The Lean methodology to improve the patient's experience

Glòria Galvez

There are management methods that having proved useful in the industrial sector have now ended up being incorporated into the health sector. For them to be successful, in addition to the methodology used, it’s essential to give the appropriate approach. This is the case of the Lean methodology that tries to eliminate or minimize everything that doesn’t contribute value in the processes. It was initially applied in the automotive sector; hence it is the reason why it was received with some scepticism in the sanitary sector with the argument that "People are not cars". However there are numerous examples in the USA, Canada or Spain of their positive impact on hospitals; such as the case of the Consorci Sanitari del Garraf, which has recently been awarded at the World Hospital Congress 2017 for implementing the Lean Healthcare methodology in its health centres.

According to Daniel Jones, Lean in Health has to do with:

• Improve the quality of patient care and experience
• Simplify the tasks of professionals
• Better use of resources (equipment, beds, professionals, etc.) in order to serve a larger number of patients with existing resources.

The use of the Lean methodology allows us to work not only on the final results of the care process (costs, outcomes...) but also on the process itself, which is fundamental for the experience of the patient and his/her relatives. However, in a recent study published in BMJ Quality and Safety, Pokinska et al. compared two groups of 23 primary care centres based on whether or not they used Lean methodology among their management tools. Differences in patient satisfaction were not relevant between the centres of both groups. In the discussion it’s argued that Lean focused primarily on reducing costs, paying little attention to the patient's perspective. For example, tools such as the Value Stream Map, which focuses on reducing inefficiencies or Six Sigma to reduce the variation in hospital processes, were used to eliminate inefficiencies from the perspective of professionals, without taking into account the meaning and value it had for the patient.

In an editorial response, Blackmore and Kaplan discussed the study's findings by focusing on the importance of incorporating the patient's perspective to make the Lean application successful. They suggested avoiding some errors:

1. Use Lean as a short-term shock measure, because, although it may be effective, it’s more indicated in the framework of a comprehensive management system.
2. Inefficiencies or actions that don’t contribute value should be defined from the point of view of the patient. Thus, in a medical visit, the value to the patient lies in their interaction with the professional and, therefore, Lean improvements should focus on maximizing this interaction, eliminating other activities that are not part of the care process.
3. The objectives from the perspective of the patient are the quality, safety, accessibility and experience of their care. If Lean is simply about reducing costs or increasing efficiency, the opportunity to improve care decreases.
4. It’s important to take into account the priorities of frontline professionals, who are more concerned with patient needs than cost control. If the goal is only cost minimization, the frontline professional, a key player in the patient care process, will not feel involved in the improvements.

The results of the study stimulate reflection on whether placing the patient at the centre of the system is really a priority for health care organizations. If we apply the Lean methodology, we must review the perspective from which we do it and define, for those who are negligible, the activities that are considered to be of no value (for patients, professionals, health managers...). If patient satisfaction doesn’t improve, it’s not necessarily a Lean failure, it will be necessary to reflect whether it’s the result of not prioritizing the patient's values ​​and experience, and whether they have been involved in the definition of value.