How hospital HTM departments are using lean principles to streamline and optimize their work.
By Chris Hayhurst
Nine years and counting. When Boyd Hutchins, CTM, thinks back on how his HTM department got to where it is today, time is the main metric that comes to mind. Its transformation has been an ongoing process, he says, and it’s one that will continue into the years ahead.
Welcome to the world of “lean” in healthcare technology management, where HTM departments in hospitals and health systems embark on a journey defined by constant change. The lean ideal of continuous quality improvement—an ethos first popularized on the production line at Toyota—holds that waste can and should be eliminated at every stage of any process. Whether your company is making cars on a factory floor or your staff of trained technicians is providing services to clinicians, there are always ways to streamline and do your job better—and in so doing, continuously evolve.
Hutchins, who leads an HTM team of nine biomeds, three PACS administrators, and two equipment-distribution techs at Arkansas Children’s Hospitals, says he learned about the lean process a decade ago when an equipment vendor led a lean training session for the organization’s laboratory. “I could see how it might apply to the way we ran our shop—so after that, bit by bit, I exposed our engineers to the same concepts.”
For instance, Hutchins says, 10 years ago his team did “batch” repairs. “We’d collect infusion pumps and store them on a shelf and wait until that shelf was full, and then we’d take a day or two and run through them all as quickly as we could.” Once a device was repaired, it would be placed on a delivery cart, “and then only when that cart was full would we go out and deliver them back to the departments that needed them.” This approach, Hutchins remembers, seemed efficient at the time, but it wound up creating “a lot of dissatisfied customers,” who wondered why it took so long for their repairs to be completed.
Now, instead—and in tune with lean thinking—they tackle such repairs using a “single-piece flow” approach. “When equipment comes in, we’re going to take care of it right away, or at least as soon as we possibly can,” he says.
The lean mindset has also become central to other aspects of his department’s business, Hutchins notes. When it comes to tasks like ordering parts, for example, they only place orders for exactly what they need. Specifically, the department uses PartsSource to identify parts that are out of stock or slow to ship, thus minimizing back-order delays and leaning out the parts ordering process.
“A part comes in, and it goes into a machine and it leaves,” Hutchins says. “That keeps our space clean; it helps us manage what we have in our parts room, and that leads to more-satisfied customers because we’re providing them with better service.”
Similarly, when new equipment arrives at their facility, colored floor tiles are used to delineate the specific areas where items should go, and their equipment-distribution program itself now includes a lean-inspired cleaning service for portable devices like infusion pumps.
“We don’t waste any time on collecting pumps and bringing them to the shop or even taking them to a central sterile location,” Hutchins says. Instead, when a patient is disconnected from a pump, the device is put in a soiled utility room on the same floor, “and our technicians do everything they need right there.”
The Lean ‘Philosophy’
Lean, Hutchins says, “can’t be something you do; it has to become a philosophy.” He knows of other healthcare organizations that have experimented with lean methodology unsuccessfully “because it was just a program they tried to put in place; they didn’t have buy-in from everyone involved.” Arkansas Children’s Hospital found success, he notes, by taking it slow and nurturing the transformation, and not attempting to push it through. “You don’t get there overnight,” he says. “It takes time because you’re changing the way you think.”
Dallas Sutton, supervisor of the clinical engineering department at WakeMed in Raleigh, N.C., agrees. “A lot of people will say, ‘I can’t do that. I can’t get my people to do that; it’s not going to work for us,’ because they don’t want to invest the time and energy it takes to be successful.”
His department’s lean transition has been underway for the last year and a half, he says, excluding the time it took to complete the policy-writing and staff training—roughly a year. “It’s about implementing new processes and new programs, and then being accountable and making the necessary changes when something’s not working as well as it should be.”
WakeMed, Sutton says, requires all hospital leaders to go through a lean-training program called the “WakeWay 2 Excellence.” (The program was developed through consultation with Virginia Mason Medical Center, an organization widely recognized as a pioneer in lean healthcare.) Sutton completed the WakeWay training himself after earning “green belt” certification in a methodology known as Lean Six Sigma, and eventually introduced a number of lean-inspired initiatives that have helped his team work more effectively and efficiently.
“There was one stretch of time where because of retirements and FLMAs, we had a 25% reduction in manpower in our shop,” he says. “But our productivity actually increased during that period just because we implemented a few lean practices, and it’s been going up consistently ever since.”
One of those practices, Sutton says, involves a daily all-staff “huddle.” The 15-minute meetings—known as accountability huddles in lean methodology— are designed to bring leadership up to speed on where everyone on the team stands with their work. Such a tactic helps teams find solutions to any problems or barriers hindering progress, Sutton explains.
If someone isn’t keeping up with their PMs, for example, “that’s where we’re going to talk about it,” he says. For instance, “I’ll say, ‘If there’s something preventing you from making progress, tell us what those barriers are. Tell us what we can do to help you reach your goal.’” The purpose of the huddles is not, however, to “chastise people” for not completing their assigned work.
