Covid-19: lean management can help hospitals save more lives
Covid-19: lean management can help hospitals save more lives (Photo: Reza Estakhrian via Getty Images)
The capacity of health systems is at the center of everyone's attention at this time of escalating Covid-19 cases in our country and in so many others.
Several management principles, most of them coming from industrial environments, have been developed over the last decades with the aim of eliminating waste and simplifying flows, resulting in increased capacity.
Many of these approaches have also been used for some time in health care, as in the example of initiatives applying the lean concept, also known as lean thinking, in hospitals. However, the dissemination of these practices has not yet reached a large share of health care organizations. This means that many of these organizations, in addition to all the serious problems they face, may have efficiency losses in their processes that could be minimized through some good practices from lean thinking.
In the same way that the pandemic has been demanding a high sense of urgency at all levels, some of these principles can be applied quickly, helping more people to be treated in this scenario of overburdened human and material resources.
For example, the analysis of complete flows, from beginning to end, is a widely used technique, and it is applicable to the most varied processes. A well-known way to speed things up and increase productivity is to create specialized flows, separating different situations, eliminating waste and optimizing all the activities in each of them.
Because of the very risk of contamination, authorities have already been announcing the designation of some hospitals, wings or floors exclusively for the treatment of Covid-19. But even in these dedicated units, patients arrive in different situations and undergo different treatments, according to established medical protocols. A meticulous triage, carried out by experienced professionals, is a first measure to correctly direct each case to the flow that can give it the greatest speed and safety.
Physical organization and the dedication of human and material resources, according to the demand for each flow, is another measure that can be important. This makes it possible to minimize countless wastes of the care teams' precious time, in movements and actions that add no value to what matters most: caring for patients. Several techniques, such as optimizing layouts based on the analysis of repetitive movements and creating stations with support materials closer to the points of use, among many others, can be applied for this purpose.
Those who work in management know that processes are best executed when people know exactly what to do. This is what we call in lean management “standardized work.” In this sense, as in any organization, another practice that can help is to try to make it as absolutely clear as possible to the professionals involved what they should do and how they should act. For example, by translating the care protocols and the process flows to be followed in a precise and didactic way.
For this, it can be useful to create, for example, visual management boards, with simple but detailed infographics, which make it automatically evident at a glance how procedures should be carried out. This also helps speed up care and increase safety.
Another aspect that has drawn great attention in this crisis concerns supply chains. The supply bottlenecks for tests, mechanical ventilation equipment, masks, gloves, hand sanitizer gel and other items have become crucial. This is a demand for which the world was not prepared and to which we can respond more quickly if we have flexible and adaptable production chains.
In addition to this structural, macro-supply problem, problems can also occur in the flow to the end point, where these products need to arrive. Even when the distribution of these items improves, reaching the cities with the greatest demand, their path to each hospital is anything but trivial, and within each one, from the storerooms to the medical teams and patients. Concepts such as the pull system, replenishment signaled by kanbans, in small batches and through routes with rapid supply cycles, are very characteristic of lean thinking and make it possible to improve the availability of resources where they are needed, with lower inventories. These ideas have already been used successfully, for example, to supply medicines in hospitals and can be used for all supplies. Preventive maintenance techniques can also be used to keep vital equipment from going out of operation.
There are several other ways to improve hospital management, such as balancing, or “leveling,” the workload among team members, eliminating unnecessary effort and focusing on what is a priority, cutting red tape in support processes, improving communication among team members, etc.
Some health care managers have already been successfully applying lean thinking concepts to reduce queues and improve care. The rapid dissemination and broader use of some of these good practices can certainly be an important help at this time. To contribute in this regard, I recommend here a quick read with essential tips for applying lean management concepts and practices to hospital processes immediately and practically: Read the article.
Disseminating relevant information that can help fight the coronavirus is one of the most effective weapons we can use at this time. Also with regard to management.
