Monday, December 1, 2014

Why and When Physicians should learn Lean

As I do the Green Belt course I’ve been asking myself when and why physicians should be interested in learning Lean? At first I struggled a little to find out how the physician’s mindset could fit in with what I was learning – it is hard to extrapolate from non-clinical material to a clinical world. I do think that Lean training for physicians needs to be clinical and to that end will help push that forward as my own agenda as best I can. But in thinking offhand as to why a physician should learn Lean I came up with two salient reasons.

First, in practicing medicine I’ve come to realize with such a demanding domain that everyone – yes, everyone - needs help. For example, in comparing the not-so-remote system of written orders versus computer order entry which can trigger one to remember more, I feel the latter is better. No one wants to acknowledge that they don’t know or remember everything – indeed there is a striking amount of cockiness in physicians when it comes to assessing what they think they know concretely – but having a standardized, computerized, evidence-based system in place which helps one’s thought processes be non-omittingly comprehensive helps non-threateningly alleviate this real issue. Expectedly, as good computer order entry implementation is really a “mini-Lean” process, Lean methodology mirrors computer order entry’s philosophy:  namely that clean standardization of processes due to an acknowledgment that what we think we know isn’t always what actually is, is imperative for error-reduction. Both entities refuse to rely solely on individual recall and perception for progress with the knowledge that these are inevitably, routinely incomplete.

Second, in conjunction with the above, I think that analyzing processes from the way one has always analyzed them is less than fruitful. To be in medicine and to assume that one has the answers to process issues because medicine is indeed different is false. Actually, processes are often processes and it frequently takes an outside perspective (not a consultative perspective, just an outside perspective) to understand what one didn’t before. For a physician to learn Lean is to currently step outside of the medical domain and learn something new which then can provide a novel approach as to what to do with standard process issues which have benefitted from Lean/Six Sigma elsewhere. Physicians above all should step outside of their domain to learn Lean because they deserve to be running the show of medicine, given how their sacrificial and hard-working existences are impacted by it.

And as to the question of when to learn Lean? Very possibly early on, in medical school. Lean appears to be catching on in medicine, from hospital to hospital but still, it is a piecemeal approach, one that largely hasn’t yet been embraced collectively by physicians but more so by many ancillary to the medical process. This isn’t bad but again as with so much in medicine, the power shouldn’t be given away – physicians need to be overseeing process improvement which impacts them directly. With this, it would be great if the thought process were already innate, and truth to tell, the earlier one learns a subject, the more time one has to incorporate it into his or her world experience. Medical school might be the optimal time to tie in Lean training into the world of medicine, to get the creative juices flowing.

So, those are the thoughts for now, why and when physicians should learn Lean. Yes, Lean will likely be beneficial for medical process improvement, especially if clinically oriented. And with this, physicians, who are caught by edicts from so many directions, would best be served by learning (at minimum) this one methodology, if not more, early on and comprehensively to be able to assert greater sensible control over their unique domain.