- Decoding the DNA of the Toyota Production System (Spear and Bowen Harvard Business Review, January 2006)
Tuesday, February 11, 2014
Lean and TPS in Healthcare: pros and cons.
Theme of the fourth week of our Supply Chain Management course is the concept of lean manufacturing, or simply Lean, and its best representation in the Toyota Production System (TPS).
Lean is, as Wikipedia defines it, “a production practice that considers the expenditure of resources for any goal other than the creation of value (action or process that a customer would be willing to pay for) for the end customer to be wasteful, and thus a target for elimination.”  In line with this definition are the words of Taiichi Ohno, the father of TPS: “All we are doing is looking at the timeline from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that time by removing the non-value-added wastes.” 
This new approach has been mainly developed for manufacturing industries; nowadays, companies in different areas are trying to adopt it in order to expand their production effectively and efficiently. Healthcare is one of the sectors where the introduction of the concepts of lean production and TPS has given good results (in terms of eliminating waste, keeping inventory low, increasing efficiency, valuing people, and non-stop improving).
Eliminating non-value-added actions, such as patients’ waiting time in the ER or in a clinic, is one of the issues that could be tackled with Lean. This problem can be analyzed both from the perspective of the patient, who is forced to wait in order to be examined, and the perspective of the doctor/physician, who knows that s/he did not add “value” to the patients – in fact, s/he caused an annoyance. Improvements in this case are not typically conducted by the hospital/clinic management, but directly by staff members, people who work “in the field” and are familiar with the causes of such delays. The application of lean principles to staff training can reduce patients’ waiting time, both at registration and in the surgery department. For instance, Lean would suggest the elimination of excessive documents and forms to fill in, it would reduce the time needed to search for supplies, or to redirect patients to the appropriate office to schedule a new appointment. 
Lean and the Just-In-Time (JIT) strategy (basically consisting in avoiding over-stocking) have also inspired improvements for managing the inventory and the related operating expenses. Specifically, the utilization of technologies, such as scanner and bar code, has allowed inventory managers to be immediately informed about a scarcity of supplies, such as gloves, bandages, syringes, and it has facilitated a efficient management of medicines, avoiding that they could expire. 
Emphasizing the importance of people, making them aware that they are an integral part of the process, giving them the opportunity to analyze a problem and suggest a solution are fundamental aspects of the TPS. In the Virginia Mason Medical Center, for example, doctors and nurses realized that they needed to avoid the risk of catheters’ wrong installation or incorrect positioning, which would imply a double operation on the patient. Therefore, they suggested decreasing the available variety of catheters, because they had different installation processes. 
Does the adoption of Lean in healthcare have only positive aspects, as it seems to be the case in manufacturing? Probably not.
Some sociological aspects of Lean thinking are possibly under-valued in healthcare. Specifically, a lean process that promotes standardized work, which surely increases efficiency, may not fit perfectly an environment such as a hospital or a clinic, where very different patients come in and where the human interaction between doctor/nurse and patient is as crucial as a timely, accurate medical treatment. Since the business of healthcare providers is human health and well-being, shouldn’t human interaction be emphasized, even if it is at the expense of economic efficiency? Do all healthcare providers make sure that this important part of the service is indeed considered as a value-added action?