Teaching Lean Thinking in HIM

In the June print issue Robert James Campbell writes on applying lean thinking techniques to healthcare. The process improvement technique can be used to identify and eliminate waste in any activity. Campbell, an assistant professor at East Carolina University in Greenville, NC, teaches the lean thinking technique to health services and health information students. Here he shares one project in which students reengineer a patient transfer process using lean thinking.

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As healthcare expenses continue to erode household, government, and provider budgets, the industry needs better methods to reduce the cost of care. One tool that can increase efficiency and value is a change management technique called lean thinking.

Lean thinking is based on the Toyota Production Model and is built upon five steps to identify and eliminate waste: value, value stream, flow, pull, and perfection. The ultimate goal of lean thinking as applied to healthcare is to provide services and products that add value to the patient by improving care in the most efficient manner possible.

Lean thinking can also be used to implement technology within healthcare. A leading reason why so many health IT projects fail is because organizations do not perform a workflow analysis.

Workflow analysis examines how current processes are performed and then reengineers those processes to make them more efficient. When health IT is overlaid on efficient processes, chances are greater that healthcare professionals will adopt and use it on a daily basis.

Watch, Assess, Reengineer

At East Carolina University we use a video simulation of a patient transfer to teach health services and health information students how to use lean thinking to perform workflow analysis. The simulation was created by the College of Nursing’s Video Simulation Laboratory and produced by a former emergency room nurse and a former director of a neonatal intensive care unit.

The simulation depicts an infant undergoing a Norwood procedure and the subsequent transfer of the infant from the surgical theater to a neonatal intensive care unit. Throughout the whole process, the nurses and medical and nursing students in the simulation make errors; for example, they contaminate the sterile field and fail to perform a proper SBAR. It is up to the health services and health information students watching the video to detect the errors and reengineer the transfer process to eliminate them.

Students use each step in the lean thinking model to create what is known as a future state. The future state represents how the process will be carried out once appropriate changes have been made. Students also consider how health IT can be used to record important patient health information and make the transfer process flow more efficiently.

The video simulation serves two main purposes. First, it provides students with a visual depiction of a clinical process and the ways a process can be performed incorrectly. This provides students with a mental picture of the process, which allows them to manipulate the process in their minds and think of ways to improve the process.

Second, the video simulation allows students to work with the techniques associated with lean thinking and workflow analysis in a nonthreatening and safe environment. No one will die if the students don’t get the transfer correct the first time.

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