Implement Lean in a healthcare environment is a difficult task. Its application often leads to resistance and the common arguments are (among others) that a manufacturing approach cannot work in a hospital setting, that the personnel are too busy to implement lean, or that business approaches neglect the sociotechnical aspects of health care. Many people are reluctant to view the work they have been performing for many years as wasteful and according to that, they become defensive and resist any effort to change the situation.
However, several experiences have demonstrated that techniques developed in manufacturing really work in hospitals and the potential gains of Lean application are enormous. Bolton Hospitals NHS is one of these experiences: before Lean implementation the hospital had a financial deficit and significant problems with long waits for diagnostics and treatments, after three years of Lean application, the financial balance was restored and the waiting times reduced.
Lean can improve safety, improve staff morale and reduce costs, but some differences between the application of Lean in manufacturing and healthcare have to be taken into consideration. First of all, healthcare professionals deal with a group of customers who are often weak, vulnerable and frightened and in addition, the degree of organizational complexity is high and many procedures have a significant level of risk. Due to that, the outcomes of mistakes (drug errors, infections or misdiagnoses, among others) are often more critical than in manufacturing companies. Moreover, the patients consider as truly valuable aspects such as pain relief, wish for information, cleanliness or hygiene which are completely different of the value consideration in manufacturing.
Second, the balance between achieving high quality and remaining financially viable is becoming a major issue for hospitals today. If hospitals were like most companies, they could compensate the rising costs increasing the selling price; nonetheless hospitals are not like most companies. According to that, the goal is to understand that good quality can cost less not more. In addition, setting delivering benefit in a healthcare environment is one of the most difficult tasks and it is important to define whether it is reduction of mortality, improvements in productivity or patient satisfaction increase. In health care, different actors have different views of value and for instance, the doctor’s clinical value oftentimes differs of the manager’s operational value.
Finally, how processes should ideally work is often described in manufacturing companies, but it is rarely described in health care operations. This creates inconsistency in care, unpredictable delivery systems, and constant caregiver interruptions which in turn create inefficiencies, higher operating costs, errors increasing and worker frustration. In addition, different hospitals units may require different approaches to implementation. Whereas laboratory, pharmacy and information staff are normally process-focused; nursing units and senior leaders experiment greater difficulty in that aspect.
Having examined the differences, in my next post I will consider the similitudes between the application of Lean in manufacturing and healthcare.
Fillingham, D. (2007), “Can lean save lives?” Leadership in Health Services, Vol. 20 No. 4, pp. 231-241.
Jimmerson, C., Weber, D., and Sobek, D. (2005), “Reducing waste and errors: Piloting Lean Principles at IHC”, Journal on Quality and Safety, Vol. 31 No. 5, pp. 249-257.
Joosten, T., Bongers, I., and Janssen, R. (2009), “Application of lean thinking to health care: issues and observations”, International Journal for Quality in Health Care, Vol. 21 No. 5, pp. 341-347.
Zidel, T. G. (2006), “A Lean Toolbox: Using Lean Principles and Techniques in Healthcare”, Journal for Healthcare Quality Web Exclusive, Vol. 28 No. 1, pp. 1-7.