From the factory to the hospital: What can healthcare services learn from the automotive industry?
Laura van der Werf Paintings
A woman has been sitting in the blue plastic chairs in the waiting room for half an hour. She is happy, she finally has the appointment with the orthopedist for which she has been waiting for several months. This time, "there was an agenda." Finally, she hears her name being called and walks into the office, hoping to come up with a plan for her knee, which hurts more every day. He enters the office with a folder where he judiciously keeps all the diagnostic tests that have been done to him during the last years. The orthopedist asks for the MRI scan he requested at the last appointment. When he opens it, he looks at it in frustration. The MRI is more than a year old, the orthopedist does not consider that making a decision with it is appropriate. The woman, also frustrated, leaves the office with a new order to take a new MRI. When he finally manages to have an updated MRI, he calls to get an appointment with the orthopedist again. No appointments available. Meanwhile, the orthopedist is treating another woman whose MRI is too old to make a decision.
The story of this woman is just one example of the thousands of diagnostic tests that are taken, but cannot be used, of the medical appointments in which it is not possible to define a clinical conduct because the information that the doctor already had is not available requested. We know that many resources are wasted in the health system, but there is not as much clarity on what practical and feasible methods exist to identify why these wastes occur during the provision of services in an organization or on how to reduce them.
Despite the fact that the resources for the Colombian health system have been increasing, as in other parts of the world, it faces growing health needs, having limited resources to satisfy them. If to this is added the waste of resources, it is impossible to have a sustainable system.
Since the appearance of the first mobile assembly line at Ford, the automotive industry has been characterized by the development and refinement of forms of production in which the waste of resources is reduced to maximize efficiency. But is it possible to adapt learning from the automotive industry to health services in Colombia?
What is Lean thinking?
Lean thinking is a systematic way of analyzing production processes that seeks to identify and eliminate waste. This method started with the Just-in-time from Toyota and was later taken up and refined by Womak, director of research for the International Motor Vehicle Program (IMVP) at the Massachusetts Institute of Technology (MIT), who dubbed it the Lean manufacturing method (1). Later the method was expanded to the service sector and within them, to the health sector. The application of this method in health is known as Lean Healthcare (2).
In essence, this method of analysis begins by defining what the user of health services considers valuable. Subsequently, the activities that are part of the health care process are determined. These activities are then analyzed from the perspective of whether or not they add value for the user of health services, eliminating all those activities that do not. Anything that does not add value is considered a waste. The different types of waste that exist are classified according to this method into eight categories: waiting, defects, over-processing, excess inventory, over-production, excessive movement, unnecessary transportation, and unused human talent. .
From the identification of waste, more efficient and fluid processes are designed that seek to improve user satisfaction. In addition, this method seeks to improve the satisfaction of health workers with the work they do.
Challenges in applying Lean thinking in health
A challenge for the application of the Lean method in health revolves around the definition of what is valuable for the users of this service. Unlike what happens in other sectors, in the provision of health services, people who have a certain disease require the support of health professionals to determine the best treatment. Consequently, what is valuable must be agreed between patients and health professionals. Also, because people's health is being dealt with, that definition of value needs to be based on the best available scientific knowledge. For this reason, the application of the Lean method in the improvement of the processes in the provision of health services requires the support of different branches of research in this field.
Evidence-Based Medicine, by evaluating the efficacy and safety of interventions, allows generating management recommendations for different diseases and clinical practice guidelines (see: https://www.neuroeconomix.com/claro-una-guia-practica-clinica-se-adoptan-se-adaptan-se-actualizan/). These allow greater clarity about those activities that should be part of the care processes, because they generate results that are important for patients. Economic evaluations of health technologies also make it possible to identify those technologies that, with fewer resources, produce better results (see: https://www.neuroeconomix.com/analisis-costo-efectividad-4-claves-comprenderlo/).
The design of health care processes, applying the Lean method, drawing on the advances of various branches of health research, can be what allows identifying the roots of the waste of resources in the system and eliminating them.
Adapting a method created in the automotive industry to health services is not a simple process. Using a method designed to improve the operation of a factory in the health services may sound, at first glance, dehumanizing and inappropriate. However, when it is understood that this method seeks to put the patient's needs at the center of the provision of health services, it is possible to think that this method could be exactly what these services need to be more humane.
In our next blog, we will approach the need to improve efficiency in the provision of health services from another perspective. We will discuss vertical integration and its relationship with reducing the waste of resources in the health system.
If you think that learning more about the application of Lean thinking to improve the efficiency and quality of health services could help you, Contact Us.
1. Womack JP, Jones DT, Roos D. The machine that changed the world. Bus Horiz [Internet]. 1992; 35 (3): 81-2. Available from: http://www.scopus.com/scopus/openurl/link.url?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&svc_val_fmt=info:ofi/fmt:kev:mtx:sch_svc&svc .citedby = yes & rft_id = info: eid / 2-s2.0-27244461475 & rfr_id = http: //search.ebscohost.com&rfr_dat=partnerID: NnvIuKwx & rfr_dat =
2. Brandao de Souza L. Trends and approaches in Lean healthcare. Vol. 22, Leadership in Health Services. 2009. 121-139 p.