By applying some practical techniques from lean methodology, you can build a more streamlined, efficient department

Companies like GE and Motorola have made Six Sigma, a data-driven methodology for eliminating defects, a household name since the 1980s. Rooted in statistical analysis, the Six Sigma approach is known for removing variation in a process. It’s generally seen as a high-tech mathematical approach to solving problems.

Somewhat lesser known is the lean methodology, which offers a more low-tech, common sense, no-nonsense way of solving problems. Lean focuses on streamlining a process through the elimination of waste, by removing anything not necessary to produce a given product or service. These concepts were used by Henry Ford in 1913 when he combined interchangeable parts with a standard, assembly line workflow.

Lean manufacturing is now most closely associated with Toyota, which originated the lean philosophy in the late 1940s. It focuses on the elimination of waste arising from three core flaws: unnecessary or ineffective processes (referred to by the Japanese term muda), lack of standardization (mura), and unbalanced workloads (muri). There are many facets to lean, but this article will focus on the basic ideas of elimination of muda, value stream mapping, and Kaizen events.

Six Sigma and lean both have merit and value: They’re just different approaches. When choosing between them, you need to look at what problem you’re trying to solve before picking the best method to use. (See “The Six Sigma Way” for more background on Six Sigma principles.)

Lean is not driven by statistics like Six Sigma is, but it does use one common measure: time. Reducing wasted movement or downtime during the production or service process means eliminating excess time so you can offer that product or service more efficiently. Lean methodology can help review the flow of a process to identify these areas. There are several other major steps to lean we’ll cover here, such as:

  • Identifying what is considered valuable and eliminating wasted movement
  • Recording the flow of a process through value stream mapping
  • Streamlining a process to include only value-added activities and bring about a future state

Elimination of Wasted Movement

Waste can be associated with almost any word with a “re” prefix. Redo, repair, retrain, and return are just a few. These words create the feeling that something was not done properly the first time. You would not have to look far to find simple examples of relying on lean methodology in your own life. Think about how you might plan your errands to achieve the most efficient route home: You would not zigzag across town, retracing your steps, to go to the department store, dry cleaner, grocery store, and gas station. You would plan a smooth path, avoiding constructions zones, U-turns, and left turns. This is a simple way to start thinking of lean.

How can that approach fit into the biomed world? During one lean course the instructor told the class, “Waste is anything the customer would not want to pay for.” Now try applying that philosophy to your department’s regular activities and customers. Would hospital administrators be comfortable paying for you to repair an IV pump? Yes. Would they be comfortable paying for you to perform a PM on an IV pump? Certainly. Would they be comfortable paying for you to walk the hospital halls for 2 hours looking for an IV pump due for PM? I doubt it. If the answer is not “yes” to any of the ways your department spends its time, there might be room for improvement by eliminating wasted steps.

For example, many years ago our facility used yellow stickers to track PM for all devices. Searching for IV pumps was a painful process. It was common to do a room-to-room search and then have to get within 2 to 3 feet of the device to read the due date. To make identification easier, we started to use different color stickers. The planning was simple: Select a color scheme for the stickers and use the hospital floor plan to draw a map identifying areas with devices requiring updated stickers. A notice was sent to the nursing staff explaining that the sticker color would be changing based on the PM due date of the device. The communication included pictures of the new stickers and encouraged nursing staff to contact our department if they saw devices with the old stickers. This tactic made them part of the solution and reduced the time we spent searching for the devices. I am sure many facilities are already doing this and never considered it a lean concept.

Value Stream Mapping

Value stream mapping is a systemic approach to looking at an existing process and eliminating wasted steps. If you look at any process to map out exactly what you doing now and then map out the ideal situation, you will see there is typically a difference. Value stream mapping can be thought of as any actions required to bring a product from its raw material to a final product. Similarly, it could represent the effort needed to bring a service from the customer’s initial service request to final delivery of the service event. When you take a value stream perspective you work on the big picture, not just on individual processes. Value stream mapping is important because it helps you visualize more than just a single process: You can see how all these elements interact. It also helps identify duplicate efforts.

With any lean process, you have to look at your current state of affairs. Creating a visual map of your current state can help you clearly see what your existing process looks like and where there is room for improvement. To identify the current state, you may have to walk through the process and identify what is taking place.

