Traditionally, health care professionals think Lean Six Sigma, a system for removing waste and identifying and correcting problems, is just a tool for manufacturing and not applicable to our industry. I see it differently. Perhaps it was my early background in manufacturing operations. But now that I'm in a leadership role at Florida Cancer Specialists & Research Institute, the largest privately owned oncology practice in America, I'm fascinated with solving problems and improving broken processes throughout our operations.
And the principles of Lean Six Sigma, which I learned early in my career to improve manufacturing operations, have become a guiding leadership philosophy for me.
Health care and manufacturing have many similarities. In health care, we have inventory; we have messy workspaces; we need to optimize the downtime with our key drivers of revenue; and we move people through complex care sites that rely on many people and processes to operate effectively, both independently and together. If these processes are not effectively operated, we will create problems.
And to improve the patient experience, these problems will need resolving.
For example, at Florida Cancer Specialists & Research Institute, we examine patient wait times very seriously — and strive to find the underlying factors that create longer wait times so that we can find the best solutions. Moving faster through patient encounters makes logical sense, but it doesn't work for patients or providers. The real solution isn't to move faster, it's to move smarter.
As it turns out, cancer centers tend to be especially busy from 10 a.m. to 2 p.m., and specific days of the week are correspondingly busy. Traditionally, we are very busy on Tuesday and continue to get busier throughout the week — until there's a sudden, dramatic drop-off on Friday. In order to move smarter, we first need to balance out appointments Monday through Friday to deliver a more predictable experience for both patients and providers. After that, we can begin to even the patient load throughout each day.
“The real solution isn’t to move faster, it’s to move smarter.”
As we balance schedules vertically, we can deliver a consistent and predictable experience for our patients. That balancing, though, is based on the capacity to treat patients. You can have 15 patients show up in a given time slot, but if you have only two lab chairs, you will create bottlenecks in your process. You can do one of three things: add chairs, add employees, or better manage the patient flow.
Making these changes either solves the problem or creates a new bottleneck in the care delivery workflow. Being able to understand all the pieces in the care delivery chain is akin to moving inventory through a manufacturing plant. Small variables — such as having only two chairs available — can add up and result in a large impact on our patients.
Lean Six Sigma: A tool for good leaders
This is where Lean Six Sigma comes in. Lean Six Sigma methodology relies on a collaborative team effort to improve performance by removing waste. At its most basic, Lean Six Sigma is a framework to examine problems and correct them through trial and error. Success through repetition makes sense to me, because I enjoy the process of slowing things down to move ahead in a methodical manner.
Still, I would argue that Lean Six Sigma is actually more important as a leadership philosophy. A leader should naturally bring collaborative teams together to solve problems, should be transparent by defining the process to solve problems, and should uncover the operational metrics to define the problem and define what success looks like.
The framework for Lean Six Sigma provides a five-stage approach to iterate and fix processes that are not working. But as a leadership philosophy, it becomes a tool to solve broken processes. Solutions aren't dependent upon one person or the leader with this philosophy. Instead, they can happen independently throughout the organization.
The stage of Lean Six Sigma
- Define. What is the problem we are trying to solve? What is the goal of our project? When you define something clearly for your team to improve or accomplish, it sets a clear path for others to follow.
- Measure. Collect and gather as much information or data points as needed to make smart decisions. The more data we have at our disposal, the easier it becomes to help define the scope of the project for others.
- Analyze. How do we determine and verify the cause-and-effect relationships when we change the variables? As leaders begin to implement change, we must be aware of how that change affects the organization — either positively or negatively.
- Improve. This is the tinker phase, during which we change variables to measure the impact on the process. I like to think of this as the iterative phase or the “fail small" phase of achieving a desired outcome. Pilot programs fall into this phase. Leaders need to learn from their mistakes and create an environment where constant innvoation and improvement flows throughout the organization.
- Control. Once you have an efficient process or workflow, how do you ensure that it remains optimized and running smoothly? How do you recognize when the processes begin to deviate from the optimal state so they can be course corrected before turning into bigger problems? Our ultimate goal, as leaders, is to creating an environment in which evidence-based learning from failure and constant improvement is the norm.
Whenever I look at a good leader, I see a person who defines a problem, measures it, fixes it, and makes sure it never happens again. Good leaders make decisions based on available information that proves or disproves a problem. The five-step methodology of Lean Six Sigma provides leaders with a philosophy to troubleshoot problems, to move an organization cohesively toward a mission and vision, and to earn employee loyalty.
Lean Six Sigma helps me understand the 30,000-foot view and, at the same time, allows me to focus my energy on the 5,000-foot view. I can understand how all the little details in a process or workflow, which are easy enough to overlook on their own, impact our larger strategic goal: delivering the highest quality patient-centered oncology care.
Jeremy Behling is the Division Vice President at DaVita Kidney Care
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