Reducing Waste and Improving

Health Care Processes Through

the Application of Lean
Sheri Eisert, PhD
Associate Professor
University of Colorado Health Sciences Center
Director of Health Services Research
Denver Health
9/27/07
AHRQ Annual Conference: Improving Health Care, Improving Lives

This project was supported by the Agency for Healthcare Research and Quality under IDSRN
Contract No. 290-00-0014,TO #11.

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Purpose of Lean Implementation
 Continued rise in health care costs and uninsured.
 Reduction and uncertainty in health care resources.
 Workforce shortages.
 Need to improve patient safety/quality.
 Silos of care and communication.
 Almost every health care process includes non-value
added activities.
 Lean philosophy and tools can be readily understood by
all employees.

Was driven by healthcare system leadership.

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 Scope of Lean Implementation
 Place: Denver Health, an Integrated Safety Net
Healthcare System
 1- 500 Bed Hospital
 8 Community Health Centers
 Over 4,000 Employees

 Timeframe:
 June 2005: Pilot in OR
 October 2005: 5 Systems Areas
 June 2007: 14 System Areas

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 How Lean Implemented?
 Executive Staff assigned to system areas or value streams.
 Lean Facilitators assigned to value streams (3 FTE then 8
FTE).
 50 mid managers and clinical personnel Lean trained as
“Lean Belts”.
 Projects identified by mapping the flow of a value stream.
 Rapid Improvement Events (RIEs), where teams of 6-8
people map scope of process, eliminate waste in process and
pilot new process during this week long event.

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How Impact of Lean Evaluated?
Three levels of metrics:
1. System -readily available such as Net Revenue, Employee
Turnover, Medication Errors, Patient Satisfaction, Patient
Volume
2. Value Steam -related to healthcare system area such as
divert rate for the hospital, clinic visit cycle time for
outpatient
3. RIE -specifically identified for a particular process such as
reduced patient waiting time in surgery clinic, decrease in the
amount of time from patient discharge to bed cleaned and
reduction in OR overtime.

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 Results of Lean Implementation:
From October 2005 –July 2007
 94 RIEs implemented.
 395 employees participated.
 $8.1 million in reduced costs/increased revenue
($3.5m in 2006, $4.6m in 2007).
 Examples of improved quality of care:
 Diabetic Foot Exams: 14% to 24%
 Recovery Time: 210 minutes to 134 minutes
 Antibiotic within 60 minutes of incision: 80% to
90%

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 Business Case Considerations
 Accounting for indirect implementation costs
such as the opportunity cost of employee time
in RIEs, Executive staff time, data analysis.
 Controlling for outside market and regulatory
factors that may impact metrics.
 Return may not be realized until a year into
implementation.
 Reducing waste and improving quality of care.

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 Lessons Learned
 Necessary to implement many projects for their to be a
tipping point.
 Identifying and defining metrics linked to process
change is challenge for operational staff.
 Important to establish infrastructure for evaluation with
system redesign
 Quantitative evaluation not rigorous research –lack of
controls and randomization.
 Physician participation a challenge.
 Lean tools needed to be adapted to the healthcare
environment.

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 Knowledge Transfer
 Lean in Healthcare National conference targeting
safety-nets supported by AHRQ small conference grant
(2005-06).
 Participation in Lean activities by Denver City
Government and Denver University.
 Site visits by Commonwealth Fund and Singapore
Government Officials.
 Partnership with DH, consultant and NYCHHC.
 Presentations at IHI, NAPH and locally.
 Publications in Industrial Engineer and Academic Medicine.
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 Next Steps
 Expand knowledge transfer to Healthcare Lean
Education Institute.
 Continue implementing RIEs, while improving
defining scope of process improvement and
metrics.
 Continue monitoring impact at the 3 levels.
 2 articles under peer-review and national and
regional presentations.

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