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Leaning Towards Excellence: The HHC Cancer Institute embraces the Lean philosophy of eliminating obstacles to patient care

May 13, 2014 By Hartford HealthCare

Mohamed Saleh used to design seats for airplanes. Today, the quality improvement expert is designing a better way to deliver cancer care. There is not as much difference as you might think.

Saleh is a performance improvement facilitator for Hartford HealthCare and an expert in Lean principles, the philosophy that guides both continuous improvement and respect for people in the development of practices for the Hartford HealthCare Cancer Institute. Saleh said the HHC Cancer Institute has excelled so far in establishing the groundwork for a Lean Management System, and he is confident that the system will be embraced at all levels. As a result, he said the Institute will be able to avoid many of the challenges other organizations are subjected to when adopting this philosophy from scratch.

Lean principles have their roots in the manufacturing industry. Lean encourages organizations to thoroughly and systematically analyze their practices to eliminate waste and reduce variability. As Saleh explains with enthusiasm, Lean originated with the Japanese car builder Toyota, which skyrocketed to success in the 1980s due to the company’s underlying principles, tools and building blocks. Since then, many industries and companies have emulated the “Toyota Way,” as the Lean management philosophy has been called, including health care organizations. But within the HHC Cancer Institute, the philosophy is being taken to a pioneering level.

“We are really embracing Lean practices in a way that’s never been done before,” said Saleh, who is also a faculty member in the graduate Technology/Engineering Department for the Application of Lean Principles at Central Connecticut State University.

Saleh’s work as an academic and practitioner of Lean strategies has made him a leading world sensei, or expert, in implementing Lean practices in a variety of organizational settings. The opportunity to apply Lean practices within the context of the HHC Cancer Institute has been especially rewarding for Saleh, who has a clear vision for making the most of Lean principles as a way to enhance cancer care.

While adopting the core foundational tenets of the Lean management philosophy, Saleh has created a new strategy deployment operational structure that will allow for these tenets to take effect and align practices across the Institute.

In particular, Saleh and the HHC Cancer Institute Executive Team have established Lean-based pillars for virtually all aspects of the Institute’s operations, ensuring that there is accountability, focus, alignment, rapid deployment and ownership within all of the cancer facilities within the Institute. The overall goal is to deliver better and quicker cancer care to our patients.

The ability to hardwire the core Lean tenets will serve to systematically identify and eliminate waste in the various outdated practices and business habits that lead to inefficiency, redundancy, frustrations and low productivity, while creating significant value for patients and staff. Saleh said the fundamental essence of Lean thinking is the ability to specify value and, by doing so, simultaneously uncover waste.

“Our employees give a critical portion of their lives to this organization, so we must strive to use their time in a waste-free manner to allow them to deliver that exceptional care,” Saleh said.

Identifying eight kinds of waste

  1. Defects – Anything within an organization that requires rework
  2. Overproduction – Doing something that is either earlier, faster or in more quantity than needed.
  3. Waiting – Unnecessary idle time  for patients, staff or any resource
  4. Non-respectful behaviors – Behaviors that do not contribute to respect for people and go against the organization’s H3W Leadership behaviors.
  5. Transportation – Unnecessary time patients spend moving from one service to the next
  6. Inventory – Any supply in excess or below customer demand
  7. Motion – Unnecessary movement of staff or poor ergonomics for staff
  8. Excess processing – Processes that are not changing form, fit, or function to the service

The Cancer Institute is now implementing these practices at levels large and small, said Donna Handley, vice president of operations for the Institute. She pointed out that Lean management practices are supportive of the H3W philosophy that guides practices across the Hartford HealthCare system. By incorporating Lean into H3W practices, she said, the Institute will make faster progress in reducing variation and creating a single standard of care.

“Patients are struggling with a difficult diagnosis, and they deserve to be treated in a setting that eliminates all the obstacles to receiving the very best care,” she said. “That’s what the Lean philosophy encourages, and that’s why we’re so excited about this process.”