title: Application of lean thinking to health care: issues and observations.
abstract: 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.
authors.affiliation: Tranzo, Scientific Centre for Care and Welfare, Tilburg University, The Netherlands. t.c.m.joosten@uvt.nl
authors.forename: Tom
authors.initials: T
authors.lastname: Joosten
authors.forename: Inge
authors.initials: I
authors.lastname: Bongers
authors.forename: Richard
authors.initials: R
authors.lastname: Janssen
mesh_terms: D017598:Efficiency, Organizational; D006739:Hospital Administration / Q000379:methods* / Q000592:standards; D006801:Humans; D015279:Organizational Culture; D017749:Total Quality Management / Q000379:methods* / Q000592:standards
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