Adoption of Lean Management in Healthcare Industry

In this paper, the changes in the healthcare industry including its process, practices and operations will be discussed. In past 10-15 years, it had changed a lot producing lots of medical advantages and enhancement in patient care.

This industry is also known as a medical industry, which is one of the world’s biggest and fastest growing industries (Leventhal, 2013). It is typically divided into many areas consisting of Hospital activities, human health activities and medical activities.

With the increase in demand for care, Healthcare systems are facing growing challenges where their financial conditions are not improving and in some cases, it is even worsening.

Over the past few years, this healthcare industry is adopting various management and industrial practices, which make their operations in an efficient manner. In every hospitality, the process of these operations was divided into several maps, which starts with the registration of the patient to its treatment. For managing these processes in an effective manner, various hospitals try to adopt the management practices of a well-established company. This helps them to reduce costs and improve quality, as the rising cost of healthcare is the biggest barrier to health coverage.

Therefore, to solve the problem of rising health care costs and service quality, many hospitals adopting the approaches of the Lean Management system which evolves from one of the prominent automobile car making company – Toyota Motors (Brandao de Souza, 2009). One successful example of a healthcare industry is at the Community Medical Clinic in Missoula, Montana.

It has been estimated that around 53% of US hospital adopted this approach, which leads to the enhancement of capacity, quality and safety while containing costs.

Lean Management Systems

This system is also known by its other name i.e. Toyota Production System (TPS) which was found in the auto industry by Taiichi Ohno in 1990 (Greeve, 2017). This was referenced to a Toyota model in which the management of the company faced manufacturing problems.

Later, this Toyota Production System (TPS) was evolved which serve as a tool for the knowledge and innovation. This all happen because of the lean principles, which include (Meiling , Backlund , & Johnsson , 2012) –

• Identifying the value of a customer.
• “Value Stream” Management.
• Increasing capabilities of flow production.
• Changing the mechanism to “Pull” for supporting the flow of materials at constrained operations.
• Make zero waste and promote perfection.

Lean is a multi-faceted approach, which makes enterprise to perceive several dimensions of the view. In 2006, it was implemented in the health care system and by 2009, most of the hospitals are almost using this approach. The waste in the term of cost and time also divided in to many ways like waiting time on information searching and materials, excess of unnecessary motions, transportation of information by mail, cart or foot travel, time spent of fixing defects (repairing of material or information) and producing of more information than the consumer requirement (Davis, 2009).

Many researchers think that lean is a tool, which can be used to improve the efficiency in the operations. However, it is not a tool and neither a system, Lean is a management style and approach.

With the help of lean management tools (TPS), many tools were also derived like value stream analysis, visual controls, root-cause analysis, spaghetti chart etc.

Disruptive Innovation and Technology

The most important tool of lean management i.e. value steam mapping defines the value from the consumer perspectives and map the various processes to bring common understanding which helps in finding the weakness that can be corrected (Martin & Osterling, 2013).

In addition, lean management can be called as the starting point of disruptive innovation in any industry, which can make a company take a faster pace in leading the industry with the help of innovation and creativity.

Disruptive Innovation and technology

“Disruption” is a process where small/new companies with fewer resources can able to challenges well-established businesses. Disruptive technologies have the potential to create a new marketplace by break through the usual product/technology capabilities and create a competitive paradigm (Armstrong, 2017).

Source: (Newbert, 2015)

The major benefits of disruptive technologies are (Ndubuisi, 2012)–

• Can create an immediate profitable environment
• Allow the business to quick entry into the competitive market
• Growth opportunities are high
• More capabilities in a shorter period of development.

In addition, various disruptive technologies which supports lean management and used in the hospitals are mention below –

Disruptive Technology in Hospitals

• Artificial Intelligence – It is an area of computer science where machines are programmed with various algorithms to learn and think like a human. In any business, implementation of AI can help in saving time and money due its automation process (Froese & Ziemke, 2009). It can also increase productivity through operational efficiencies. AI will be the most significant descriptive technology as it can handle and operate end-less amount of data with its radical computational power and advances in deep neural
• Various big hospitals are planning to use artificial intelligence to replace traditional task performed by nurses and doctors. In London, the ATI (Alan turning Institute) and the hospital made a contractual agreement for three years with the aim to bring the benefit of the machine learning (AI) to the NHS (National Healthcare Service) on a big scale. One of the simple tasks, which include diagnosing cancer on CT scans for analysing, which A&E patients are seen. Before it was done by the nurses but now it will handle by the AI algorithms
• Disruptive innovation in the Healthcare Industry (MAP)

The modern industries encountered the problem of the operations in the manufacturing process. To hold the position in the competitive market, an industry needs to stabilize its production process with the help of lean management and disruptive innovation.

