Elsevier

Business Horizons

Volume 61, Issue 1, January–February 2018, Pages 13-22
Business Horizons

Reconstituting lean in healthcare: From waste elimination toward ‘queue-less’ patient-focused care

https://doi.org/10.1016/j.bushor.2017.09.001Get rights and content

Abstract

With ultra-short sightlines to its patient-customers, healthcare should pursue lean in its own way rather than follow the often wayward lean practices of manufacturing, a sector in which few people ever see real customers. Because of the distance in manufacturing from end customers, this sector’s lean practices usually focus inward on operational efficiency through waste elimination. The nature of healthcare—with customers up close and immediate—calls for elevating its lean efforts toward customer-focused lean effectiveness: flexibly quick response along the multiple flow paths leading to and involving patients. This article illustrates that approach to lean by drawing from a case study in which widely scattered heart attack patients were transported to a central treatment hospital in a system-wide, highly coordinated program of quick response. This article shows that the keys to success—including high rates of saving lives and lean healthcare in general—boil down to just five lean methodologies, each focused on quick response. Lean healthcare, when practiced in this way, becomes deserving of status as a fixture in strategic management of the enterprise.

Section snippets

Lean lessons from manufacturing: A poor fit in healthcare

A few years ago, I was in treatment at my health organization’s physical therapy department. As Jennie, my PT, showed me some stretches that would loosen up my stiff and sore shoulder, she asked what kind of work I did. In my response, I mentioned research and writing, including on the topic of lean management. “Is lean management in use here?” I asked. Nodding, she replied impishly: “You said a bad word.”

I could not fully disagree. In this article, I explore the misapplication of lean

Living up to lean’s potential in healthcare

After a late start, lean implementations today are flourishing in health centers globally (Aherne and Whelton, 2010, Bisgaard, 2009; Protzman, Mayzell, & Kerpchar, 2011). Oft-cited U.S. examples include Seattle Children’s Hospital, ThedaCare with multiple locations in Northwestern Wisconsin, and Virginia Mason with a main hospital complex and network of clinics in greater Seattle. Virginia Mason’s prominence in the practice of lean (Kenney, 2011) has made it a go-to location for lean healthcare

Lean healthcare in method-specific terms

Table 3 summarizes five lean methodologies that describe the workings of the MHI program and its outcomes, and support the view that those same lean methods should serve in many or most other healthcare contexts. These methods, all focused on quick-response, are extra-relevant in healthcare, given its customer-facing nature and high importance of immediacy. Each is discussed next using MHI case-study particulars as supportive arguments.

The lean management jungle

Still, for reasons other than those from the Radnor et al. (2012) article, elevating lean healthcare to a systems level may not yield sustainably impressive results. For one, the term lean itself has become problematic. An internet search for “lean controversies” brings up little else than hits relating to the widely discussed book from the women’s movement, Lean In (Sandberg, 2013). Aside from Sandberg’s book, the public generally thinks of lean in relation to diet or body mass (i.e., the

Patient-centered lean effectiveness as strategy

The remainder of this article is aimed at deeper treatments of what I think are the two most salient lean-in-healthcare issues arising in this article. First is how and why healthcare should be pursuing lean’s foundational objective of quick response and doing so as a permanent element of healthcare strategy, as opposed to manufacturing’s lean formula of focusing inwardly on waste and operational efficiency. Second is capitalizing upon healthcare’s natural lean advantage and urgency, namely,

Delivery of lean healthcare: A summary

The points that have been discussed in this article may be summarized in three main points. First and most important, healthcare should take full advantage of its intimate connection with patients—its customers. The term lean may need to be discarded in favor of words and actions that everyone, including patients, can positively relate to: quick response, queue-less service, time-to-care, etc. Or, as Seattle Children’s Hospital has done, healthcare should rebrand lean as continuous process

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