Getting lean Featured

8:00pm EDT October 26, 2009

For every business seeking marked improvements, there are scores of management theories awaiting their consideration. Every few years a new solution, buzzword or fad surfaces — from management by objectives, matrix management and total quality management to reengineering, quality circles and even Dilbert’s principle, based on the popular cartoon character’s musings on how to better the workplace.

While theories grow and wane based on their real-life contributions to better management and workflow, one that is appearing to stick is the “lean” concept, a term describing Toyota’s decades-old industrial principles now embraced by many manufacturing companies.

Lean processes are emerging as a significant factor in the delivery of health care services. To learn more, Smart Business turned to Barry Arbuckle, Ph.D., president and CEO of MemorialCare Health System and past chair of the California Hospital Association.

Why is health care turning to lean concepts?

Health care organizations are facing declining reimbursement, escalating costs and a continual demand for increased value, quality and outcomes. The lean approach — when well understood, planned and executed — can add value to those we serve while minimizing waste, eliminating errors, utilizing fewer resources, reducing unnecessary costs and increasing throughput. It provides a meaningful pathway for continuous and prolonged improvements in streamlining processes and improving the quality and efficiency of care delivered to our patients and communities. Patient satisfaction can rise significantly as well.

How does the lean process impact staff?

The lean management philosophy is designed to create a sense of purpose, team problem-solving and long-term thinking by proactively engaging employees, physicians and patients in lean workshops that redesign patient care from the ground up. This significantly reduces redundancies, simplifies processes of providing care and standardizes the workplace environment, while also breaking down bottlenecks and miscommunications.

By implementing lean methodology, we successfully remove barriers experienced by staff as they care for our patients and their families.

What happens in the workshops?

During five-day workshops, participants use a Rapid Process Improvement theory to methodically and rigorously reengineer work processes. This helps to accelerate improvements and produce dramatic reductions in cost and time associated with the countless processes found in the health care setting. We also focus on Rapid Process Design that, after another five-day workshop, results in implementing new or dramatically redesigned processes.

Our Focused Improvement Workshops replicate successful programs from one area into multiple locations throughout our organization. The ideal lean system process designs simple, effective systems, recognizes that there is always room for improvements and continuously enhances the system design.

Can you provide examples of how lean works?

At Saddleback Memorial Medical Center, workshops helped participants identify ways to successfully remove waste and redundancies throughout the processes of scheduling, registration, exam and result report turnaround time in outpatient imaging. Patients now move more smoothly through the system and receive diagnostic results sooner. Lean implementation within the Saddleback Memorial Medical Center’s surgery and patient care units improved time in accessing medications and supplies. At Orange Coast Memorial Medical Center, the workshops resulted in inventory controls that ensure equipment and supplies are available in the right place, at the right amount and at the right time. Our teams created more user-friendly workspaces that support smooth patient flow with reduced wait time. At Long Beach Memorial Medical Center, process improvement impacted patient flow, reduced the number of process steps and distance traveled, thus allowing staff to spend more time on care at the bedside.

Where else have you seen improvements?

There are myriad examples, including improving efficiencies in the discharge planning process for patients discharged to a skilled nursing facilities and reducing the turnaround time for physicians and nurses to receive results when patients have their blood drawn. One of the best outcomes is the impact on the morale, pride and engagement of our staff with 100 percent compliance in sustaining the changes that employees, physicians and patients have helped design.

How has it impacted your bottom line?

In one year, we were able to eliminate 123 unnecessary process steps, make 1,302 square feet available and reduce the distance staff travels in carrying out their responsibilities by 730 miles. Return on investment during this fiscal year should reach $3.8 million, rising to $17.2 million over the next three years. This helps us curb rapid escalating health care costs and notably improve care of our communities. MemorialCare Health System, a lean process innovator in the health care industry, offers expertise to help others adopt these principles into their own workplace.

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers ( and past chair of the California Hospital Association. Reach him at or (562) 933-9708. MemorialCare Medical Centers include Saddleback Memorial Medical Center in Laguna Hills, Orange Coast Medical Center in Fountain Valley, Long Beach Memorial Medical Center, Miller Children’s Hospital in Long Beach and Saddleback Memorial Medical Center in San Clemente.