Experience of implementing lean thinking in an Indian healthcare institution

Purpose The purpose of this study is to document the experience and impact of implementing lean thinking (LT) in an Indian healthcare institution. Design/methodology/approach A detailed review of literature documenting the experience of implementing LT in healthcare institutions is carried out. Review revealed that there is a dearth of documentation on implementation of LT in Indian healthcare institutions. To address this gap, the experience of implementing LT in an Indian case hospital is documented by adopting a single case study research methodology. Findings Lean practices adopted by the Indian case hospital are documented. Performance measures before and after implementation of lean practices in the case hospital are compared. Based on this experience, a framework for implementing LT is proposed for healthcare institutions. Research limitations/implications The current study documents the experience of an Indian case hospital, which is only at its initial stages of LT implementation. Future studies can be undertaken to assess the long-term impact of implementing LT in a healthcare institution. Similarly, the proposed framework for implementing LT can be validated by using the same in different healthcare institutions. Practical implications Review of lean principles, practices and performance measures discussed in the literature on implementing LT in healthcare institutions can act as a ready reckoner for practitioners. Framework proposed based on the experience of the case hospital is expected to guide healthcare practitioners in their lean journey. Originality/value This study is unique, as it documents the experience of implementing LT in an Indian healthcare institution and proposes a framework for implementing LT for future validation.

[1]  Ann Esain,et al.  Combining Planned and Emergent Change in a Healthcare Lean Transformation , 2008 .

[2]  Thomas J Persoon,et al.  Improving preanalytic processes using the principles of lean production (Toyota Production System). , 2006, American journal of clinical pathology.

[3]  Zoe J. Radnor,et al.  Learning to Walk Before We Try to Run: Adapting Lean for the Public Sector , 2008 .

[4]  A. Gurumurthy,et al.  A case study on downstream supply chain of an Indian alcoholic beverage manufacturer , 2015 .

[5]  Nicolaj Siggelkow Persuasion with case studies , 2007 .

[6]  Zoe Radnor,et al.  Evaluating Lean in healthcare. , 2013, International journal of health care quality assurance.

[7]  Walter Sermeus,et al.  Efficacy and efficiency of a lean cataract pathway: a comparative study , 2010, Quality and Safety in Health Care.

[8]  Christopher S Kim,et al.  Lean health care: what can hospitals learn from a world-class automaker? , 2006, Journal of hospital medicine.

[9]  Rachel Harvey,et al.  Lean information management: the use of observational data in health care , 2009 .

[10]  Jennifer Towne Going 'lean' streamlines processes, empowers staff and enhances care. , 2006, Hospitals & health networks.

[11]  Durward K. Sobek,et al.  Reducing waste and errors: piloting lean principles at Intermountain Healthcare. , 2005, Joint Commission journal on quality and patient safety.

[12]  Melissa L Dougherty,et al.  Lean thinking across a hospital: redesigning care at the Flinders Medical Centre. , 2007, Australian health review : a publication of the Australian Hospital Association.

[13]  Pamela Mazzocato,et al.  Lean thinking in healthcare: a realist review of the literature , 2010, Quality and Safety in Health Care.

[14]  Elaine J Huggins,et al.  Lean Methodology: Supporting Battlefield Medical Fitness by Cutting Process Waste , 2010, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[15]  Jens J. Dahlgaard,et al.  Quality and lean health care: A system for assessing and improving the health of healthcare organisations , 2011 .

[16]  E. Dickson,et al.  Use of lean in the emergency department: a case series of 4 hospitals. , 2009, Annals of emergency medicine.

[17]  K. Eisenhardt Building theories from case study research , 1989, STUDI ORGANIZZATIVI.

[18]  Luciano Brandão de Souza,et al.  Trends and approaches in lean healthcare , 2009 .

[19]  Michael Pidd,et al.  Exploring the barriers to lean health care implementation , 2011 .

[20]  M. A. S. Monfared,et al.  Structural Properties and vulnerability of Iranian 400kv Power Transmission Grid: a Complex Systems Approach , 2013 .

[21]  P. Gabow,et al.  A broad and structured approach to improving patient safety and quality: lessons from Denver Health. , 2011, Health affairs.

[22]  John Toussaint,et al.  Writing the new playbook for U.S. health care: lessons from Wisconsin. , 2009, Health affairs.

[23]  Sylwia Męcfal Recenzja książki. Robert K. yin, Case Study Research. Design and Methods (fourth Edition), thousand Oaks, CA: Sage Publications, 2009 , 2012 .

[24]  Shreeranga Bhat,et al.  Application of Lean Six Sigma methodology in the registration process of a hospital , 2014 .

[25]  D. Fillingham Can lean save lives? , 2007, Leadership in health services.

