Thursday, August 26, 2010

Lean Hospitals Drive Profits and Productivity But Leave Questions Pending Regarding Patient Care

I'm having a hard time embracing the idea of Lean Six Sigma in a healthcare setting. After reading the book Lean Six Sigma For Service I am still convinced that there are no short cuts when it comes to patient care and services. Although many say this book provides clear ideas on how to apply the concept in a healthcare setting, and although there are testimonials on the Internet regarding hospitals that turned around due to implementing Lean and Six Sigma thinking, (yes, they are two separate concepts) I have not been convinced there is anything more to this than good old common sense and perhaps an underline beneath the idea that the hospital should operate as a business.

There is an age old question that many shy away from answering-is the hospital providing a service or is it a business? I still cringe when I overhear the opposing viewpoint that hospitals are businesses and are entitled to turn a profit. I respect that viewpoint, however, in all honesty, it negates the roots of the healthcare industry. Every major hospital began with the idea that the service should be offered to those that could not afford the care, or just plain and simple, needed medical attention. What a clever idea-offering a service to those that are in need of it, as opposed to a business where you try to convince your consumer that they need what you have to offer. When a hospital is identified as a business, healthcare professionals will do whatever it takes to drive profits north, sacrificing the patient in the process. Because, after all, stockholders must remain happy with their shares, eliminating the debt within the business becomes priority, and the consumer is nothing but a pawn used to get these jobs done.

"Lean Six Sigma for services is a business improvement methodology that maximizes the shareholder value...." Does that reasoning, taken directly from page 6 in Lean Six Sigma For Service, have any place in the healthcare industry? This mindset promotes productivity-getting more done quicker-for the sake of the shareholder and that is where the patient has gotten lost in the system. When a hospital is viewed as a provider of healthcare service, being efficient is still part of the equation because doing a job quickly while eliminating errors is in the best interest of the patient and hospital. There needs to be that balance brought to the "methodology" while contemplating healthcare and Lean Six Sigma. It can't be a decision between shareholder or patient-and if it becomes that, I hope the decision leans in favor of the patient.

St. Luke's Hospital is excited that Lean helped them treat heart patients more effectively. "Studies show us time and again if you walk into the emergency room with chest pains there’s a 90-minute window where you get the best outcome … This lean system has helped us hit that target every time now for 10 months." No hospital worth it's name would allow a heart patient to wait in the Emergency Department without immediately providing basic treatment. If ED's are still that negligent and slow, there is a triage issue but not necessarily a Lean issue. This is not a firm argument for Lean Six Sigma in the healthcare setting.

I'm not saying hospitals shouldn't concentrate on greasing their system to insure patients get care as quickly as possible. I'm not saying that thinking in terms of good business practices (like cost reduction, error proofing treatments ect) is a bad thing. I do believe there is an error in judgement when you make the conscious effort to place your shareholders higher than your patient. What if law enforcement, firemen and our military began talking in terms of "profit, shareholder value, and business methodology"? It seems like a contradiction when these are primarily thought of as public servants. If the local ambulance service decided to cut back on service days because of the cost of fuel, many patients would be in trouble. There is a time and place for thinking in terms of business related profits and shareholders, but my belief is that the healthcare industry is not the time or place. Hospitals can make a profit-I'm not opposed to that. But when a profit becomes more important than the patient, that is when the objective needs to change.

A service structure that places the emphasis on the patient seems to be smoke in mirrors. Many healthcare institutions claim the patient is high on their priority list but when I see the emphasis on the happiness of the shareholder through programs such as Lean Six Sigma in the healthcare setting, it saddens me. I believe within the healthcare crisis, among the conversation of offering care to those that need it, there is too much talk of funding the care in terms of turning a profit-not necessarily funding the care in terms of meeting costs. There is more than enough money in our country to fund good care-think St Judes Hospital that operates entirely from private contributions. Our healthcare system is as sick as the patients it endeavors to treat, but trying to fix that system by turning profits is a mistake. A mistake that I believe has sacrificed the patient as well as the American way of healthcare service.

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