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Topic Title: Lean thinking in healthcare
Topic Summary: I need help to find the best starting point to apply lean thinking in hospital
Created On: 05/04/2016 08:40 PM
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05/08/2016 09:31 PM
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Mutwalli
Ebtihal Mutwalli



I am conducting research into possible applications of lean thinking within a public sector hospital. This institution has already incorporated ERP in the HR department and has some employees in the Quality Department who have some knowledge of lean six sigma. This demonstrates some level of receptiveness to lean thinking of course.
Can anyone help me to find the best starting point?
Can I start with a survey that is designed to better understand and evaluate the current state? IF yes, then:
. Is it better to begin at the operational level, or strategic level?
. Is it preferable to begin with the patients so that I can glean a fuller picture from the service users?
. Or is it better to start with the healthcare providers; i.e. the doctors and nurses etc.? Or with the managers?
. Is there any guidance (including books or journal articles) that might help me in making this choice?
Is it best to try to identify waste first, so that I can help to eliminate it?
Are there any specific texts that would help to better understand the whole of lean philosophy?
05/11/2016 04:34 PM
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EAdel1023
Emily Adelgren



A survey on current state would be a good start. I would start at the strategic level interviewing the C Suite on their knowledge of lean and lean culture (do they know what it is? There will be your first sign on what to do next), and construct it in a way that would get at the heart of their willingness to adopt the philosophy and practices (if they know what it is). Next it would be middle management, providers, staff. Has there been organization wide education (white or yellow belt type curriculum)?

These seem like two very different topics and I am curious about your role in the organization. You are probing about research, which leads me to wonder if you are doing a study, and then there is a comment about identifying waste, which is executing lean. Are you charged with studying or executing?
05/13/2016 10:20 AM
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Mutwalli
Ebtihal Mutwalli



Thank you for your suggestion, that is helpful. I am indeed starting where you suggest. I don't have a role inside the organisation, I am just carrying out research. As such, I am simply studying and making recommendations, rather than actually having to execute any possible changes.
05/17/2016 07:15 AM
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22767
Sam Tomas



This very extensive article may help. It also has a very large list of reference articles.

Application of lean thinking to health care: issues and observations.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742394/


Sam Tomas
05/19/2016 07:16 AM
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304369
Keith Lodahl



I haven't read that article and will when I have time, but be aware that it was published seven years ago, and health care Lean has morphed a bunch in the past seven years.
02/27/2017 10:32 AM
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AaronHunt
Aaron Hunt



Lean in Healthcare:

Understanding the overall concepts of Lean Philosophy:

Lean Hospitals by Mark Graban
Creating a Lean Culture by David Mann.

More specific texts on healthcare implementation:
Beyond Hereos - Kim Barnas
Power of Ideas to Transform healthcare - Steve Hoeft
On the Mend - Dr. John Toussaint

Other resources:
Leanblog.org
createvalue.org

Regarding a starting point: Assess executive-level support. That is probably the most significant preliminary indicator of potential for lean to deliver benefits. Is the executive staff willing to lead differently? Lean works everywhere, but it's not magic; the organization must still do the learning and the work of creating the change they want to be.
02/27/2017 10:32 AM
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DanielMunoz
Daniel Munoz



That is a great article! Loved it.

I have a tough issue regarding standarisation in order to delegate to lower levels of health workers: legislation. In most countries legislation requires highly specialized doctors to perform certain tasks that are easily delegated. How have you dealed with rigid and often mindless legal constraints regarding how medicine must be done?
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