[26]  David Ollier Weber,et al.  Toyota-style management drives Virginia Mason. , 2006, Physician executive.

[27]  Lisa Cox,et al.  Improving emergency department efficiency by patient streaming to outcomes-based teams. , 2007, Australian health review : a publication of the Australian Hospital Association.

[28]  J. J. Dahlgaard,et al.  Measuring lean initiatives in health care services: issues and findings , 2006 .

[29]  D. King,et al.  Redesigning emergency department patient flows: Application of Lean Thinking to health care , 2006, Emergency medicine Australasia : EMA.

[30]  Roger Moser,et al.  Indian healthcare value chain – status quo not a sustainable solution , 2017 .

[31]  Simon Bishop,et al.  Lean healthcare: rhetoric, ritual and resistance. , 2010, Social science & medicine.

[32]  Djoko Setijono,et al.  Decision support system and the adoption of lean in a Swedish emergency ward , 2010 .

[33]  G. Widdershoven,et al.  Lean leadership: an ethnographic study. , 2015, Leadership in health services.

[34]  Dana L Nelson-Peterson,et al.  Creating an Environment for Caring Using Lean Principles of the Virginia Mason Production System , 2007, Journal of Nursing Administration.

[35]  Richard Miller,et al.  Utilizing lean tools to improve value and reduce outpatient wait times in an Indian hospital. , 2015, Leadership in health services.

[36]  Olga Matthias,et al.  Implementing operations strategy through Lean processes within health care , 2016 .

[37]  Nuri Özgür Doğan,et al.  Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital , 2016 .

[38]  Matthew B. Miles,et al.  Qualitative Data Analysis: An Expanded Sourcebook , 1994 .

[39]  Zoe Radnor,et al.  Implementing Lean in Health Care: Making the Link Between the Approach, Readiness and Sustainability , 2009, International Journal of Industrial Engineering and Management.

[40]  A. Chiarini,et al.  TQM and lean strategy deployment in Italian hospitals. , 2016, Leadership in health services.

[41]  Zoe Radnor,et al.  The role of actor associations in understanding the implementation of Lean thinking in healthcare , 2011 .

[42]  Christopher S Kim,et al.  The application of lean thinking to the care of patients with bone and brain metastasis with radiation therapy. , 2007, Journal of oncology practice.

[43]  Jill Maben,et al.  Implementing large-scale quality improvement: lessons from The Productive Ward: Releasing Time to Care. , 2012, International journal of health care quality assurance.

[44]  S. Wood,et al.  Thinking Lean: Implementing DMAIC Methods to Improve Efficiency Within a Cystic Fibrosis Clinic , 2011, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[45]  Hoangmai H Pham,et al.  Redesigning care delivery in response to a high-performance network: the Virginia Mason Medical Center. , 2007, Health affairs.

[46]  A. Gupta Medical tourism in India: winners and losers. , 2008 .

[47]  Guilherme Luís Roehe Vaccaro,et al.  Lean healthcare supply chain management: minimizing waste and costs , 2014 .

[48]  L. Berry,et al.  The promise of Lean in health care. , 2013, Mayo Clinic proceedings.

[49]  P. Tsasis,et al.  Organizational change through Lean Thinking , 2008, Health services management research.

[50]  A. Gurumurthy,et al.  Leanness assessment: a literature review , 2016 .

[51]  J. Connell Medical tourism: Sea, sun, sand and … surgery , 2006 .

[52]  Angel Díaz,et al.  Improving healthcare services: lean lessons from Aravind , 2012 .

[53]  Michael Ballé,et al.  Lean as a learning system in a hospital ward. , 2007, Leadership in health services.

[54]  V. Roger,et al.  From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability. , 2014, Health affairs.

[55]  H. Meyer Life in the 'lean' lane: performance improvement at Denver Health. , 2010, Health affairs.

[56]  Cathie Furman,et al.  Applying the Toyota Production System: using a patient safety alert system to reduce error. , 2007, Joint Commission journal on quality and patient safety.

[57]  G. Rees New Zealand Organisational readiness and Lean Thinking implementation : Findings from three emergency , 2014 .

[58]  John Toussaint,et al.  Mistake-proofing healthcare: Why stopping processes may be a good start , 2010 .

[59]  Wayne L Feyereisn,et al.  Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine, Mayo Clinic , 2008, Health services management research.

[60]  Rachna Shah,et al.  Explaining Anomalous High Performance in a Health Care Supply Chain , 2008, Decis. Sci..

[61]  Kathleen M. Eisenhardt,et al.  Theory Building From Cases: Opportunities And Challenges , 2007 .

[62]  Oswaldo Luiz Agostinho,et al.  Lean office in health organization in the Brazilian army , 2015 .