The relentless pursuit of clutter: Health care takes a lean lesson from manufacturing

TRAVERSE CITY – Urgent Care at Munson Community Health Center has "gone lean." The number of patients who leave without being seen was down 35 percent the past 12 months over the year before; the number of patients diagnosed and treated is up nearly eight percent this first quarter compared to the same period last year, and the clinic has eliminated $5,000 worth of unnecessary forms and paperwork from the admissions process.

Lean thinking is not new-Henry Ford could even be called one of its forefathers-but it's getting "new buzz" as organizations look to push performance to new levels, says Chuck Wyers, director of management engineering for Munson Medical Center and an industrial engineer in healthcare for 20 years.

Wyers began the lean process at Urgent Care by having staff members ask themselves: "Why do we always do it this way?" The answers led to breakthroughs in patient care.

"We stripped the redundancies, got rid of unnecessary info and now we have…a combined registration and triage process which allows for patients to get a clinical assessment shortly upon arrival to the clinic," Wyers said. "This helps mitigate pain earlier in the care process."

Wyers said his favorite "for instance" is the elimination of the religious preference question on the clinic's admission form.

"You're thinking, 'I've just got a sore throat and you're asking me about last rites.'"

A worthwhile question at one time, it is now obsolete.

"(Lean is) the relentless pursuit of all that clutter," Wyers added.

The physical layout of the Urgent Care facility also changed so that processes can be done in parallel instead of sequential steps. As patients move through the process, timers are used to remind staff how long a patient has been waiting.

"Earlier intervention combined with improved communication has proven to be a real satisfier for our patients," Wyers said.

Wyers' next effort is a "through-put" project to reduce the amount of time it takes to move a patient from the Munson ER to an inpatient bed.

Leaning into it

Lean is most readily associated with Japanese manufacturing, particularly the Toyota Production System (TPS), which focuses on the flow of the product throughout the manufacturing process.

"At its core, lean is about the elimination of all waste from a system," said Richard Wolin, director of Northwestern Michigan College's Training and Research, the satellite office of the Michigan Manufacturing Technology Center (MMTC) and local lean training provider.

Currently, lean training accounts for half the office's workload-and health care training is a large portion of that.

"I think lean in healthcare will reach the tipping point in three to five years," said Wolin, noting that it will likely be shorter for Munson given the projects already happening in Traverse City and at some affiliate hospitals across the region.

Lean Team

A team of employees at Mercy Hospital in Cadillac sought training from MMTC after hearing of successful lean projects at some of its sister hospitals, including Mercy Hospital in Grayling.

"It's the only model we knew of to reduce work, make us more efficient and make us more customer-focused," said Joyce Nichols, director of quality management at Mercy Cadillac.

The hospital tackled its first lean project, focused on outpatient services, in January 2006.

"We do a huge amount of outpatient services and it was very common to see people sitting in a lobby waiting, and we got a lot of complaints," said Nichols.

The lean team set a "reasonable" goal of reducing "clinical touch" wait time from 30-plus minutes to 10.

"In most areas, with the exception of radiology, the goal is met over 90 percent of the time," Nichols said. In radiology, it drops down to about 75 percent.

The hospital also implemented lean improvement projects in its emergency room and operating room departments.

"The rapid change of lean is unlike anything I've seen in healthcare," said Cristen Brandsma, director of obstetrics at Mercy Cadillac and a lean-trained employee. "You need the right supports in place and to be cognizant of what an organization can do."

Does waste reduction lead to fewer employees? No, says Wolin-a "no-layoff policy" is one of the key principles of lean management. However, a more efficient organization requires fewer staff, so as people leave they aren't replaced, Wolin explained.

For more information on lean programs, you can reach NMC Training & Research at 995-2218 or