Don’t get Sick on the Weekend – Why Lean is Difficult in Healthcare

The current way healthcare services are delivered in this country is, at its core, the opposite of lean.  Those of us working in the industry need to do much more to become truly patient-centered, or lean, as stated in so many of our mission statements.

To elaborate this point, I will focus on “flow and pull value,” a fundamental principle of lean.  When this principle has been applied to the care process, the patient dictates where, when, and how often a service is provided. In addition, waste has been eliminated, so that service can be provided at the lowest cost possible.   Examples of this principle in action may include:

• Available appointments or inpatient beds when the patient needs them for the right level of care.
• All services coming to the patient in one location and during the same visit, rather than the patient going to them.
• Moving from one doctor to the next as you receive care for one condition without any re-testing, re-questioning, or other unnecessary processes.
• Going to the doctor and leaving with all questions answered, and a followup plan.
• Calling the doctor’s office and speaking to a live person who answers all your questions without handoffs.
• Receiving support with coordination of care between providers for complex conditions.
• Same level of care services available 24/7.

While there are healthcare organizations implementing some of these practices with great results, including members of the Healthcare Value Network, they are in the minority.  More common situations include patients who are unable to get timely appointments with the next specialist on the list; are forced to travel to a number of locations for diagnostic testing; are confused about which doctor is supposed to do what for their care; and the struggle to get care after business hours or on weekends.

Providing access to care at the time needed is of particular importance to patients.  Disease and accidents happen 24/7, but most clinical services are only available Monday-Friday, during business hours.  In my experience, “after-hours” available options only include expensive emergency rooms, telephone answering services, limited-service emergency clinics, and/or nothing.  This system works well for those who suffer serious accidents, but not for everyone else.

During the past year here are some of the situations I’ve encountered while seeking after-hours care from six healthcare providers in three markets:

• Coming full circle into a wall:  A telephone answering message at a specialist’s office with instructions to call another provider; the next provider’s answering service saying we should call the specialist because the patient was now in their care.
• Compensation barrier:  A provider telling us they do not offer after-hours care because they don’t get paid for that time.
• Limited phone service:  Automated nurse-line messages that instruct you to leave a message, resulting in phone tagging going on for days.
• Overloaded emergency rooms:  During more than 50 visits to emergency rooms regularly waiting 3-4 hours for care.
• Waiting for prescriptions:  More than once being told to wait until Monday for a needed prescription to be filled.

What if airlines, internet providers, hotels, cable companies, grocery stores, and malls operated the same way?  They would be out of business because consumers would not choose to use their services.

But healthcare is different.  Consumer options are limited to what is offered in their geographic area (with some exceptions for elective care) and changing doctors can be a daunting task.  Even if patients wanted to do this, finding another doctor is like hunting in the dark since there is no reliable information from which to make an informed decision. Moreover, we have no choice – we cannot opt out of acquiring healthcare services; aside from behavioral modifications, we have very little control over when and where disease or accidents strike.

Therefore, I encourage healthcare leaders to think deeply about what it truly means to adopt lean principles.  It doesn’t mean designing care services to meet the needs of the people working in their organization or of third-party providers.  It means defining value from the point of view of patients and their families (no more waiting, no extra costs, no repetitive data collection) and then designing systems that allow them to “pull” for services exactly when and where they need them, thus achieving “flow.”

Marta Karlov
Education Director
ThedaCare Center for Healthcare Value