The first step in this process is to identify the bottlenecks in the operation process and Value stream mapping gives a clear view of the information and material shows in the organization.

Below is given a flowchart of a hospital emergency room in a view of VSM (Value Stream Mapping) 

In the above flowchart, the patient is pushed into the system by the department of hospitals. The more time, the patient being processed in the system with the various elements i.e. Registration counter and nurse or doctor attendance, the more will be the havoc on the system. One of the problems can also occur if the doctor is not available or in the emergency room and so cannot attend to the patient.

System Description

This proposed system begins with the making the patient ready to be services into three groups. The first is through patient registration system where all details of the patient will be noted first and enter into the system so that patient historical data can be check easily. In the second or third case, the patient can be examined directly via a nurse or doctor.

The next stage will be started by the waiting area space or followed by ER room. The nurse can also attend the patients who are allowed to sit in the ER room for the first stage or initial check-up. Now, the nurse will start inspection patient problem and this check-up can transfer to a doctor for further examination.

With the direction of doctor words, the nurse can bring medical supplies so that doctor can treat in an effective manner.

Now, the next stage according to the flowchart will be departing instructions are given by the prescribed doctor and a nurse can assist the patient while his/her departure. Each information of departure will be listed in hospital records for later analysis.

Disruptive Technology in Hospitals

One of the significant aspects of this full system is the efficient use of the scheduling plan so that the patient has a steady glow to the door. In addition, the hospital map of the emergency room deals with the real human people and not with the hardware and so the acceptable amount of WIP cannot be evaluated.

Therefore, in the whole system, the flowing of information and materials in the emergency room are established in a systematic way starts from the patient registration to its departure and follow-up.

Suggested Future State

After the observation of the present state and identifying the bottlenecks, the first reaction can be the implementation of a pull system by replacing the existing push system. Using a large number of available elements for attending the patient can create large variation and this can affect the quality of care if not focused correctly.

For making this state more efficient, this can be applied in the industry:

• A pre-scheduled appointment can prove to be an effective solution. For this, hospitals can use the digital technology and allow users to book an appointment through just their fingers.
• All in-process inventories must be evaluated after the end of the day with the help of various advanced data management tools like ORG database, IBM and SAS Data Management (Shethna, 2016).
• In addition, there is a need to well-equipped all the key areas of the service map with the newborn technologies and those derived via lean management styles.

The intersection of healthcare and disruptive technologies will rise to various market opportunity (Crump, 2014). Various new strategies will be developed by the companies so that to disrupt the market with the innovative technologies.

Several disruptive technologies can be used in the service map of healthcare and some of these disruptive technologies are given below –

• IoT(Internet Of Things)
• AI (Artificial Intelligence)
• 3D printing
• Medical innovation
• Robotics
• Autonomous Vehicles packed with AI algorithms.

Now, it will be discussed that how these technologies can be effectively fitted into the organization.

IOT, which connects every element to the internet, can also help doctors to fill the gap of geographic boundaries, which separate them from the patient. A robotic system named as RP Vita relies on IoT help doctors by eliminating the problem of – how to visit more number of patients in less time (Hornyak, 2013). Many IoT devices are also manufactured which can be wear by the patient and the doctors so that to take up health issues on a continuous basis. It helps the doctor to track the status of health in real time and allow numbers of practitioners to monitors patients remotely and even patient can also self-monitor himself, which can reduce the cost of person (doctor or nurse) visits.

IoT even produces an innovation, which makes easier to capture data from various medical devices like respirators ad cardiac monitors, which were previously the biggest challenge (Ianace, 2015).

In addition, it helps in improving the overall efficiency of the hospital by deploying cloud-connected smart sensors, which also help to reduce cost in every stage of their operations.

In the above-given stream map, IoT can connect all the way of information flowing from every map of the emergency room.

The next innovation in the healthcare industry is in the term of AI (Artificial Intelligence) which has altered the face of hospital management. AI helps in improving medical records and treatment solutions by making possible to interact with the personal medical history (Agah, 2013). With the help of digital innovation, it is now more effective to collect, store and analyse the data, which leads to getting faster medical feedback.

System Description

For implementing AI in this service map of the emergency room, the most important places to set up within is the – when the doctor examines the patient when doctor treat the patient, patient history and vital analysis, and all in the alignment of the insurance firm.

Many hospitals also spend a lot of time and resources to build a good relationship with the customers and any of these services are basic in nature that can be done via technology. Model of CRM is significant for understanding queries of customers and providing correct responses relating to necessary sharing, appointment or certain other facts. In relation to solving all these problems, AI aided chatbots are intrudes which provide necessary solutions by using data of question and items (Marr, 2018). Therefore, healthcare industry needs to focus on building these knowledge libraries.