“We recognize that things come up—that sometimes a PM that is supposed to take an hour actually takes four hours because there’s a problem you need to fix. If that happens, well maybe we can offload some of your work to someone else. Or maybe we can give you overtime or call the manufacturer for help. We’re going to figure out what tools we need to use to correct that shortcoming and keep moving [forward].”
Both Sutton and Hutchins say that “lean thinking” has led to measurable gains in their departments.WakeMed, for example, has a 27,000-piece inventory, and while checking the numbers one recent morning, Sutton saw that his team had a total of 140 open, unscheduled work orders—which, he says, “includes those awaiting parts, [those] awaiting vendor service, and pending equipment availability across three hospitals and over 160 offsite locations.”
“And for our ‘cannot locates’,” Sutton says, you’d expect there to be around 300 or 400 for a health system of our size. “During today’s daily check, we had 32.”
Likewise Hutchins says going lean has had a very positive impact lean on Arkansas Children’s Hospitals’ staff. “We haven’t had an employee injury in years, and at least part of that is because we don’t have any trip hazards—there’s a place for everything, and if it’s waste, we get rid of it.” The lean philosophy, Hutchins adds, has become so ingrained in his team’s culture that it’s rarely, if ever, discussed. “It’s second nature to all of us now. It’s really just become part of the system.”
Chris Hayhurst is a contributing writer for 24×7 Magazine. Questions and comments can be directed to chief editor Keri Forsythe-Stephens at [email protected].
Anyone interested in learning more about Lean in healthcare should begin by reading two books on the subject, says Dallas Sutton. He describes the first as “inspirational,” while the second he calls “very technical.”
1.Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience, 1st edition, by Charles Kenney, CRC Press, 2010.
2. Creating a Lean Culture: Tools to Sustain Lean Conversions, 2nd ed., by David Mann, Productivity Press, 2010.
A Lean Checklist
Key strategies used in Lean management include value-stream mapping, optimization of workflow, and a relentless focus on continuous improvement. Here’s a nine-point checklist HTM departments can follow as they apply the tenets of lean management to their own organizations.
- Assign leaders and secure executive support. Developing a lean culture must be a strategic objective with support from stakeholders across the enterprise.
- Seek input and suggestions from everyone in the department. Above all else, lean thinking emphasizes continuous quality improvement and a willingness to learn from mistakes. Staff must feel free to propose changes to processes if they believe there may be a better way.
- Think like a team. Instilling change across an organization requires doing away with professional silos. As you incorporate lean thinking into your systems and processes, be sure to work closely with customers, including clinicians and other professionals.
- Work on workflows. Look closely at all departmental and administrative processes and then refine workflows to make them more efficient.
- Whittle away waste. Use value-stream mapping to identify the root causes of waste, then implement countermeasures and reassess processes to determine if further changes are necessary.
- Aim for the top. Staff should be held to the highest standards of performance. Accountability—PMs done on time, for example—is key.
- Prioritize planning. Morning meetings and other planning sessions should be part of the process. Such measures save time, reduce work, and get results.
- Create a quality-management committee. The committee should supervise the quality-improvement process and track progress and results. Schedule quarterly or monthly meetings to share data with HTM team members so that everyone has a common “line of sight.”
- Automate where possible. After analyzing and reengineering workflows, consider whether certain technologies might improve processes even further.
Leaning Out Waste in HTM
The lean philosophy holds that eight types of waste undermine the value of the products and services organizations offer.
- Defects: A defect is a type of waste that results from omissions, inaccurate information, or mistakes.
- Overproduction: When an HTM department provides more services than are needed (by doing all PMs according to manufacturer guidelines, instead of developing alternative equipment maintenance programs, for example), it’s creating waste through “overproduction.”
- Waiting: This is the waste created when staff members stand idle as they wait to do their jobs. A lean solution may involve redesigning workflows so staff can remain productive throughout the day.
- Not fully utilized: HTM departments that don’t fully use the talent, creativity, and skills of their staff leave value on the table. One way to avoid such a fate: Delegate or automate tasks, when possible, so more experienced staff can focus on the specialized work that really allows them to make a difference.
- Transportation: Anyone in healthcare knows how moving people, equipment, and supplies takes up valuable time and resources. A lean approach to HTM might address this problem by reducing the need for transportation in the first place. For example, if equipment can be serviced on the hospital floor, that’s preferable to moving it to the biomed shop.
- Inventory: Inventory problems occur when there are more resources available than required to meet demand. Minimize excess inventory by only stocking what you know you will need until the next resupply.
- Motion: Lean organizations always try to minimize the steps required to complete any given task.
- Excess processing: The last aspect of lean-related waste refers to redundant and other non-value-added activities.
The most important thing to realize when it comes to lean management? Every HTM department can cut back on waste. No matter how “lean” an organization appears to be, there are always additional ways to improve.