Lean Health Care

Lean Health Care is the application of Lean Enterprise to health care organizations. The emphasis is on optimizing the system, not the individual components comprising the system. Application of Womack’s Five Principles of Lean is a good place to start. These fall short of Lean Enterprise but are useful in having health care providers focus in on the key value-adding components of heath care, streamlining service delivery, improving cycle times, enhancing patient flow. The Five Principles of Lean are:

  • Specify value from the standpoint of the end customer by product family.
  • Identify all the steps in the value stream for each product family, eliminating whenever possible those steps that do not create value.
  • Make the value-creating steps occur in tight sequence so the product will flow smoothly toward the customer.
  • As flow is introduced, let customers pull value from the next upstream activity.
  • As value is specified, value streams are identified, wasted steps are removed, and flow and pull are introduced, begin the process again and continue it until a state of perfection is reached in which perfect value is created with no waste.
As useful as these principles are, they cannot be said to constitute an Lean Enterprise approach to health care (or anything else). What’s missing is the broader systems/lean thinking. Applying the Five Principles of Lean, therefore, results in a tools-oriented, piece-meal approach. Improvement activity is undertaken, but under a Command and Control Management Model that severely constrains improvement activity. In the end, performance gains are marginal, barely worth the investment, and what changes are made, gradually retreat into the old habits. The devastating effects command and control are detailed in our technical report The Decline of Health Services in Alberta.
To go Lean is to understand the thinking behind it–Systems Thinking. Lean Health Care and a transformation to a performance oriented health care organization only comes about when the tools of Lean are worked in combination with the Systems Thinking that gave rise to Lean.