The lean transformation model continuously improves customer value-driven purpose, process and people. It has helped manufacturing and service industries maximize customer value and efficiency and create consistency in products and services. But, could lean processes adapted to health care also increase patient outcomes and optimize the value of patient care services, eliminate waste, and reduce complications? Rajiv K. Sethi, MD, an orthopaedic surgeon specializing in spine surgery and health services research and executive director of Virginia Mason Neuroscience Institute’s Complex Spine Surgery and Spine Center of Excellence Programs, explains his findings in a review published in the November issue of the Journal of the American Academy of Orthopaedic Surgeons.

A lean organization’s goal is to provide value to the customer through a process with zero waste. The methods revolutionized manufacturing in Japan in the late 20th century, and soon after prominent U.S.-based manufacturing and service industry companies also began adopting lean processes.

“Consider the aviation industry, which has embraced lean processes and a culture of safety. When flying an aircraft from New York to Seattle, there is minimal pilot variability in how the plane takes off and lands because of automation and standard, checklist-based processes that are universal among pilots of all types,” explained Dr. Sethi.

“Simple things like less waiting, getting the right care at the right time, reducing overutilization of drugs and procedures that don’t help patients and a more predictable hospital stay after a procedure” are examples of the patient experience that Dr. Sethi and his co-authors said the lean process improvement can enhance. “Variability in health care creates waste and errors. Lean process improvement standardizes processes and algorithms to remove these barriers, decrease medical errors, enhance patient safety and enhance outcomes,” said Dr. Sethi. The authors’ findings suggest lean process improvement can be used in any process in which there is major variability and waste across the medical landscape to enhance cost-effectiveness and the patient experience.

The Virginia Mason Medical Center (VMMC) in Seattle, Wash., was one of the first health care institutions to implement the lean methods. Their initial work reduced the incidences of ventilator-associated pneumonia at VMMC from 34 cases with five deaths in 2002 to four cases with one death in 2004. VMMC’s usage of lean processes later extended into orthopaedic surgery and spine surgery—known as the Seattle Spine Team approach. Key service providers (i.e., the spine care team) helped define the customer (i.e., the patient) value, driving them to deliver the safest and most effective complex spine surgery at the lowest cost. The processes reduced avoidable complications in complex environments with known extensive risks and the need for unplanned secondary surgeries.

According to the review, hospital groups that implemented lean processes reported striking findings:

• VMMC’s Seattle Spine Team approach significantly reduced overall complex spine surgery complication rates by 36%—from 52% to 16%.
  • The hospital successfully sustained the lower complication rate over a seven-year period through continuous pre-, intra- and postoperative process improvements. Due to this sustained continuous improvement, the hospital now receives preferred contracts from large private employers bringing spine and total joint patients to Seattle from all over the United States.
  • Dr. Sethi’s group recently published findings in Spine demonstrating that 60% of patients offered spinal fusions in community hospitals were offered non-surgical options by the Virginia Mason multidisciplinary panel, which equally empowers surgeons and other spine providers such as physiatrists and psychologists in the decision-making process.
  • Optimizing preoperative communic