The Current State of Lean Implementation in Health Care: Literature Review

Purpose: The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. Design/Methodology/Approach: A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Findings: Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

[1]  R J Lilford,et al.  Top-rated British business research: has the emperor got any clothes? , 2003, Health services management research.

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

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

[4]  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.

[5]  Marjorie M Godfrey,et al.  Creating a lean practice. , 2006, Family practice management.

[6]  Susan Scachitti,et al.  ADAPTATION OF LEAN METHODOLOGIES FOR HEALTHCARE APPLICATIONS , 2007 .

[7]  S I McClean,et al.  A critical look at Lean Thinking in healthcare , 2008, Quality & Safety in Health Care.

[8]  Melissa L Dougherty,et al.  Redesigning care at the Flinders Medical Centre: clinical process redesign using “lean thinking” , 2008, The Medical journal of Australia.

[9]  Kate Silvester,et al.  NHS Modernisation Agency's way to improve health care , 2004, BMJ : British Medical Journal.

[10]  J. Klein,et al.  Using industrial processes to improve patient care , 2004, BMJ : British Medical Journal.

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

[12]  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.

[13]  P. Hines,et al.  Learning to evolve: A review of contemporary lean thinking , 2004 .

[14]  Sylvia Mobley Joyce Shelest Becky Bushell,et al.  Column: Site Visit: Discovering Lean Thinking at Progressive Healthcare , 2002 .

[15]  Steven J Spear,et al.  Fixing health care from the inside, today. , 2005, Harvard business review.

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

[17]  Andreas Hellström,et al.  Process management in healthcare: investigating why it's easier said than done , 2010 .

[18]  Sabi Singh,et al.  Application of lean manufacturing techniques in the Emergency Department. , 2009, The Journal of emergency medicine.

[19]  Y. Sugimori,et al.  Toyota production system and Kanban system Materialization of just-in-time and respect-for-human system , 1977 .

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

[21]  Edwin M. Bartee,et al.  Organizational Development: Theory, Practice, and Research , 1979 .

[22]  J. Bahensky,et al.  Lean sigma--will it work for healthcare? , 2005, Journal of healthcare information management : JHIM.

[23]  Jennifer L Condel,et al.  Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods. , 2006, American journal of obstetrics and gynecology.

[24]  Steven J Spear,et al.  Fixing Healthcare from the Inside: Teaching Residents to Heal Broken Delivery Processes As They Heal Sick Patients , 2006, Academic medicine : journal of the Association of American Medical Colleges.

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

[26]  David Bamford,et al.  New Development: Using Lean Techniques to Reduce Radiology Waiting Times , 2007 .

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

[28]  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.

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

[30]  Kajsa Lindberg,et al.  Curing a meagre health care system by lean methods--translating 'chains of care' in the Swedish health care sector. , 2004, The International journal of health planning and management.

[31]  門田 安弘,et al.  Toyota production system : practical approach to production management , 1983 .

[32]  Thanos Papadopoulos,et al.  Stakeholder Network Dynamics and Emergent Trajectories of Lean Implementation Projects: A Study in the UK National Health Service , 2008 .

[33]  Jacob S. Hacker Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America’s Largest Service Industry , 1997 .

[34]  Anthony Manos,et al.  Make healthcare Lean , 2006 .

[35]  Anita L. Tucker,et al.  Why Hospitals Don't Learn from Failures: Organizational and Psychological Dynamics That Inhibit System Change , 2003 .

[36]  Ross Stolle,et al.  It's not easy being lean, but scripting can help. , 2007, Health management technology.

[37]  Matthew R. Herasuta A “Lean” Laboratory , 2007 .

[38]  Zoe J. Radnor,et al.  Editorial: Lean in Public Services—Panacea or Paradox? , 2008 .

[39]  Robert J Weber,et al.  Pittsburgh Regional Healthcare Initiative: a systems approach for achieving perfect patient care. , 2003, Health affairs.

[40]  Regina E. Herzlinger,et al.  Market Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry , 1996 .

[41]  John Johansen,et al.  Applying Lean Thinking in Hospitals - Exploring Implementation Difficulties , 2003 .

[42]  Rachna Shah,et al.  Defining and developing measures of lean production , 2007 .

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

[44]  Marjorie M. Godfrey,et al.  Creating a lean , 2006 .

[45]  Gary S Kaplan,et al.  Seeking perfection in healthcare. A case study in adopting Toyota Production System methods. , 2008, Healthcare executive.

[46]  Jostein Pettersen,et al.  Defining Lean Production : Some conceptual and practical issues , 2008 .

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

[48]  Joe Aherne Think lean: Joe Aherne explains the advantages of educating healthcare staff in the principles and practices of lean thinking , 2007 .

[49]  Daniel Roos,et al.  The machine that changed the world : the story of lean production , 1991 .

[50]  Jeffrey K. Liker,et al.  Becoming lean : inside stories of U.S. manufacturers , 1997 .

[51]  James P. Womack,et al.  Lean Thinking: Banish Waste and Create Wealth in Your Corporation , 1996 .

[52]  Sharon J. Williams,et al.  CANDO: implementing change in an NHS Trust , 2005 .