By August 14, 2013 4 Comments Read More →

What the Book “Lean Thinking” Said About Healthcare in 1996

Lean_ThinkingWhen the book Lean Thinking (by Jim Womack and Dan Jones) was originally published in 1996, it seems likely that hardly any was applying Lean principles in healthcare. Sure, you had organizations applying TQM or CQI principles (or even some of the lessons of Dr. W. Edwards Deming) and Joan Wellman did some of her first Lean healthcare experiments in 1995, but there weren’t any “Lean healthcare” case studies yet.

The book (with the same text in the original and updated editions) spends about two pages talking about the potential of Lean principles in healthcare. You can likely read the pages (289 and 290) through the Amazon “look inside” feature or possibly through Google Books (search for “medical care”).

What points did Womack and Jones make?

With increasingly specialized “centers of expertise” in healthcare, there are increasing demands to keep each of these silos “fully occupied.” This leads to long waits for patients, of course (and is a big problem, still, in 2013).

“How would things work if the medical system embraced lean thinking?”

First, Womack and Jones say “the patient would be placed in the foreground, with time and comfort included as key performance measures of the system.”

We see this increased focus on patient flow in settings ranging from Sami Bahri DSS to ThedaCare’s primary care to hospitals, large and small.

Second, they recommend that healthcare break down departmental functional structures and “reorganize much of its expertise into multi-skilled teams.”

We see this today in ThedaCare’s “collaborative care” model and in integrated cancer centers like the  Park Nicollet Frauenshuh Cancer Center (“where care comes to you”).

Another recommendation (to improve flow and cross-functional care) is to have “right-sized” equipment and facilities.

We see this in the decentralized clinic labs at ThedaCare and I saw similar thinking in Sweden with the “right sized” operating room in a cardiac unit.

Finally, Womack and Jones said the patient “would need to be actively involved in the process and up-skilled — made a member of the team — so that many problems can be solved through prevention or addressed from home.”

We see this patient engagement in the “e-Patient” community (and my friend “e-Patient Dave” deBronkart). We see the use of Lean thinking in “Patient Centered Medical Homes” like those run by Group Health Cooperative, which includes the use of telemedicine and electronic patient communication, as suggested in Lean Thinking.

What did Womack and Jones predict we would see with Lean healthcare:

  • Time and the number of steps required would “fall dramatically”
  • Quality of care should improve due to a reduced number of handoffs (less information lost)
  • Lower costs would free up research to find new cures

They ended the section by saying “most of today’s health care debate in the political arena is simply a cost shifting or service elimination contest as the various parties along the value stream try to defend their own interests at the expense of others.” Remember, this was the era of “HillaryCare,” not “ObamaCare.”

17 years later, how are we doing?

Thanks for reading! I’d love to hear your thoughts. Please scroll down to post a comment. Click here to receive posts via email.

Now Available – The updated, expanded, and revised 3rd Edition of Mark Graban’s Shingo Research Award-Winning Book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. You can buy the book today, including signed copies from the author.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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4 Comments on "What the Book “Lean Thinking” Said About Healthcare in 1996"

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  1. BD Patterson says:

    Just don’t try to involve the patient by wearing a button encouraging them to ask a question about hand hygiene. That’s the wrong kind of involvement/up-skilling.

  2. Jim Hudson says:

    Good article Mark. To add to your excellent writing, Joanne Poggetti and John Black, both of John Black and Associates were the first to apply Lean to healthcare in the mid 90s, before James Womack had published the book. In fact, Womack was in Japan on a tour at the same time Joanne and John were on the tour hosted by Awata, so it may well be that he got some of his ideas from them.

    Additionally, Joan Wellman learned to apply Lean thinking to healthcare as a result of working with John in the late 90s. And it was John Black and Associates who originally trained both Virginia Mason and then Park Nicollet, which is where Tina Hallberg worked before she joined JBA.

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