What the Book “Lean Thinking” Said About Healthcare in 1996
When the book Lean Thinking (by Jim Womack and Dan Jones) was originally published in 1996, it seems likely that hardly anyone 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.”
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.
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?