Lean Healthcare's Wayward Path: Following Dubious Lean Practices from Manufacturing

What is it about?

Aim: This article questions the tendency of lean in health care to follow practices from manufacturing that focus excessively on lean efficiency though waste elimination, and instead advises elevating its lean efforts toward customer-focused lean effectiveness, calling for quick, “queue-free” response and higher quality along the multiple flow paths leading to and involving patients. (Lean efficiency is contrasted with lean effectiveness in a two-part article by Schonberger, 2014.) Background: Lean methodologies, developed in Japan in the 1960s and 1970s, migrated to the West in the 1980s under the names just-in-time manufacturing and Toyota production system, renamed later as lean manufacturing, then lean management. Lean implementations in manufacturing were extended to manufacturing’s back-office functions, and onward to human services, including health care. Today lean in health care is widespread globally. Methods: This research draws from diverse published sources, supplemented by on-site investigations of lean implementations in health care, other services, and manufacturing. Findings come from hospitals prominent in lean health care today, and also include lean lessons from medical centers dating from the early 1990s and the 1980s. Results: Evidences and arguments support the aims of this article: that health care, with its ultra-short sight lines to its patient-customers, should pursue lean in its own way, rather than following the often wayward lean practices of manufacturing in which few people ever see a real customer. Among the many and confusing lean terms and methodologies that have grown apace within manufacturing, a short list—targeted primarily at minimizing queues and waiting times—should find their way to prominence within health care. Conclusion: Focusing lean on its benefits to patient-customers, with reduced emphasis on becoming efficient through waste elimination, should upgrade lean in the eyes of all parties in the health-care organization. That includes clinical staff, for whom lean can free up time for improved care; and senior executives, who may see lean, so-presented, as essential elements of long-term health-care strategy.

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