promising management approach implemented by some leading health care institutions is Lean, a quality
improvement philosophy and set of principles originated by the Toyota Motor Company. Health care
cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing.
When well executed, Lean transforms how an organization works and creates an insatiable quest for
improvement. In this blog, we deﬁne Lean and present 6 principles that constitute the essential dynamic
of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for
front-line workers, visual tracking, and ﬂexible regimentation. The goal of this blog is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.
Seven critical wastes in healthcare that are addressed by Lean:
-Incorrect floor layout (e.g., inefficient emergency department patient flow)
-“Searching” for information (e.g., lack of operability of EMR)
-Waiting for paper work
-Planning full utilization of assets/labor
-Large batches of material and supplies inventory
-Cost of patient re-admissions
-Non-optimized resource leveling
-Redundant activities (e.g., excess administrative costs)
Principles of Lean:
Principle 1: Lean is an attitude of continuous improvement.
Principle 2: Lean is value creating.
Principle 3: Lean is Unity of Purpose.
Principle 4: Lean is Respect for the People who do the Work.
Principle 5: Lean is Visual.
Principle 6: Lean is Flexible Regimentation.
Adoption of Lean in healthcare delivery:
Many healthcare improvement groups have described Lean as a critical methodology for healthcare providers to adopt. The Institute for Healthcare Improvement (“IHI”) states that there is growing agreement “among healthcare leaders that Lean principles can reduce the waste that is pervasive in the U.S. healthcare system...Adoption of Lean management strategies — while not a simple task — can help healthcare organizations improve processes and outcomes, reduce cost, and increase satisfaction among patients, providers and staff .”
While Lean has proven successful in reducing healthcare waste and increasing provider profitability, surveys of hospital leaders continue to find full deployment of Lean in healthcare very low. In a March 17, 2009 survey by the American Society for Quality (“ASQ”), the same organization that administers the prestigious Malcolm Baldridge National Quality Award, disclosed that only 4 percent of U.S. hospitals reported a full deployment of Lean. However, 53% of the 77 hospitals responding reported some level of use of Lean in their organization. So why is the full deployment of Lean within healthcare so low?
According to ASQ respondents, the key reasons are:
• Lack of resources (59% of respondents)
• Not enough information (41% of respondents)
• Lack of buy-in from leadership (30% of respondents)
The results of this survey stand in stark contrast to the successful implementations of Lean in healthcare organizations throughout the world. Studies over many years have shown Lean to have a wide range of applications to hospital operations ranging from:
1. Reducing inappropriate hospital stays.
2. Improving the quality and financial efficiency of trauma care.
3. Reducing the cost of temporary staff.
4. Improving operating room and emergency department efficiency.
5. Improving radiology processes.
6. Reaching better strategic decisions affecting marketing and capacity management, among other uses of Lean leading to improved hospital profitability.