Let’s use the example of the request for a service contract. The biomed identifies the device they would like under contract, but what process do they follow? How do they know if it should be a full service contract or for time and materials repair in the first place?

To try this process, get a large piece of paper or a white board with an eraser. Walk through each step of the process so you understand the flow. Write down everything you see and get input from others regarding the process you are investigating. Ask each person involved for details so you can understand the big picture. Be sure to capture any data that may be required during your process. Then draw out the process, starting with the end and working backwards.

Your current state map may include a review of the past number of vendor service calls, the amount of money spent on service calls and parts, the criticality of the device in question, and the time spent for in-house staff to service the device. Other steps may include contacting the vendor to find out if a service school is being offered or if a shared service agreement is an option.

During your process, capture any wait times, such as the length of time it takes for the contract to be approved. The next element of the mapping process is flow. How does information regarding the contract request flow from the technician to the department manager and from the manager back to the technician?

Now that the process has been mapped out, start to note if there are any duplicate efforts or potential bottlenecks. What about overall wait times? How much time is spent on the process from start to finish, and where are the communication triggers? After all the steps and associated times have been captured, you can then start to look for areas of improvement.

Creating a Future State

After you have selected the process you want to evaluate and built a map of the current state, you can start to identify areas of waste. After studying the big picture, including wait times and all required steps, you can begin to build the future state of the process. You must take caution not to be overly aggressive and eliminate too many steps at once, which might lead to breakdowns in the process. Before reducing or eliminating steps, be certain to check with the individuals most knowledgeable about the process to ensure there are no unintended consequences.

There are times when this project must be completed by a team rather them an individual. If a healthcare organization or department wants to quickly improve a core process, they can implement a Kaizen event. Kaizen is a Japanese term meaning “continuous improvement.” During this process, those involved review a problem, produce a value stream map and future state map, and plan to execute changes. These steps typically take place on a compressed timeline over several days, but the results can be dramatic.

The Kaizen Event

A Kaizen event includes many of the concepts discussed already. During the event, the problem is identified and defined. The current situation is documented through value stream mapping, and the ideal state is visualized. Once the team has an awareness of the issue, they must plan how they want to change it. The steps below will help you outline how to execute this change.

First, you must define measurement targets at the outset. Your team must agree on what “success” looks like before the process starts. Different people might have different visions of success, and the goal should not be framed with vague wording such as “make it better.” The targets must be measurable and data-driven.

Next, brainstorm solutions to the problem with the team. You should strive to maintain a safe environment that allows for open discussion without members worrying that their ideas will be automatically rejected. Before the brainstorming session starts, discuss some ground rules such as clearly stating the problem before you begin so that everyone understands what it is. As the brainstorming takes place, you will begin building ideas. The focus here should be on quantity over quality. Quality will come later. The more ideas provided at this stage, the better the chance you will produce a more creative, effective solution. Most of all, have fun.

After the brainstorming session is completed, you will develop and implement a Kaizen plan. This roadmap typically includes very specific actions that will be taken to make improvements. The Kaizen plan can include information like who is responsible for executing certain actions and who is impacted by the change. You can think of it as the 5 Ws and 1 H: who, what, where, when, why, and how?

A Kaizen plan can typically be implemented in a relatively short period of time. The entire process, from mapping the current state to implementation, should take place over about a week. This tool is designed for quick change and rapid results. After the implementation, be sure to measure and monitor the success of the change. A positive change will not have long-lasting results if it is not sustainable.

Lean methodology is meant to be a simple, fast-paced process to implement change and reduce wasted movement, time, and activity. There are many facets to lean philosophy, and this brief article only touched upon the basic concepts. For more information, there are several websites and books you could explore. The New Lean Office Pocket Guide by Donald Tapping provides a great foundation. As you become more familiar with lean methodology and use it more often, you will never look at a process the same way again.

For a brief overview of Six Sigma principles, read the companion article, “The Six Sigma Way.”

Randell Orner, PhD, MBA, LBC is a 20-year veteran of the biomed industry. Shannon Barr-Marinetti, DBA is a college professor and business consultant. For more information, contact chief editor Jenny Lower at [email protected].

Photo credit: © Mark Eaton |