Many of the articles on the Lean Healthcare Exchange discuss the critical steps required for transforming the existing culture of a healthcare organization into an entity that continuously includes the Lean concepts and tools into regular work.  Important transformation strategies such as Lean tools training, establishment of model areas, daily management practices and the use of A3 problem solving are all vital to creating a Lean army of engaged practitioners in your organization.  We all recognize that the journey to a Lean transformation is a unique challenge, requiring both significant time and energy.

We must remember that the Lean concepts and tools can also be valuable when we choose to focus them on a specific strategic challenge.   Organizational transformation is always our IDEAL state but the point application of Lean along the way provides an excellent opportunity to showcase the value of the Lean mission.

LeanHealthcare_ImagingValueStreamI recently worked with an organization that demonstrated the potential value of this stand-alone capability.  A medium size healthcare system was facing a critical problem.  Their fleet of more than 200 pieces of diagnostic imaging equipment (X-Ray, CT, MRI, Ultrasound equipment) was aging and in some instances, not anticipated to be compliant with future expected safety requirements.  Maintenance costs on this equipment exceeds $600,000 per month.  However, the replacement cost of the aging equipment is very large and system leadership has some data that indicates that the existing equipment is not being operated as efficiently as possible.  Is there an opportunity to use Lean thinking to improve imaging operations such that the savings achieved would at least partially fund the replacement of the existing equipment?

Operational assessments of the existing equipment, focused on identification of waste in imaging operations, highlighted a number of potential opportunities:

  • Poor equipment utilization: Based on the current level patient demand, an analysis of data reflected that a significant number of pieces of equipment were drastically underutilized. A five-whys style of inquiry showed that extra equipment was in place for a number of reasons including: poor equipment reliability, less than optimal machine accessibility and uneven patient demand.
  • Lack of standard protocols: Due to differing diagnostic protocols, some routine procedures required significantly longer machine times at some locations than at others. Standardization of protocols could offer higher capacity on some machines, reducing the need for other partially utilized equipment.
  • Sub-optimal imaging workflows: Many of the imaging operations assessments indicated that significant opportunities exist to increase machine usage by improving imaging department workflows. Delays due to scheduling issues and patient readiness issues were observed.  Observations showed that these issues typically compromised machine usage within the imaging departments.  In addition, some assessments indicated that problems in scheduling and processing patients were likely reducing the number of repeat customers.
  • Imaging Technician training: A significant opportunity was identified during assessment work to improve the overall operating performance through improved technician skills training. Creating a larger pool of cross trained radiology techs was identified as an important opportunity.

Overall, the assessment work identified that a plan to address these opportunities could provide as much as $6.5 million in annual savings. A road map to the ultimate savings goal is now under development and an improvement team, that includes significant outside resources, is now identified.

Strategic challenges like this one can provide a fantastic opportunity to demonstrate to your organization the rationale for your larger scale transformation effort.  Linking the Lean effort to a significant strategic goal, such as updating diagnostic imaging equipment, provides a real and tangible platform for change.  Last but not least, the savings achieved through these targeted Lean efforts can provide much needed funds for specific needs.


Dave Krebs, Senior Manager for Lean Healthcare and Process Improvement at HPPToday’s blog was written David Krebs, senior manager with HPP.

David oversees various HPP projects and Lean Healthcare projects for clients throughout the United States.  David is also a licensed Professional Engineer in the state of Tennessee, with more than 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissan’s “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame. 

Photo by liz west/cc by

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