Health Transformation Blog
As many know, Lean approaches, developed more than forty years ago at Toyota, are continuing to appearing across the service industries for process efficiency and cost reduction. Hospitals have embarked on their use of Lean as well.
But are the lessons of this successful manufacturing company applicable to hospitals? The hospital is a very professional universe, which is different from a factory for several reasons:
- Duties are various and non-hierarchical
- There is often little to no shared vision between the various participants in measuring the performance of the hospital
- The activity of the hospital applies to individual products: each patient with their particular needs
- The relationship of the staff to the patient is radically different from the relation of the worker to his product
- The professions are tighter in evolving and in the distribution of duties.
Despite these differences, Lean provides a new way of thinking that can be an asset to a hospital. For example:
- Lean endeavors to make the choice of the quality criteria for the patient a factor in motivating all the staff at the hospital in the procedure for progress.
- The governance of Lean projects reflect the diversity of the responsibilities and professions in the reorganization of the processes.
In the end, we see Lean contributing value to the hospital setting along three dimensions:
- Expectations of patients at the center of the approach for improving the hospital (e.g., getting an appointment quickly, understanding the consequences of their treatment, knowing how long they will stay in hospital, being able to choose their meals, etc.). These become incentives for changing the organization of the hospital.
- Focus on improving the quality of the product or service by rigorously analyzing the causes for failure and checking the procedures for continuous improvement. Far from being opposed to striving for efficiency this practice to improve the quality (as perceived by the patient) results in improving the performance of the hospital.
- An approach supported by methodological tools which can be easily appropriated within the hospital by the various professions thereby pledging to the organization a commitment to perpetuate the new practice beyond an introductory project.
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As someone who moved from manufacturing to healthcare in 2005, I’d disagree with the “non-hierarchical” comment.
Hospitals are incredibly hierarchical in 2 ways:
1) Top down management structures and relationships
2) Informal hierarchy of MD > Nurse > Tech. Eventhough the MDs are typically not employees, it’s clear that the MD ranks above all and “jump when they say jump.” That’s not necessarily compatible with Lean and makes things difficult, to say the least.
But Lean *does* work in healthcare, I agree with the rest of what you say.
Mark, Thank you for the comment. I asked Antoine (the author of the posting) for his response. Antoine’s view given 25 years in hospital consulting work in France, is that your comment on hierarchical or not is strongly country dependent. His posting was written given France medical culture and he agreed that your comment is probably right for other countries. I personally find that interesting because my assumption had been that the most significant difference across the country boundaries was the methods and business models for reimbursement.
Since lean management in any organization including hospitals takes process improvement to a whole new level, dissolution of the conventional top down hierarchy , formal and informal, will then extract the most in the revenue stream. I am in agreement with the fundamental change in thinking that is much needed to incorporate change management with lean processes.
Thank you for outlining the aforementioned.
Rajat Dhameja