BackgroundIncidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.Development, theory and application of lean thinking to health careLean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles.DiscussionWe believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.

Higher cost sharing for seriously ill and low-income patients could discourage treatment of vulnerable populations and create substantial downstream costs.

Summary To prevent rigidity within teams in health care and to support teams in detecting early warning signs of decreasing flexibility, a program has been co‐created in collaboration with mental healthcare teams. This program is intended to systematically monitor team behavior, and by doing so to facilitate team intervention. We aim to lay foundations for the further development of methods that can help teams to recognize and respond to processes going on under the surface. This paper introduces the program to the reader; and describes its premises and the co‐creation process, leading to a program of nine steps. Then, it describes the application of the program within a team, what a team needs to use the program, and whether the nine steps are sufficient. This pilot shows that the program is a helpful framework within which teams can talk about rigidity, define indicators of their flexibility, and think about appropriate actions and interventions for maintaining or restoring their flexibility. Team ownership and the customizability of the program are important attributes. The program appears to provide a useful framework that helps a team to observe and discuss processes. Team members become aware of the indicators of their team and make their goals explicit.

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