Lean in Healthcare (II)

In my previous post I mentioned the differences between the application of Lean in manufacturing and healthcare. However, which are the similarities? Moreover and perhaps more importantly: how to succeed implementing lean in healthcare?

First, it is very important to achieve the management commitment, and we should start making them understand Lean in order to get their support because a manager’s most important task is to create an environment where interaction between team members leads to a high level of performance. In addition, it is important taking into consideration that lean is a learning method more than anything else, and learning cannot occur if basic stability has not been achieved.

Second, the tools used for eliminating waste are similar in every type of organization, including healthcare. For instance, tools such “5 Whys” (used to discover the root cause of the problems), “5S” (used to create order and cleanliness, and to ensure that are maintenance day to day), “Kanban” (used to avoid the run out of supplies and to ensure that the oldest items are used first, eliminating waste due to expiration), “visual controls” (used to create a workplace where everything needed is displayed and immediately available) and “standardization” (used to identify and eliminate waste on processes, making the changes standard) can help any organization to implement Lean transformation. Furthermore, there are other tools like “Value Stream Map” (used to distinguish value-adding versus non-value-adding steps) that can be easily adapted to both health care operations and manufacturing processes.

In order to succeed with Lean in the healthcare environment is important that people involved understand what Lean means first. The Key concept is value, which is defined as the capability to deliver exactly the product or service a customer wants with the minimal time. For that reason, people involvement and support for front-line staff to make improvements is very important. Some employees tend to resist imposed change, but most employees will be ready to make changes that will improve their own work and efficiency.

Having achieved people involvement, the first step of the process is direct observation to understand what is going on the clinical area, to see how patients flow through the system and what obstacles and barriers are. Doing that we will understand what is truly valuable to patients, as well as establish whether or not what we are delivering is valuable.

Keeping this in mind, a good way to start implementing Lean tools is using a Value Stream Map. VSMs are easily adapted to most healthcare operations and are designed to distinguish value-adding versus non-value adding steps. In healthcare, a value-adding step would be a nurse’s interview to obtain important information from the patient, whereas a non-value adding step would be a patient waiting for doctor to arrive at the examination room. Once discovered the wastes is time to eliminate them and improve the processes. As we said before, Lean proposes several tools for eliminating waste. However, it is very important to underline that continuous improvement is needed in Lean and continued adoption and application of the tools will lead Lean becoming a standard way of solving problems.

VSM - Odense Hospital

Source: Linköping University. Department of management & engineering

Implementing all explained above, we will reach the 5 Lean principles in healthcare which are the following: specify value from the standpoint of the patient, identify the value stream to diagnose and treat the patient, enable patient to flow smoothly through every step, match capacity with demand and manage towards perfection

Implementing lean is a difficult task. Perseverance, high quality leadership, patience and dedicated professionals are needed. Scepticism and resistance will be high and success not guaranteed. However, Lean can really work in a healthcare environment and its application can improve quality, productivity and team working environment.


Ballé, M. and Regnier, A. (2007), “Lean as a learning system in a hospital ward”, Leadership in Health Services, Vol. 20 No. 1, pp. 33-41.

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.

Poksinska, B. (2012). Lean Healthcare, Lecture slides . Linköping University

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.

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