Lakeview Healthcare (LHC) is a nonprofit, comprehensive health care system on the Eastern seaboard. It consists of four hospitals (over 1,000 beds), an ambulatory care center, physician offices, rehabilitation services, long-term care centers, home care services, physical therapy services, and mobile intensive care units. Lean has been implemented as part of a larger set of tools and initiatives to ensure quality and outstanding patient experience. It is viewed as an organization-wide initiative and part of a larger quality improvement strategy that predates Lean.
A new chief operating officer (COO) was a driving force in LHC's adoption of Lean as a means to reduce waste. LHC tasked its internal management engineers to launch and implement Lean. The management engineers began to implement projects (or "Kaizen events") within different areas of the organization. A Kaizen event brings employees together from various departments to examine a problem, propose solutions, and implement changes.
To implement Lean, the leadership first assessed what tools were missing from their toolbox to be able to achieve their goals in terms of people, process, and strategy. Lean was selected as a complement to Six Sigma to address an identified gap in tools targeting process goals. Senior leaders worked with an external process improvement consultant and LHC's management engineers to identify potential projects and collect initial data for those projects.
As part of a multisite study of Lean implementation, we conducted a rigorous comparative case study of LHC and several other delivery systems. At LHC, we selected five Lean projects for analysis. Two projects—(1) Bed Flow Value Stream and (2) Outpatient Medical Records and Patient Flow—were studied retrospectively after the work on the projects was completed, which allowed for longer term outcomes and sustainability issues to be studied. Three projects were studied prospectively as the work on the project was being completed to better understand specific project implementation strategies. Two of the prospective projects were not fully implemented or completed during the study period—Outpatient Electronic Health Records and Surgeons' Preference Cards. The third prospective project was a study of the construction of a hospital using Lean principles. In addition, we studied two specific process changes implemented at LHC's new Horizon Hospital to enrich our findings. A total of 67 interviews were conducted with 65 staff members at various levels in the organization between December 2009 and September 2011. Data were collected during three site visits through digital diaries recorded by Lean project participants and through phone interviews.
As part of Lean implementation and related efforts, interviewees reported that LHC has experienced improvements in organizational culture, employee satisfaction, and efficiency. Executives report a $29 million return on investment since 2000 when use of the external consultant's process improvement toolkit began. A portion of that return on investment can be attributed to Lean, which was introduced in 2003.
The LHC case highlights the importance of aligning Lean with the organization, having supportive and visible leadership, and including a multidisciplinary team in Lean projects. This case also points to the need for resources—specifically staff time, data, information technology, and Lean expertise—to implement and sustain Lean.
