Some challenges facing Lean Thinking in healthcare

While improvement methods have delivered higher efficiency and better quality products, the question of applicability in healthcare is still clouded by uncertainty. Traditionally, there have been opposing views: on the one hand promoting large-scale industrial-type improvement to bring healthcare into the modern era and, on the other, arguing that people are not motor cars and that simplistic adoption will only exacerbate the extreme difficulties of delivering uniform, high-quality, care within tight resources to populations whose expectations continue to rise. Lean Thinking originated with Taiichi Ohno [1], focused initially on operations management. Laursen et al. [2] describe how Lean Thinking reached operations around 1992, services around 1996 and the medical domain in the early 2000s. Its five steps to improvement are based on the concept of producers who create value 'in terms of specific products with specific capability offered at specific prices through a dialogue with specific customers' [3]. Value stream mapping of end-to-end process shows up activities that do not add Value, while products should flow smoothly from process to process without delay or waste, tackling obvious waste (e.g. repeat activities) and hidden waste (e.g. cost of managing inventories). Pull and the quest for perfection complete the quintet [3]. As global healthcare expenditure soars above $3.2 trillion [4, 5], and as systems are increasingly required to deliver better care to more people using less resource, the challenge to explore the promises of Lean Thinking is compelling. Lean Thinking is now widely recognized in care delivery circles around the world and there is a growing corpus of good news stories, guides and journal papers. As we show elsewhere [6], the adoption trend for Lean in healthcare appears to involve ad hoc practice, and so the fact that Lean approaches are widely articulated need not indicate that the process is particularly or exclusively Lean. Staff may, for instance, be describing an improvement initiative generally understood to be within the spirit of Lean. Having said that, there is evidence that improvement methods are bedding down in healthcare. To bring some focus to what is a fast-moving and perhaps blurred scene, we identify three critical challenges that face Lean if it is to be more widely applied in a more discriminating fashion by delivery communities around the world: evidence , value and metrics. Evidence Adoption of new practices in healthcare is more related to evidence than is the case in managing a factory. In …