Although the Lean business improvement methodology was initially developed to improve the quality and productivity of automotive factories, it has been used with great success in industries and settings of all types, including software development, government, retail, and other service settings.
Healthcare organizations, in particular, have found that the approach can be used to reduce costs and improve quality and patient satisfaction at the same time.
One of the core principles of Lean is the elimination of waste, which is defined as anything that doesn’t add value to the customer. Practitioners target eight specific types of waste (there were originally seven - more on that later). They are as common in healthcare as they are in manufacturing.
While defects in manufacturing are expensive and troublesome, in healthcare they can be deadly. They may include:
- Administration of incorrect medications
- Hospital acquired conditions
- Incorrect IDC codes
The waste includes the time spent creating a defect, reworking these defects, and inspecting these defects. Even though we consider inspection to be waste, we can't eliminate inspection altogether until we have a perfect defect-free process. Even Toyota still has final inspection in the year 2016... but they consider it to be waste that they'd hope to eliminate some day.
In manufacturing, waiting occurs when parts can't flow or when team members can’t perform their tasks due to problems, such as a lack of inventory or equipment failure. Waiting in healthcare is a problem for both patients and providers.
- Patients in waiting rooms (or exam rooms)
- Staff members with uneven workloads waiting for their next task
- Emergency department patients and physicians waiting for test results
- ED patients waiting to be admitted to the hospital
- Patients waiting to be discharged once medically ready.
The waste of transportation occurs when materials are moved around inefficiently. In healthcare it occurs when:
- Patients are moved from department to department or room to room
- Medication is moved from the pharmacy to where it is needed
- Supplies are moved from storage to the floor
Some of this transportation is considered "necessary" waste to be minimized, even if it can't be completely eliminated.
Overproduction in manufacturing results in excess "work in process" or unsold inventory of "finished goods." It is more difficult to spot in healthcare, but it occurs when providers do more than is needed by the customer at this moment. It includes:
- Unnecessary diagnostic tests
- Uneaten meals
- Ordering medications that the patient doesn’t need
- Peak staffing during non-peak hours
Over-processing means doing more work, making it more complex or more expensive than is necessary. It takes the form of:
- Ordering complex diagnostic imagery (MRI) when a simpler method would suffice (X-ray)
- Unnecessary paperwork
- Surgical intervention in lieu of an equally effective medical alternative
- Follow-up appointments that don’t improve patient outcomes
- Treatment by specialists that could be done by primary providers
Manufacturers have largely moved to a just-in-time approach to inventory in order to reduce costs related to storage, movement, spoilage and wastage. Healthcare organizations look to do the same as it relates to:
- Medication that may expire
- Overstocked consumables
- Pre-printed forms
- Excess bedside equipment
Motion refers to unnecessary movement of people within a facility or campus. This happens when:
- Office or hospital layout is not consistent with workflow
- Supplies are not stored where needed
- Equipment is not conveniently located
The first step in combating the wastes of Lean is recognizing them within your organization. For most, examining each of these specific frequent contributors to waste leads to the discovery of multiple opportunities for improvement. We can also strive to eliminate wasted motion (including clicks) in software systems.
Some early sources in the Lean literature refer to 7 wastes of Lean. In recent years, though, most publications have started referring to an eighth type of waste - failing to utilize people's talent or human potential. Examples include:
- Not listening to employees
- Pressuring people to hide and cover up problems
- People habitually working below their level of licensure