Most managers are familiar with the principles of process improvement, especially Toyota’s Lean production system and Motorola’s Six Sigma. But can these principles be applied to areas outside of manufacturing where the customer is the focus or to decentralized supply chains with several independent organizations working together?

Carlson School researchers Susan Meyer Goldstein (right), an associate professor in operations and management sciences, and Rachna Shah, an assistant professor in the same department, believe that the answer to this question is “yes.” In a new paper, “Explaining Anomalous High Performance in a Health Care Supply Chain,” they explore a case at the Minneapolis Heart Institute at Abbot Northwestern Hospital which used Lean principles to improve a process for heart attack treatment among three key partners: trained emergency transportation professionals, emergency departments at community hospitals throughout the state, and the interventional cardiology team at Abbott Northwestern.

Improving front office operations

“In our research, we examine how process improvement techniques can improve customer-focused, front office situations like treating patients,” says Goldstein. “Delivering patient care in a health care setting differs significantly from back office operations such as processing checks in a bank or manufacturing a widget because patients differ from each other in a variety of ways, each presenting a separate set of challenges and requirements,” says Goldstein.

In the Minneapolis Heart Institute case, health care professionals began by setting a performance improvement goal: to treat heart attack patients within two hours after the start of symptoms, the timeframe recommended by health care regulatory organizations. When heart attack patients were transported from small hospitals in greater Minnesota to Minneapolis Heart Institute (MHI) for treatment, it could take four hours or longer—at least twice the recommended time.


Savings lives with Lean principles

With a goal of saving lives and improving long-term results, doctors, nurses and administrators used Lean management principles to streamline the process of transporting and treating heart attack patients. The process enhancements generated impressive results: for patients arriving at trained community hospitals, treatments are now completed for a majority of patients in less then two hours after their heart attacks begin, the process goal. As a result of this speed, there have been significant improvements in patients’ survival and recovery rates. In fact, Minneapolis Heart Institute now has one of the best heart attack survival rates in the country.

How did health care professionals attain such great results? “The key to understanding a poorly managed process is the ability to uncover measurable factors,” says Shah. “If you can’t measure it, you can’t manage it. In this case, the program leaders uncovered time-wasting processes that varied from hospital to hospital, and even from doctor to doctor.”

Removing waste and saving time

According to Goldstein and Shah, “MHI reduced its transfer/treatment time by making numerous changes throughout the supply chain. They removed waste in various ways - by reducing waiting time and eliminating unnecessary decisions, tests, treatments, phone calls, and information transfer—all of which delayed patients’ movement toward treatment. The close relationships between supply chain members also helped the group attain goals. These strong working relationships enabled them to share goals and knowledge and participate in ongoing improvement efforts.”


Now, potentially life-saving time-savers are built into the process. Patients receive a standardized set of drugs, which are pre-stocked in a convenient kit. This eliminates decisions on which and how much of various drugs to administer as well as the time-consuming doctor-to-doctor transfer of information about which drugs were given when.

Another critical change is that outstate doctors no longer have to call MHI to check if a bed is available before sending a patient. Instead, MHI guarantees room for heart attack patients at all times. “This is the kind of decision that process management facilitates: one that seems obvious once it has been made, but beforehand presents apparent barriers,” says Goldstein. “A lack of open beds usually means that a hospital has no capacity to treat additional patients. But rather than miss the critical window when surgery could be life-saving, the hospital administration chose to deal with the risk of heart attack patients waiting for a room after surgery.”

Making the most of unpredictability

The MHI case shows that Lean principles have application in unpredictable, irregular situations. At the same time, the researchers note that the process includes room for flexibility. “While the process steps are highly specified by MHI, the implementation—how the process is carried out—is customized in each community hospital, but is highly specified within each respective hospital,” says Shah.

Goldstein adds that flexibility is possible because Lean companies teach their employees not only what to do and how to do it, but also why they must do the work a certain way. “Understanding ‘why’ means employees can see the relationships between causes and effects, between actions and outcomes, and how the work of a person in the outstate hospital impacts customers (employees) immediately downstream at MHI, as well as the ultimate customer (patient),” she says.

Products manufactured in the United States have improved greatly from process improvement and Lean management strategies, and consumers have benefited from the improvements. Goldstein and Shah’s research shows that these same process improvement techniques can improve health care services - and other service businesses. The application is different, but the results are the same—the consumer gets better service.