Other innovations in AI fields are – tracking of ital. stats of ICU patients, health insurance verification and decoding of lab result.

In the emergency room service map, AI can be used at various aspects like while diagnosing the patient, during the treatment of the patient and during the time of registration (Insurance verification).

The next other disruptive innovation will be known as 3D printing in the healthcare industry. It is also known as additive manufacturing and the concept was aroused in 1984. Global spending in 3D healthcare printing takes an upturn from last few years and the market will be expected to be worth of 1.3 billion by 2020. Future 3D printers can able to build various tissues and organs such as kidneys, hearts and liver with the help of bio-inks (Ventola, 2014). This will lead to saving on more numbers of patient lives as they will not have to rely on doctors for organ transplants. However, it is still a challenge today from printing inorganic material into living cells.

With relation to the service map, this technology can help by elimination one of the process in the row and that is the first time treatment of a patient by the doctor. As with the time, even nurse will able to easily operate this technology and the time can be saved and utilizes in the treatment of another patient from the side of a doctor.

Medical innovation in future can be in the direction of genetic editing, DNA testing, using of protein biomarker to screen cancer and more. This can help the doctors at the treatment stage (Consoli, Mina, & Nelson, 2015).

Using robotics also a part of changing healthcare system where robotic medical assistants can help in monitoring the patient vital statistics and alert the nurses if there any need for the human presence in the room. Also, this robotic application and algorithm can automatically enter the information into the record of patient healthcare. Various hospitals are started using robotic carts for moving various suppliers in the corridor and these benefits the doctors to conduct surgery with full focus.

Robotic personal assistants can help a lot and Japanese have taken the lead to build it. One of their machines is called Paro, which respond to the human speech and the other is humanoid which aid y personal care, socialization and training.

This technology can be used in all the areas of the service map and with this technology, hospitals can save a lot of time and cost. It can help in pre-stage of registration of welcoming the patient and note down the necessary details in the hospital server relating to patient name, address, type of disease, insurance verification etc. It can also be beneficial between the time of waiting and treatment by understanding more about the disease and symptoms. For supplying medicines and other material to the nurses or doctors, it will be helpful.

One of the last but most important disruptive technology, which can benefit the healthcare industry in many ways, is the autonomous vehicles. This project started 3,000 years later but in the science fiction movies but in reality, it creates a stand today. Autonomous vehicles include driverless cars, which can come in all sizes, shape, and create a hope of making life easier.

In the terms of health-care industry, these autonomous vehicles can have faster response time than the ambulances as normally; ambulances face many obstacles like driver behaviour of not obeying traffic rules, the daily route from patient to hospital and non-competent availability of tools to make inside treatment of the ambulance (Walker, 2016).

One of the most innovative disruptive technology, which can be used in personal life or in the healthcare industry (as of their interrelations), is the autonomous vehicles and ambulances.

From personal use perspectives, the rate of accidents can be reduced if one uses the power of autonomous driving and this will ultimately lead to fewer deaths and injuries.

From health-care industry perspectives, it was founded that around 10 to 51 per cent of patients stated that they could not able to get access to health care in a timely manner because of lack of transportation.

This lacking area can be resolved with the launched of AI packed autonomous vehicles which can help the hospital and patient in many ways like schedule the most efficient map area from patient to hospital or vice versa, inside treatment in the ambulance with the help of AI packed machines which can able to diagnose and cure in emergency situation.

In addition to this, on-demand health service can also be proved beneficial where the hospital “healthcare cloud” can provide nearby access and information with health services based on the respective monitoring and feedbacks (Soman, 2011). For example, MedStar Health in Maryland has collaborated with Uber to help transport the patient to and from appointments. This will help in decreasing missed appointments and expenses as according to the journal of the American Medical Association, around 3.6 million Americans miss medical appointments every year due to the transportations problem.

Conclusion

Most of the sectors have historically led in the implementations of lean principles and the healthcare industry is one such sector. Financial pressures are forcing hospitals around the globe to finding for appropriate ways for the cutting of costs and improving efficiencies.

This report stated that many hospitals have already implemented lean management principles in their systems and now their focus is to make disruptive innovation with the help of booming technologies.

Working with those above disruptive technologies is a challenging task but the benefits of after implementations are more beneficial for the whole industry and the result of this study indicating the layout in process of the map influenced complete healthcare perception of quality, cost-effectiveness and safety problems in a process.

Although the process map showed the whole process of the information and material flow in a single image, it is a vitally important aspect of how that process proceeds.

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