Lean healthcare is the application of “lean” ideas in healthcare facilities to minimize waste in every process, procedure, and task through an ongoing system of improvement. Using lean principles, all members of the organization, from clinicians to operations and administration staff, continually strive to identify areas of waste and eliminate anything that does not add value for patients. Taiichi Ohno of Toyota, was the originator of lean principles. He described eight areas of waste that occur in every industry.

A new study found that Lean is a suitable methodology to accelerate patient recovery by reducing the time between on-the-job accidents and the beginning of physical therapy treatment.

The study identified ways to address inefficiencies in the workers’ compensation system and concluded that eliminating pre-authorization for physical therapy and the additional lead time it creates can improve health outcomes and reduce claim costs.

Omar Taha, in collaboration with his peers designed and deployed multiple case studies to better understand the journey of an injured worker within the workers’ compensation system.

This study was in partnership with a national healthcare provider in the field of workers’ compensation to conduct direct observations in five of their clinics across Florida and Pennsylvania. Researchers analyzed the data of 263 injured workers with eight or more physical therapy visits who were treated at clinics in both states over 31 days.

The research concluded activities associated with the pre-authorization of treatment were the primary non-value-added activity from the perspective of the injured worker based on delayed physical therapy treatment. Removing pre-authorization requirements could significantly reduce the lead time for treatment of injured workers. An injured worker could, for example, visit their referring physician and complete their first physical therapy session within the same office visit.

Half of the injured Pennsylvania workers in the researchers’ dataset attended their first physical therapy treatment within less than a day of obtaining a prescription whereas injured Florida workers required more than five days. In Florida, injured workers needed an average of 39.58 days to complete eight physical therapy visits compared to only 27.92 days to complete the same number of visits in Pennsylvania, a median of 34.09 vs. 22.15 days.

The disparity between the two states is likely due to Pennsylvania eliminating pre-authorization activities, according to the study.

“Physical therapy plays a significant role in the treatment of most work-related injuries and drives medical and indemnity costs of workers’ compensation claims,” said Taha, One Call senior director of continuous improvement and doctoral candidate in systems engineering at The George Washington University.

“Our findings corroborate that Lean is an effective methodology in identifying and removing administrative inefficiencies from the treatment process, which could accelerate patients’ recovery, reduce administrative burden on healthcare providers, and improve the overall claim cost,” said Taha.

“Patterns emerged that showed inefficiencies in the information flow between insurance companies, referring care providers, and treatment care providers,” said Professor Thomas A. Mazzuchi from the Department of Engineering Management and Systems Engineering at The George Washington University. “This negatively impacts the delivery of care for injured workers.”

This was the first study to apply Lean methodology to workers’ compensation. The paper titled “Uncovering inefficiencies in the workers’ compensation industry using Lean methodology” was published in The TQM Journal.