You may have heard of companies flipping traditional management styles and placing more emphasis on continuous improvement and efficiency. Such trends are founded in a management system known as Lean, which was largely derived from automotive manufacturer Toyota Motor Company. In recent years, Lean has gained traction in far flung fields, including healthcare. (Mayo Clinic 2013)
One of the major focuses of Lean systems is the reduction of waste—from wasted product to wasted human potential. In Lean philosophy, these are categorized into 8 separate types of waste. Medical practitioners across the country are joining the movement to improve efficiency and increase the level of care they provide by ridding their hospitals and practices of these 8 wastes.
The progression of Lean management in healthcare is leading toward telemedicine, a game changer when it comes to eliminating waste from your practice. I have seen myself how telemedicine and Lean management go hand in hand. Let’s talk about each of the 8 wastes and then dive into a case study to see exactly where telemedicine can take us ever further in the effort to improve our care by eliminating wasteful practices.
First, though, let’s clarify what is meant by waste. A key focus in Lean philosophy is how much the customer values the product. In healthcare, that translates into how much value a patient places on the care they receive. A waste is any activity that does not add value. As you eliminate waste, you ensure that your resources are being used in a way that maximizes your patient’s satisfaction. Waste can broadly be divided into the following 8 types:
Simply put, overproduction refers to doing more than is necessary or doing something sooner than is needed. A common example of overproduction in healthcare is doing more diagnostic procedures than are needed. Overproduction can be costly and can end up adding to all the other forms of waste.
Defects refer to the time lost when a mistake or error is made. You lose additional time inspecting for errors and then correcting any you find. Defects can happen at any level in a medical practice. A missing tool, an incomplete patient record, or an early discharge from the hospital are all examples of defects. A study conducted in 2013 found that among seriously injured or ill children treated in rural emergency departments, physician-related medication errors were significantly reduced when the patients had a telemedicine consultation (Dharmar et al. 2013).
Long wait times are a problem for patients and providers alike. Spending a long time in a waiting room may diminish a patient’s value of the care they receive. As a doctor, waiting for tools or supplies is a waste of your potential. Over and over, the use of a telehealth solution has shown to reduce the amount of time waiting, both for the doctor and the patient.
Transportation can include the movement of products or people. Patients travel to and from your office or are moved between different areas in the hospital. Supplies or equipment are also moved to and from various sections in a practice or hospital. The potential of telemedicine to reduce this type of waste is large, as can be seen in a study conducted of the University of California Davis Health System. This study considered records of telemedicine consultations from 1996 to 2013 and found that they had resulted in a saving of 5,345,602 miles of travel for the patients involved. (Dullet et al. 2017).
Motion refers to the physical movement of employees. This includes when you move from room to room or even bend or twist to reach an instrument. A nurse sustaining an injury while helping a patient from a wheelchair to a bed is an example of motion waste.
Telemedicine almost entirely removes motion waste because the healthcare providers can set up their workstations in a way that is most conducive for them, and then the patients are “brought” right to them through the technology. When some of your practice is conducted through telehealth, this also frees up your other staff to continue to serve your other patients.
Over-processing involves any processing activity that does not add to patient value. A good example of over-processing in healthcare is the creation of reports that no one else will ever read.
Your inventory becomes wasteful when you have more supplies than you need. Lean philosophy urges us to minimize our inventory by replenishing supplies as they are used, rather than attempting to predict how much we will need for a given time in the future.
8. Human Potential
This final waste is a more recent addition to Lean philosophy. It includes anything that does not fully utilize the human potential of employees. One example would be not listening to an employee’s suggestions or concerns. At that point, you are not utilizing their capacity to problem solve or think creatively. You can see how Lean management works to eliminate this type of waste in this article about a hospital using a team of employees to streamline efficiency.
Now let’s examine a case study in which telemedicine was used in a way that eliminated some of these wastes for healthcare providers. In 2014, the American Journal of Managed Care published an article that described the use of a telemedicine system to provide after-hour care to over 350 patients via video conferencing. Those patients stated that without this remote care, they would have gone to an emergency room.
When you consider this scenario, you see that it reduced or eliminated several potential wastes. First, emergency rooms represent limited resources, including facilities, diagnostic tools, and employees. Those resources are there to handle emergencies, but are often overused when patients are unable to see their normal provider, such as after hours. Hence, we can end up with overproduction, using more resources than is necessary to serve the patient’s non-emergency problem. Having the patient use a telemedicine service after hours for non-emergency services prevents that overproduction.
The patient can also receive that service in their home, reducing transportation waste. Nurses, doctors, and other employees who might have been involved in the patient’s care had they gone to the emergency room are spared the motion of treating that particular patient. When you consider the time and effort it takes to process a patient in the emergency room, as well as supplies such as paperwork and equipment involved, you can see that the telemedicine visit also reduced over-processing and inventory waste.
As you can see, telemedicine has an incredible capacity to eliminate the 8 wastes. As more practitioners embrace both Lean philosophy and telemedicine platforms like OrthoLive in their practices, I think we will see an increase in how much patients value their care, which leads to return visits and referrals that in turn lead to new doctor-patient relationships. All of this helps to build your practice and improve the level of care you are able to provide.