the origin of lean principles
Lean principles is a concept that originated in Venice in the 1450’s although most attribute it to Ford and Toyota in the early 1900’s. https://www.wevalgo.com/know-how/lean-management/lean-management-history#:~:text=1991%20Birth%20of%20«%20Lean%20»,Womack%2C%20Daniel%20T.
This method is defined ultimately as the elimination of waste in processes that don’t add value to the industry. This can apply to any industry including healthcare. Lean principles was first implemented in healthcare in the year 2000. The goal was to eliminate waste both in product and process to facilitate a more organized business and ultimately a safer patient environment.
searching for the perfect process
There are multiple theories and ways to achieve the lean principles. Six Sigma is the one that I have seen in action up close and personal. They have 5 main goals that are promised to lead to perfection of execution. 
https://sixsigmadsi.com/the-impact-of-lean-in-healthcare/ There are two ways to approach this- the Six Sigma and the lean. One is metric driven and the other an incremental process that anyone can employ. Six Sigma combined the two.
Lean and Six Sigma can sometimes be confused. However, they are often used together in healthcare and other industries to make improvements. But they do it in different ways. Six Sigma, a metrics-driven system, is used to reduce medical errors and eliminate defects in healthcare delivery processes. Both methods aim to optimize operations and improve patient care. While Lean is focused on removing waste, Six Sigma focuses on decreasing defects to a particular statistical measure. The two systems have been combined to create “Lean Six Sigma,” a hybrid improvement process.
training to get lean
Like any diet, lean principles requires determination, will power and a change in lifestyle as well as mindset. These 3 things are paramount to success and sustainability. It takes a hard look at what is necessary vs. what makes us more comfortable. Kind of like choosing a salad over a plate of pasta. Both will satisfy the hunger.
It is never easy to take those first steps. It means having the ability to look ahead at the end game to recognize that the sacrifices you make today will lead to your ultimate goal.
trimming the fat
Prior to 2020 and the pandemic, the healthcare industry had identified the necessity to “trim the fat” in our age old processes. The costs of operation in the ambulatory healthcare field were staggering and not sustainable. These costs ultimately were handed down to the patients. Insurance companies were paying for less and less.
Time studies were performed to help determine where unnecessary steps could be eliminated to facilitate a more efficient way of operating. The littlest things became significant. For example, the placement of a printer. Moving this closer to the individuals would eliminate X amount of physical steps taken. (of course it didn’t help trim the fat from those behinds that remained seated).
We learned about using those plates of pasta as a tool to measure those steps. They were called ‘spaghetti maps’. This eventually promoted an increase in patient access.
One of the most difficult aspects of lean management for the industries to swallow is eliminating the extra bodies. I know an engineer whose sole job is to evaluate processes within a business and create a robotic equivalent that will perform the duties of a human. Thus saving mucho dollars in benefits, salaries and at the same time increasing productivity.
when less is more
Healthcare is a business. It is the business of taking care of people but at the end of the day it is still a business. It requires financial profit to succeed, experiences an enormous amount of loss of revenue that most businesses could never survive. The company that I worked for recognized this. They employed the Lean principles and integrated it into the day to day operations. The goal was to lead to a safer environment and an overall better experience for the patients.
They chose to not go the route of eliminating their employees but did seek for methods that would lead to more productivity and utilizing what they had instead of filling vacancies when they occurred.
That last one was the toughest battle. It is kind of like cooking. There are times that using less of something brings greater rewards. (If you’ve ever cooked with rosemary or tarragon you know what I am talking about). A little of a good thing can go a long way.
Determining that two people could do a job instead of four took some getting used to but we made it happen. As said previously, it is a change in process and mindset. This became blatantly apparent in 2020 with the pandemic.
Due to circumstances beyond anyone’s control we saw the healthcare industry tighten their belts repeatedly as employees became ill or in a lot of cases too frightened to show up to work. All of a sudden we saw these paired down numbers and a business running as lean as it ever had.
when the fat came back
Ironically, with COVID came the necessity for “extra” people. You had to have someone that could maintain a constant vigil of cleaning all surfaces. The time between patients was increased to allow cleaning and the mandatory resting time to allow the disinfectants do their job. All of a sudden our lean practices were tossed to the wind out of necessity and an abundance of caution.
Industries were encouraging employees that could perform their jobs remotely to do so. Meetings no longer took place in person but over a Zoom call.
We are on the other side now but businesses still are struggling to get employees on site. Those that worked remotely want to continue to do so. Employers have a huge job ahead of them.
a new day, a new way
It’s time for a new diet plan. Sometimes getting lean isn’t always the best thing for you. Losing too much, too fast may lead to rebounding. That’s where we are now. Like any new diet plan it requires a good hard look at where you are and what is attainable.
My suggestion would be to take a look at what you really need to operate. Those employees who won’t return and want to remain remote? Maybe that is where they need to stay…without you. You at least need a method to determine productivity and what value if any they bring by remaining home.
Zoom meetings are great and can really cut down on costs of travel. However, I would propose that the in person, human touch can have value as well. At least face to face you know that you have their full attention without the distractions you can’t see behind the camera.
Finally, do your homework. Are you operating efficiently with less? Is that plate just as satisfying without that little extra shake of salt? It may be that making these changes now will avoid leading to a fat mistake later.
Sassaleeyours…