Going Lean

Applying Lean principles to your transportation system can help achieve the triple aim of better care, better population health and lower costs.

By Jake Crampton on January 14, 2016

night and day cityscape illustration

IF YOU ASKED anyone just five years ago to define sustainability, their explanations would point more to practices that protect the earth and anything “green” rather than the more comprehensive approach we think of today. As Blair Sadler wrote last year in a post to Practice Greenhealth’s blog: “I now see [health care sustainability] as demonstrating health care’s leadership in wellness, prevention and fiscal responsibility. Moving from the single aim of better patient care to the triple aim of better care, better population health and lower costs …”

Lean and the Health Care Industry

To meet sustainability and other business objectives, more health care organizations are turning to Lean, a performance improvement methodology that began in auto manufacturing at Toyota in the 1990s. At its core, Lean is about reducing cost through the elimination of variation and waste in order to provide the best, most efficient patient care, or in other words, the triple aim of health care sustainability. According to www.lean.org: “The ultimate goal is to provide perfect value to the customer through a perfect value creation process that has zero waste.”1

With pressures mounting for health care executives to do more with less, it is easy to understand why they increasingly embrace the Lean philosophy. We’ve seen health systems attack long emergency room wait times to reduce time that’s not value added; utilize design and construction to maximize physical structures and minimize environmental impact; develop processes that reduce operating room turnover times and operating room waste; implement just-in-time inventory strategies to reduce expiring products and waste; and deploy technology that improves processes and eliminates waste.

These are all Lean examples of what health care organizations are doing to try and meet the triple aim of sustainability, but what aren’t they doing?

The Impact of Intracompany Transportation

One area of waste and variation within many health care organizations lies in their transportation system, or perhaps more accurately, their lack of a transportation “system.” Too few organizations explore or deploy intersite logistics, or intracompany transportation, through a strategic lens.

Intracompany transportation is the physical movement of patient- and business-critical supplies—laboratory specimens, pharmaceuticals, equipment, med-surg supplies, mail, print-shop materials, etc.—across a health care organization’s entire network.

While it’s a large area of opportunity that touches nearly every site within a health care organization, intracompany transportation is typically never greater than a fraction of a percent of a health system’s total expenditure. Thus, many health care executives overlook it. Often the unfortunate result is a nonoptimized network that misses opportunities to effectively utilize scale and become more efficient and less wasteful.

Examples of waste and nonsustainable practices in intracompany transportation include:

  • Laboratory overstaffing due to variable specimen arrival and later-than-optimal arrival at the end of the day.
  • Extra inventory sitting on shelves, risking expiration and waste when it could instead be shared systemwide and better utilized.
  • Capital equipment sitting idle when it could be shared or used by another facility.
  • Multiple, decentralized and redundant lab, pharmacy, print and mail operations.
  • Different couriers from the lab, pharmacy and supply chain all arriving at a hospital at the same time to pick up specimens, pharmaceuticals and equipment that are ultimately being delivered to the same locations, wasting time, fuel and producing greater auto emissions.
  • Hospitals, clinics and other facilities receiving more (or fewer) pickup/delivery stops than required to meet clinical needs.
  • Manual processes for tracking chain of custody that waste clinical time and increase risk.
  • Facilities ordering on-demand or STAT service, when regular scheduled service would suffice, creating unnecessary work for the transportation department and possibly the recipient of the item, again increasing transportation costs and fuel consumption.
  • Clinicians wasting time waiting for delayed or lost specimens, equipment and supplies.

Our world of health care operations continues to become more vast and complex with hospitals and health systems merging, affiliating and partnering with other organizations. Health systems are expanding by the number of hospital beds and also through the addition of other care settings, such as urgent care centers, ambulatory surgery centers, medical groups, rehabilitation clinics, skilled nursing facilities, home care, long-term acute care hospitals and more. With more moving parts in newly expanded health systems, the need for physical integration has never been more pronounced. More supplies are in play with more places to go, and there are simply more opportunities for sharing and better utilization of the transportation network.

“A well-designed, centralized intracompany transportation network creates a mechanism that utilizes network connectivity to deliver and deploy all goods and services throughout the network in an efficient, consistent and reliable manner. Deployed strategically, intracompany transportation adds value and eliminates over-servicing, creating a more sustainable organization.”

Health systems that still operate with a siloed transportation network—dictated by separate departments—are not taking a sustainable approach. When one department is unaware of what another is doing, there may be considerable waste and inefficiency, not to mention the increase in risk and decrease in quality.

Because transportation impacts nearly every element and department of a health system, the disintermediation of the need for redundant freight and intrasystem shipping means health systems can lower fuel consumption, while reducing emissions and expenses and improving patient care.

A well-designed, centralized intracompany transportation network creates a mechanism that utilizes network connectivity to deliver and deploy all goods and services throughout the network in an efficient, consistent and reliable manner. Deployed strategically, intracompany transportation adds value and eliminates over-servicing, creating a more sustainable organization.

Unifying transportation is not an end in and of itself. Rather, it is a means to create other opportunities for operational standardization to eliminate waste along entire value streams. All of this works together to further advance the triple aim of health care sustainability and align with the Lean philosophy.


Paper napkin with a brainstorming chart drawn on it Success: Ideas, Passion, Action, TimeRecipe for Success

Done right, health care transportation is a thoughtfully designed, customized and planned solution that physically integrates and connects health systems through the strategic, intracompany delivery of physical materials. The correct logistics layer enables the clinical layer to function most efficiently and effectively.

A best-practice health care transportation network is based on a process model that includes:

  • An ISO-certified corporate quality program, underscored by Lean and Six Sigma methodologies, to monitor and measure the quality of operations.
  • A health care-focused technology platform that ensures route optimization, complete chain of custody and data maximization for improved visibility, transparency and smarter decision-making.
  • A twofold philosophy for value creation that includes immediately achieved value directly from transportation operations, plus ongoing value created by using transportation as an asset to drive savings on the more than 99 percent of expenditures that are outside of transportation but are still impacted by it.
  • Technology, processes and the relationships necessary to seamlessly integrate with distribution partners for maximum mode optimization. —J.C.

graph depicting most common modes of transportation: Passenger Cars 43%, Light Duty Trucks 18%, Medium/Heavy Duty Trucks 22%, Aircraft 8%, Marine 3%, Rail 2%, Pipelines 1%, Buses, Motorcycles, Lubricants all less than 1%Transportation in the U.S.

  • Overall, transportation comprises more than 25 percent of greenhouse gas emissions.
  • It also consumes more than two-thirds of petroleum-based fuel use.
  • Freight alone accounts for over 25 percent of all fuel consumed and GHGs emitted.

Practice Greenhealth’s Role in Transportation: An Update

  • In October 2015, Practice Greenhealth became an affiliate of the Environmental Protection Agency’s SmartWay program.
  • CleanMed 2016 will include a preconference session on transportation best practices.
  • Practice Greenhealth is also developing a member-exclusive transportation toolkit. A draft will be available at the CleanMed 2016 transportation preconference session, with the final toolkit release planned for August.

Jake Crampton is the CEO of MedSpeed.


1. “What is Lean,” www.lean.org/whatslean.