Application of lean thinking to health care: issues and observations.
BACKGROUND
Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.
Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnical improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles.


CONCLUSIONS
We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.
Joosten
Tom
T
Tranzo, Scientific Centre for Care and Welfare, Tilburg University, The Netherlands. t.c.m.joosten@uvt.nl
Bongers
Inge
I
Janssen
Richard
R
D017598:Efficiency, Organizational; D006739:Hospital Administration / Q000379:methods* / Q000592:standards; D006801:Humans; D015279:Organizational Culture; D017749:Total Quality Management / Q000379:methods* / Q000592:standards
Qual Saf Health Care. 2003 Dec;12 Suppl 1:i2-6
14645740
Am J Psychiatry. 2003 Dec;160(12):2080-90
14638573
Aust Health Rev. 2007 Feb;31(1):10-5
17266483
Leadersh Health Serv (Bradf Engl). 2007;20(1):33-41
20690474
BMJ. 1996 Mar 9;312(7031):619-22
8595340
BMJ. 2007 Mar 3;334(7591):455-9
17332585
Med Care. 1991 Dec;29(12):1212-25
1745079
Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(6-7):477-99
17100219
Int J Health Care Qual Assur. 2008;21(5):472-86
18785346
Leadersh Health Serv (Bradf Engl). 2007;20(4):231-41
20698096
Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):3-6, 1
18173161
Jt Comm J Qual Patient Saf. 2005 Jun;31(6):330-8
15999963
Anesthesiology. 2003 Jun;98(6):1491-6
12766663
J Health Organ Manag. 2006;20(6):512-24
17168103
J Occup Health Psychol. 2000 Apr;5(2):231-45
10784287
Int J Qual Health Care. 2007 Feb;19(1):4-7
17092958
Qual Saf Health Care. 2008 Oct;17(5):382-6
18842980
Qual Saf Health Care. 2003 Feb;12(1):53-7
12571346
J Nurs Adm. 2007 Jun;37(6):287-94
17563521