Implementing Lean Management at Cork University Hospital
Apr 20, 2017 -
Author: Tony McNamara, CEO, Cork University Hospital Group
The Potential for Transformational Change
The implementation of Lean and Six Sigma techniques has historically differentiated companies like Toyota Corporation from their competitors and has given those companies significant competitive advantage over their peers. It stands to reason that many other organisations delivering goods and services throughout the world can translate the learning from the experience of implementing these techniques to improve efficiency and quality of outputs.
The health service worldwide has been relatively slow to adopt Lean and Six Sigma management tools. This is in part presumably because of the difficulty in getting healthcare practitioners to standardise processes and as a result many systems in healthcare delivery settings are working sub-optimally. An exception to this observation is Virginia Mason Hospital in Seattle, USA (www.virginiamason.org) which is one of the few hospitals internationally that has become a lean organisation in almost every sense.
In Cork University Hospital we increasingly understand the power of Lean and Six Sigma to incrementally improve efficiency in our care delivery processes, improve performance and increase the quality of services we provide. Until recently the implementation of Lean reviews was predominantly driven by individuals undertaking work in advance of attaining qualifications in Lean Management and understandably the focus was on reviews in local departments rather than at a higher level, that might have had the potential to, for example, effect a redistribution of resources throughout the hospital.
In 2016 as a result of an invitation from hospital leadership, 35 staff with Lean qualifications committed to working in small teams to implement Lean and Six Sigma in a structured way in projects sponsored by the Executive Management Board with a focus on those projects that are considered will yield maximum improvement on the basis of the Pareto Principle (80/20 rule). In this regard the preparation of a programme of reviews will be informed by management information sourced from the rich repositories of data that are embedded in our information systems. This focus on linking management information with Lean management techniques is a manifestation of the emerging appreciation of using data and informatics to inform strategy and decision making in the Hospital rather than intuition or political activity.
To date in 2017 significant reviews have been undertaken in the Hospital in respect of a diverse range of services and functions such as:
- Cardiothoracic Surgical patient pathway
- Orthopaedic Trauma patient pathway
- Endoscopy services
- Consolidation of environmental and hygiene performance audits
- Bed management function
- Conformance to Radiation Oncology key performance indicators
- Process for maximising private patient income
We have also applied the use of Lean techniques in the design of the new Radiation Oncology Department – currently under construction – to optimise patient flow and reduce staffing costs when operational.
There is a great deal of learning from these and the many other Lean and Six Sigma reviews that have been completed in the Hospital to date. In the first place and almost invariably, the reaction is to question the underlying data that informs the conclusions and recommendations and this is to be expected. Secondly it is evident that the conversion of recommendations into a change programme can be challenging because effecting change in behaviour is always challenging but can be made easier by having a key member of staff from the service department involved in reviews from the outset. Thirdly making change sustainable is always a challenge and requires management to use information such as key performance measures to measure the impact of change. In this regard the establishment of a Lean Management unit with appropriately qualified staff is a priority for leadership in the Hospital in 2017 to oversee this very important initiative. The increasing focus on Lean and Six Sigma as opportunities to effect change is greatly assisted by our colleagues in the Cork Institute of Technology www.cit.ie who have and continue to support our staff in achieving academic qualifications in this area.
The opportunities for Cork University Hospital, and for every other hospital, to use Lean and Six Sigma to effect change in patient care, service delivery, individual and corporate performance and many other dimensions are immense. At a minimum it should be possible for a fully functioning Lean programme to effect efficiencies of at least 3% initially which when annualised for Cork University Hospital with a €360m budget equates to annual efficiencies of c. €11m per annum. Obviously this does not represent a potential reduction in costs, rather it offers the opportunity for greatly improved use of resources to the benefit of the service and to the taxpayer and the cumulative impact over a period of five years has the potential to be transformational in the quality of services we will provide.
J.A. McNamara, Chief Executive Officer
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