As many have already noted, the COVID-19 virus continues to challenge healthcare providers, requiring new patterns of thinking and the ability to quickly adapt to changes.
“Lean management” is a new style of leadership that is growing in popularity in the business world and other industries, including healthcare. Lean management1 ultimately focuses on three core ideas:
- Continuous improvement
- Delivering value from the customer’s perspective
- Eliminating waste
During the pandemic, hospital systems have employed different strategies to leadership, including the lean methodology. The response of one New York City hospital using lean management is described in the February 2021 edition of the journal Nursing Management.2
Lean methodologies used in a hospital setting
First, the hospital identified and characterized the current pandemic as a VUCA environment; as such, it is:2
- Volatile: Leaders must deal with an unexpected challenge of unknown duration.
- Uncertain: The cause and effect can be identified, and while change is possible, it is not guaranteed
- Complex: The event may have interconnected parts and may be overwhelming to process
- Ambiguous: No precedent exists, and causal relationships are unclear
Hospital leaders decided to use several lean management tools, such as Gemba walks, Kaizen, and visual management to help employees implement change. The authors of the article describe Gemba as a Japanese term meaning “the real place where the work is done”. On Gemba walks, leaders engaged staff members with thinking questions to not only observe and understand processes, but to also respect and listen to staff member needs.
Kaizen, a type of rapid improvement process, focuses on reducing waste, improving productivity, and achieving sustained continual improvement in targeted activities. Leaders use visual management to help communicate organizational data in real time using tools such as a visibility board.
Applying lean management strategies to nursing
The NYC hospital identified an urgent need for more critical care beds. The facility was able to double the number of these beds in three weeks by using unusual spaces, such as operating rooms, medical-surgical floors, and conference rooms as ICUs. While this significantly altered workflow for staff nurses, daily Gemba walks by nursing management enabled leaders to develop a better understanding of bedside nurses’ needs.
Leadership also initiated virtual support groups, no-cost individual therapy sessions, and group activities like virtual mindfulness sessions to help boost staff morale.
Continuous coaching helped take staff members out of their comfort zones, allowing them to experiment with different staffing models and processes to best help Covid-19 patients. Other disciplines received cross training, such as providing hemodialysis therapy, to help nursing staff manage patients. A “resource nurse” position was created to help ensure patient safety—nurses in this role floated from low census areas to Covid-19 ICUs and received on-the-job training while working in tandem with ICU nurses.
Finally, nursing management spend a great deal of time allocating resources and collaborating with other healthcare providers to place patients in the most appropriate locations possible. Managers were present and visible to all frontline staff in Covid-19 units, and leaders took steps to help nurses break down barriers to effective patient care.
Takeaways for lean management in healthcare
Reflecting on the changes that allowed the hospital to quickly adapt to an ever-changing issue resulted in management identifying several key lessons, including:
- Communicate with staff frequently
- Coordinate share learning and other standardization with other healthcare facilities
- Create a leadership coverage plan at all levels
- Develop scalable staffing models
- Establish emergency management systems
- Plan the build-out for ICU capacity
- Practice rapid cycle implementation
- Protect staff
- Support staff well-being
The authors of the article note that the experience ultimately helped nursing leaders develop key traits, such as clarity, decisiveness, humility, courage, passion, integrity, and vision. They reflect that lean management strategies can be used to help hospital systems achieve their visions for the future by helping employees understand how and why changes are necessary, which, in turn, improves organizational excellence.
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