1. Lean Healthcare

2. Lean Management
• Definition of Lean
– a quality improvement philosophy and set of principles
originated by the Toyota Motor Company.
– Lean In Healthcare
• An organization’ s cultural commitment to applying the
scientific method to designing, performing, and continuously
improving the work delivered by teams of people, leading to
measurably better value for patients and other stakeholders.
• Transforms how an organization works and
creates an insatiable quest for improvement.

3. Lean Healthcare Principles
– Attitude of continuous improvement
– value creation
– unity of purpose
– respect for front-line workers
– visual tracking
– flexible regimentation

4. Attitude of Continuous Improvement
•
The Deming Cycle
– Plan-Do-Study-Act (PDSA)
– central tenet of Lean.
• Transform Culture
– senior management must relinquish the role of master problem solver
to those who are closer to the problems to be solved
•
Lean uses basic approach of measuring whether new process is
superior to existing process.
• Uses rapid improvement event leads to changes
– a staff huddles every morning to monitor and discuss the metrics
•
•
•
•
wait time
Call volume
Dropped call rate
among other topics.

5. Value Creation
• Improve value for patients
–
–
–
–
–
–
Fewer medication errors
fewer nosocomial infections
less nursing time away from the bedside
faster operating room turnover time
improved care team communication about patients
faster response time for emergent cases
• Benefits
–
–
–
–
–
–
patients
Physicians
Nurses
healthcare organizations
Payers
Community

6. Cont. Value Creation
• Value in health care has been conceptualized
as health outcomes per dollar spent
• value more broadly as benefits received for
burdens endured
– Monetary costs
– Nonmonetary costs.

7. Cont. Value Creation
• Benefits vs Burdens
– Conceptualization of value
• medical outcomes
• financial costs
• Extends
– patients’ perceptions of the overall healthcare experience
• Measuring improvement in processes
– Questions that robust Lean measurement should answer
• Who is affected by the changed processes and in what ways?
• Do benefits increase?
• Do burdens decrease?

8. Cont. Value Creation
• Value stream maps are a principal Lean tool
used to distinguish between discrete steps in a
process that do or do not contribute value

9. Unity of Purpose
• clarifies priorities and guides staff in improvement
work accordingly.
• Focused Work
• Priorities govern investment of improvement
resources.
• Prioritize and clearly communicate a small number of
strategic goal categories relevant throughout the
organization
• Have the most promise to strengthen the organization
• Create stakeholder value.

10. Cont. Unity of Purpose
• Projects fit within this strategic framework
• Specific improvement projects (the “ how” )
• Move the organization forward in its
prioritized goal categories (the “ what” )
• Management uses a process called catchball
– Communication back and forth in the
organization builds consensus, understanding, and
engagement around the priorities

11. Respect for Front-line Workers
• leadership upside down, with front-line
workers doing much of the innovating and
managers trusting them to do it and
supporting them
• front-line workers to have the brainpower
and commitment to improve the work must
pervade the organization
• Respect flows downward, not just upward.

12. Cont. Respect for Front-line Workers
• Management must make special efforts to
create a safe environment for innovation
• Attacking processes rather than people so that
staff members do not fear reporting problems

13. VisualTracking
• information displays mounted on the walls in
staff-only areas
• information is dynamic and directly relates to
what staff are thinking about in terms of how
best to provide what patients need and want
• The value stream maps helped prioritize
design requirements that contributed to the
facility being built

14. Flexible Regimentation
• Processes are perfectly designed to produce the
results that occur
• key to improvement is determining the root
cause (or causes) of performance shortfalls and
ridding the process of the cause(s) through
redesign.
• Take nonstandard work processes and transform
them into standard processes that improve
performance and then continue to improve the
standard work design through PDSA

15. Final Note
• Lean is an innovative management approach that has proven
successful in health care organizations.
• It offers promise for improving quality and efficiency while
controlling costs in the provision of optimum patient care.
• To implement the Lean philosophy and principles, however, is to
undertake an arduous, never-ending improvement journey.
• Because Lean transforms organizational culture from the inside
out, it offers both challenges and opportunities.
• It requires a major shift in roles:
– managers and leaders must become facilitators
– mentors, and teachers and allow front-line workers to make
improvements.
– It engages the entire staff in identifying and solving problems based on
a continuous improvement attitude, the driving force behind Lean
work.

16. References
Bell, S. C., & Orzen, M. A. (2011). Enabling and Sustaining Your Lean Transformation.
Director (p. 349). CRC Press.
Clark, D. M., Silvester, K., & Knowles, S. (2013). Lean management systems: creating a
culture of continuous quality improvement. Journal of clinical pathology, 66(8), 638–43.
doi:10.1136/jclinpath-2013-201553
Toussaint, J. S., & Berry, L. L. (2013). The promise of Lean in health care. Mayo Clinic
proceedings. Mayo Clinic, 88(1), 74–82. doi:10.1016/j.mayocp.2012.07.025
Womack, J. P., & Jones, D. T. (2005). Lean consumption. Harvard business review, 83(3), 58–
68, 148. doi:10.1049/me:20050411
Womack, J. P., Jones, D. T., & Roos, D. (1990). The Machine that Changed the World: The
Story of Lean Production. World (pp. 1–11). Harper Collins.
Yazdani, B. (1995). Toyota production system: An integrated approach to Just-In-Time.
Computer Integrated Manufacturing Systems. doi:10.1016/0951-5240(95)90010-1