By Daniel Littlefield

A hospital in the southeastern U.S. was facing significant challenges in its radiology department. Workflows had been designed to accommodate each functional area separately and as a result, wait times for MR exams were 180-plus days, while at the same time, scanner utilization was less than 35 percent. Employee morale was low, patient satisfaction scores were low and the department was bloated with inefficiencies.

Department leaders knew they had to do something different, so they shifted their approach by implementing lean methodology into all facets of their department’s processes.

Lean thinking requires managing the array of processes within a value stream, not the function itself. A lean organization uses the voice of the customer to drive operational decisions and designs, and to guide the flow of the work in a single direction using the shortest distance. Lean works by integrating the right amount of resources at the right time at the highest quality to provide what the customer needs, the right way, the first time. Using real-time performance measures and visual cues to make succinct, accurate information available, it dramatically reduces or eliminates wait times.

In the case of a radiology department, the value stream includes processes such as registration, performing the test, producing test results, and communicating those results to the ordering physician and the patient. And sometimes these processes are different depending on whether the patient needs an X-ray, CT, MR, or nuclear medicine test. After the department began incorporating lean processes through a rapid improvement event, it reduced its wait time by 70 percent and increased its MR scanner utilization by 60 percent.

Go with the flow
The lean mission is centered on waste elimination — identifying it, naming it and eliminating it — and it can be achieved in part by going with the flow. To improve flow, implement actions that create value without interruption, waiting, barriers or detours. Keys to making products and processes flow are co-location of employees performing similar functions, improvement of product quality, work level-loading and the elimination of batches.

For instance, say a technologist decides to batch process three images, and then put the results of the three patients in front of the radiologist. If the scanner takes eight minutes, and it takes 12 minutes to process each image, the first image will have waited 60 minutes before the radiologist sees it. It seems quicker to process several at one time, and it may be quicker for the employee checking off tasks on a to-do list, but a batched process is only quick for the last product processed. A better flow would be to process one image at a time and give it to the radiologist so the ordering physician receives results more quickly.

Here’s another example: Many hospitals use centralized scheduling. The scheduling staff have no expertise in radiology and use a template to allocate the amount of time for a test. If the hospital has not updated their scheduling template to reflect new scan times based on new equipment purchased, patients, physicians, radiology staff, and the scanner will have increased waste due to idle time. The list goes on. Fortunately, there are tools to help mitigate these obstacles and others like them.

Tools for getting lean
Organizations must fully commit to lean methodology (not occasional use of a lean tool) or risk falling short of achieving the performance improvement they seek. They must adopt lean as their operational model which involves integrating the use of the appropriate tool in a way that fosters continuous improvement.

• Standard work methods — assumes there is always a best way, maintains that a consistent process yields consistent outcomes, is meant to be improved and is developed by the people who do the work
• Continuous (single piece) flow as opposed to batching — decreases turnaround time, reduces potential error
• Balanced distribution of work
• Visual management controls — information sharing exposes abnormalities, prevents errors, allows for quick recovery, supports standardized work, eliminates waste, and encourages staff to surface and solve problems.
• Flexible operations
• FIFO (first in, first out) for orders and patients
• Error proofing: methods that help staff avoid mistakes
• Strong leadership

You can’t manage what you can’t measure
A lean process can create an environment that makes people uncomfortable. But it forces them to create and grow, too, which is why directly involving staff is vital. Organizations must measure the outcome of a process, but equally important is measuring how staff members conform to the new process. That will give you the “why” when overall results don’t meet expectations and something to celebrate when they do. No matter the results, organizations must be transparent with them to build a culture of trust where employees feel safe enough to bring up issues that aren’t working.

Visual management will help. Displaying metrics exposes abnormalities, and that is imperative to implementing the right change. You can’t manage what you can’t measure, and if you don’t communicate the metrics to staff, they won’t see the results and change their behavior.

In summary, lean is the creation of continuous flow and the elimination of waste in order to increase the value-added portion of the process. It’s a structured, methodical, systematic approach to solve complex process problems. Lean is more than a set of tools — it's a philosophy. Successful lean practitioners know that the whole system and structure of an organization must be aligned and plan organization strategy accordingly.

The southeastern U.S. hospital’s radiology department greatly improved its patient satisfaction and employee morale scores after employing these techniques, but this was only the beginning for this imaging team because lean organizations never arrive at a destination. There is no destination in lean methodology, only an endless journey of continuous improvement. Becoming lean is a process, not a destination!

Ready to lean in?

About the author: Vizient Inc. senior consulting director Dan Littlefield leads lean, process improvement, and transformational consulting engagements to improve patient throughput and clinical outcomes across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Ambulatory Care Clinics.