How can the change be maintained and sustained?
• How can we measure and monitor the impact of the solution?
• What are some other areas of improvement?
• How can we use what we have learned in this experiment to devise other experiments?

Whatever the project and outcome you want to achieve as part of your improvement strategy, start small, gain some wins, get comfortable with the tools, process, workflows, engage your staff and take them on the journey with you.  

Ready to take the next steps?

Email info@practicepartners.com.au to get started today!