Lean In Healthcare

INTEGRATING PEOPLE, PROCESS, AND TECHNOLOGY IN LEAN
HEALTHCARE

by

Brock C. Husby

A dissertation submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
(Industrial and Operations Engineering) in The University of Michigan
2012

Doctoral Committee:

Professor Jeffrey K. Liker, Chair Professor Lawrence Martin Seiford Professor Richard Van Harrison Associate Professor Young Kyun Ro

© Brock C. Husby, 2012

Dedication
To my dissertation committee, friends, colleagues from the IOE Department and work, and my family: It has been a long road to get to this point, but I have learned and grown much
From an early stage, I was fascinated by the

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potential of lean in service‐industry applications. When I had an opportunity to work at
Denver Health under an Agency for Healthcare Research and Quality (AHRQ) grant studying the application of lean in healthcare, Prof. Liker was very supportive. This was a great opportunity to “go to the gemba” in a unique environment. Denver Health was a safety net healthcare system, which was a strongly mission‐driven organization that served the most at‐risk portions of the population; it was also constrained on resources. If lean could work here, it could work anywhere.
When I began working in healthcare, I saw the tremendous potential of the socio‐technical lean perspective. The healthcare system I saw was full of highly educated, skilled, and hard‐ working staff who had the best technology in the world, but they struggled to provide high‐ quality care that was affordable. Whenever I would work with teams, I was always amazed by how good a job they did despite the systems they had to work with. This was the socio‐ technical disconnect that lean seeks to address, and I wanted to help these individuals
This disconnect between expected and realized outcomes reflects the high variability in patient care that is delivered, as well as the cultural norms that accept this variability [27]. This variability results in the care a patient receives depending greatly on who happens to be assigned to execute their care.

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Common Approaches
With all of these challenges and opportunities, significant resources have been applied at researching care delivery models, evidence‐based best practices, technologies, facilities, and a variety of other areas in an effort to improve care and efficiency. Despite these investments, outcomes appear to be largely unaffected and costs continue to climb [28].
The sustainability of many continuous improvement efforts have been minimal in most healthcare organizations with a tendency to shift from one initiative to another without fully implementing any one approach fully.[11]
PDCA/PDSA/FMEA/RCA
Given the magnitude of the challenge and the lack of a widely used and repeatable approach to address them, the need to identify, refine, and demonstrate an approach has never been greater. Almost all hospitals have a Plan‐Do‐Check‐Act