Lean. For a safe, fast and quality sanity

Imagine that, one day, a person who really likes sweets and chocolate, is said they are diabetic. They will have no choice but to stop eating sweets and chocolate. These news can catch as bad, or instead, see it as an opportunity to improve their lifestyle.

Public hospitals are «diabetic» suffer a hormonal disorder and eat too many sweets, but this disease will force you to change your lifestyle.

There is an unsustainable deficit in the health budget:

1. We spend many budgets
2. The current deficit does not allow us to maintain this level of spending ever.
3. The crisis does not allow us to increase the deficit, rather it forces us to cut it
4. The staff feel overburdened and discouraged because that money fails to provide the services in an appropriate manner
5. Or short-term or medium foresees a possibility to recover the salary expectation
6. Waiting lists are long and there is dissatisfaction among users
7. The current social situation, families have seen their income reduced and are not willing to pay more
8. Demand continues to grow by aging and chronic diseases increasingly

Faced with this situation of lack of resources, politicians have seen the alternative to ask for more money to the user (such as co-payment) .The temptation of politicians is to cut back on everything, and that means a great risk to health

Lean . It is time for a sensible option

Lean relates the concepts of  safety, quality, speed and efficiency . To provide safe, fast and efficient health services, we need far fewer resources than now. We lack resources are being drained within the system itself .

It’s like that diabetic person who can no longer eat as much sweet. It will take the opportunity to change lifestyle by changing your diet. But we can not cut it at random, but by reducing what your body does not metabolize and generates excesses and including minerals and salts necessary for the proper functioning of the body.

Improves safety and quality of care. You will need less money to provide the same service

We must differentiate between efficiency and effectiveness.

A sick that have been practiced two erroneous diagnoses, two interventions for complications in quirófan and survives, we can say that the clinical efficacy has been good. Instead the efficiency has been disastrous. They have spent many more resources than necessary to cure him.

Lean  to improve safety and quality split the patient no errors or treatment or diagnosis, nor suffer nosocomial infections. If we get this will not suffer complications and readmissions will not suffer as a result.

Get this sensible formula would increase efficiency and squandered those resources for other actions.

Mortality treatment errors in Spain amounted to 15,000 a year (mostly involuntary)

The biggest economic impact of medical errors is caused by people who finalmetne dies., Normally not be compensated in such cases comes from the survivors of these errors.

many resources are devoted to repair damage caused by these errors of the health sector.

Optimizes the use of shared resources

The vast majority of public hospitals agglomerating complaints about outpatient (about 80%) in which, at certain times of day agglomerations they occur. Several studies in these hospitals, the staff was very unmotivated and requested more support staff.

It was found that in many of these sites staff to breaks at the same time, clinical sessions at the same time, and began to visit at the same time. By changing these simple things, it diversifies and patients could receive better service

Removing non-value added activities. Remove duplications improving coordination and internal communication

resources by poor coordination and poor communication between services is wasted.

There are activities that do not add value to the patient. How unnecessary visits or expired presurgical tests.

If we take the example of unnecessary visits. If a medical service have to repeat the 20% of the first consultations done to make a therapeutic decision in the first test patient reportedly they are necessary. After the «second» first tests where therapeutic decisions are made will be made.

This means that 20% of visitors are duplicated, which does not add value to the patient and consumes resources of public health and could have been avoided proactively alerting the patient of the need for these tests from the doctor’s office primary and programming dates consistent with achieving results.

Removes downtime. Serve the fast admitted. You will need fewer resources

Waiting for patients admitted with acute diseases for care is dangerous and costly.

Patients hospitalized for several days waiting for them out tests or seek free operating rooms. Each physician income can cost around 300 Euros.

Simple communication of need for a test or request a role, often over several secretaries and various forms so that it can process and when they arrive aa providers need a half day to manage it, delaying stays in hospitals.

The same goes for handling high patient. If a hospital handled 20,000 a year high and middle can reduce the days of «downtime» in one patient, knowing that the opportunity cost is 300 € per day, said the hospital would need 7.5 million Euros less than a year to serve the same number of patients.

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This article is an excerpt from the editorial written by Rajaram Govindarajan in the journal MANAGEMENT CLINIC AND HEALTH Fall 2010.

Rajaram Govindarajan is an industrial engineer trained in India, Japan and USA, with work experience in the automotive industry both in Spain and in Detroit, USA He currently works as a consultant and freelance trainer for excellence in health management, applying the tools of » LEAN » such as process management, Value-Stream Diagrams, FMEA, SPC, Poke-Yoke, among others.

Rajaram’s Chief Auditor certification in nonprofit  SPG  and is a Professor-Collaborator of the Department of Operations Management and Innovation at ESADE, Barcelona.