By NHRMC President and CEO Jack Barto
As part of our continuous journey toward service excellence, we have incorporated the Lean business model at New Hanover Regional Medical Center to strengthen our processes for providing services our patients value while also reducing waste.
Lean, a method of doing business that began in post-World War II Japan as a way to improve manufacturing efficiency, has a simple goal: maximizing customer value while minimizing waste. Other industries later adopted Lean methodology, and the trend has only recently spread to health care.
When we started in 2010, New Hanover Regional was, by all accounts, a successful hospital in terms of patient care quality and resource management. But we knew we could be better. Today, our Board of Trustees, my senior team, and our physician partners and I are all in with Lean.
By “all in,” I am referring to more than 500 Lean projects completed, some lasting multiple days, and more than 2,300 employees directly involved in process improvement activities, with an additional 2,000 employees expected to take part in rapid cycle projects this year. We expect to get to the point where our workplace is filled only with problem solvers.
As it turns out, we could not have started this process at a better time. In today’s health care environment of reduced funding and more regulation, managing through Lean is not only a good idea, but a necessary one to address how we must do business today.
So what do I mean by saying we are a Lean organization? It means we reassess everything we do from the perspective of our patients. What can we eliminate that has no value to them? How do we spend more time caring for them? Can we answer why we’re doing a given task or process, and can it be done differently?
Lean starts by challenging a core assumption that leaders have all the answers, that we come up with ideas and push them down to the employees to carry out. Lean teaches us that doesn’t work.
Instead, you draft your “front line” employees –staff members working directly with patients – and engage them in a structured discussion on what they do and why. Sometimes you visit the “gemba,” another word for the area where work takes place, and observe how it actually gets done. And as leaders you listen and coach when needed – but generally stay out of the discussion.
The end result is a streamlined process, after some carefully managed trial and error, that eliminates wasteful steps. And you have a group of motivated, invested employees who are now partners actively owning how to improve your workplace.
The results so far have been astounding. For example, our Rehabilitation Acute Care Services looked at the process of how the staff schedules therapy visits. By reassessing the simple process of registering and preparing to treat patients, we found we could add an additional 12 treatment slots a day.
From a patient perspective, this is more access to a therapist. From a business perspective, an additional 12 therapy slots is the equivalent of adding a full-time therapist, but without spending a dime. In today’s business climate, this is how we will have to operate.
There are many other examples worth sharing. Our Food and Nutrition staff tackled why food trays were late and redesigned its work flow. In December, we delivered 45,105 meals, with 97% on time and 99.7% within five minutes of scheduled delivery. This represents tremendous improvement in a short time, not by adding labor or capital, but by simply improving a process.
Lean also works for future planning, especially with construction projects. We asked our front line clinical staff to help design the new Emergency Department we are building at Porter’s Neck. Instead of the typical ED flow we all thought we would build, the staff come up with something much different and much better – especially from the standpoint of a patient’s convenience and care. We estimate we will save $150,000 in construction costs and another $596,000 by cross-training employees to deliver care in a way that is more convenient to patients.
When first designed, Lean was assumed to be a manufacturing business model on how to make the same widget for less cost. But it easily translates to health care. By allowing us to be consistent and efficient in how we carry out the everyday tasks of our jobs, we create more time to care for our patients.
That’s the best outcome of all, and this is why I am such a believer in Lean as a model for making New Hanover Regional Medical Center the best it can be.