What is LEAN?

"Lean is about improving quality and productivity."

According to author Mark Graban (Lean Hospitals, 2009), “Lean is about looking at how we do our work and figuring out ways to improve how that work is done. Lean is about improving quality and productivity. Lean is about learning to fix problems permanently instead of hiding them or working around them.”

Lean has its roots in the automotive industry, with Henry Ford’s moving assembly line, implemented to eliminate wasted motion. Even during this time, Mr. Ford noted that hospitals could learn from his principals, noting in 1922, “In the ordinary hospital the nurses must make useless steps. More of their time is spent in walking than in caring for the patient.”

After World War II, Toyota developed their “Toyota Production System” (TPS) to improve quality, while increasing productivity and reducing costs. While Toyota did not call this system Lean, it is widely agreed to be the precursor of current Lean efforts, demonstrating less use of space, less labor effort, less capital, less inventory, less defects and less safety incidents.

History of Lean at UT Medical Center

In 2006 the hospital’s senior management was approached by a graduate of the Physician Executive MBA program at the University of Tennessee College of Business Administration (CBA) suggesting collaboration between the College of Business Administration and the Medical Center that would further the organization’s mission through Lean principles. The management team embraced the concept and proceeded to work with the CBA to strengthen operational processes through the application of Lean concepts, tools and management prescriptions.

A key part of this Lean journey was the appointment of the Chief Nursing Officer and Chief Operating Officer serve as executive champions. In conjunction with the CBA, 120 vice-presidents, directors, managers and physicians have been formally educated regarding Lean. As a condition to training, the individuals signed an agreement to conduct improvement events.

In addition, staff have been realigned to provide for coordination. A process engineer was hired out of a manufacturing setting to provide experience in practical use of Lean. A “Lean Toolkit” has been developed and posted on the medical center’s intranet site to provide tools for use by staff. Lean teams provide progress reports regularly to management and the Board of Directors.

The following are important principals that are integral to the success of Lean:

• How can we simplify, combine and/or eliminate processes or steps in the process to improve flow?
• Value-added is always determined from the patient’s perspective.
• Every process should be focused on adding value to the patient. Processes should flow for the patient.
• Standardize work and processes.
• Anything that does not add value is WASTE! Eliminate waste.
• Aim for perfection; don’t settle for benchmarks. We should always strive to improve.

Goal of Lean at UT Medical Center

The goal of Lean implementation at UT Medical Center is to improve processes and outcomes, increase capacity, reduce costs, and increase satisfaction among our patients, providers and staff.

Outcomes of Lean Projects at UT Medical Center 2009 - 2011