RSNA: Is radiology ready for Lean?

CHICAGO—With cost and quality pressures mounting, eeking every iota of efficiency and productivity from imaging processes, while maintaining or improving quality, is essential. Reducing waste can help, and Lean methodology provides a system that can help cash-strapped, time-crunched radiology departments achieve this ambitious objective, according to a scientific poster presented on Nov. 27, at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

Jonathan A. Flug, MD, MBA, of Winthrop University Hospital in Mineola, N.Y., delivered a crash course in Lean and emphasized its role in quality imaging. “Quality is not just about preventing unnecessary harm to patients,” he said. Quality also comprises the development of systems to optimize care delivery.

Lean, a process improvement methodology developed by Toyota, is focused on eliminating, but not reducing, waste. Flug dispelled two common misperceptions about Lean, explaining that the methodology stresses processes not technology and does not provide a formula for reducing waste.

Flug outlined the eight categories of waste defined by Lean and encouraged radiology practices to examine these through the lens of the final customers: patients, clinicians, technologists and radiologists. The multiple forms of waste are:

1. Defects such as the wrong test or wrong body part. For example, 40 percent of indeterminate CT pulmonary embolism studies are linked with poor bolus, said Flug.
2. Non-value added protocols. Examples include out-of-date and inappropriate protocols, which add costs and delay care.
3. Waiting. Whether processes require patients, techs or physicians to wait, waiting equals waste.
4. Underutilization. Idle equipment does not contribute to the bottom line.
5. Overproduction. Excess kVP or any other scenario in which a department produces more than required entails waste.
6. Transportation. Complex flows of people or materials can results in delays.
7. Excess motion. Examples includes unnecessary mouse clicks or manual steps.
8. Inventory. Storing more supplies than needed does not contribute value and instead adds costs. Flug cited an interventional radiology department that slashed expired inventory by 50 percent after implementing Lean to reduce waste.

“By applying Lean and looking at the nitty-gritty components of you department you may find waste where you don’t expect it,” said Flug.

For an in-depth review of several departments that have embraced Lean, please read “Process Improvement for the Long Haul,” in the November issue of Health Imaging.