Application of lean thinking to health care: issues and observations

Abstract

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.

Lean production tools and decision latitude enable conditions for innovative learning in organizations: A multilevel analysis

“…The philosophical level concerns how to understand value (what is needed and wanted by the customer or client) and how the work process can be improved by removing steps without value (Womack & Jones, 1996;Womack, Jones & Roos, 2007). Lean production tools are often implemented in order to eliminate non-value-adding activities and 4 reduce variability in the work process, without considering the lean production philosophy (Shah & Ward, 2001;Radnor, Holweg & Waring, 2012;Joosten, Bongers, & Janssen, 2009;Mazzocato, Savage, Brommels, Aronsson & Thor, 2010). It is often argued that failure to consider the holistic, process view of lean production and the socio-technical aspects of the interaction between human behaviour and operational tools leads to restricted success (Liker & Morgan, 2006;Joosten et al, 2009;Mazzocato et al, 2010;Radnor et al, 2012).…”

“…Lean production tools are often implemented in order to eliminate non-value-adding activities and 4 reduce variability in the work process, without considering the lean production philosophy (Shah & Ward, 2001;Radnor, Holweg & Waring, 2012;Joosten, Bongers, & Janssen, 2009;Mazzocato, Savage, Brommels, Aronsson & Thor, 2010). It is often argued that failure to consider the holistic, process view of lean production and the socio-technical aspects of the interaction between human behaviour and operational tools leads to restricted success (Liker & Morgan, 2006;Joosten et al, 2009;Mazzocato et al, 2010;Radnor et al, 2012). If aspects of lean production is combined with socio-technical thinking, where the social as well as the technical system of the organization are considered and aspects such as work content and variation, learning, decision making, recognition and coherence are acknowledged (Thorsrud & Emery, 1969), this may have beneficial effects on the work environment (Seppälä & Klemola, 2004).…”

Lean Thinking for Healthcare

“…The term "lean" is used because the lean production uses less of everything compared to other production systems. Since its introduction, the concept of lean production has changed considerably (Joosten et al 2009). It is diffused from car industry to other manufacturing industry and then to service industry (Hines et al 2004).…”

“…Originally, the application of lean at Toyota was a process-oriented concept. Currently, lean extends beyond the original Toyota operational shop fl oor concept to include "respect-for-human system" aspects besides the technical aspects of the system under study (Joosten et al 2009;Sugimori et al 1977). In other words, application of lean requires looking to the system as "sociotechnical" system in which human factor engineering and technology plays the central role.…”

“…In other words, application of lean requires looking to the system as "sociotechnical" system in which human factor engineering and technology plays the central role. Jones (1996b, 2003) enhance further the "sociotechnical" aspect of lean production through introducing fi ve principles within which the customer value and waste reduction are the cores of the lean system (Joosten et al 2009;Womack and Jones 2003). Womack and Jones coin their principles with the term "lean thinking" with emphasize to applicability of lean thinking to service industry including healthcare services.…”