Healthcare IT & Transformation

LEAN Basics

What is Lean?
 

The concept called “lean management” or “lean thinking” is most commonly associated with Japanese manufacturing, particularly the Toyota Production System (TPS). Much of the TPS way of thinking focuses on improving productivity, eliminating waste, improving the quality of their products, and lowering manufacturing costs. Now these techniques are available to hospitals in the form of Lean Healthcare.
 

So what is meant by “lean thinking”? Simply put, lean means using less to do more.
 

The basic principles of Lean are:

• Add only value (eliminate waste)
• Concentrate on people who perform value-added activities
• Respond to customer demand (pull system)
• Optimize across the organization

But we’re not building a Toyota here!
To understand the use of a methodology in two seemingly unrelated industries, it is helpful to review the definition of a process. A process is a set of logically related tasks performed to achieve a defined outcome. When you view the goal as improving the process, the actual industry becomes less important. Lean thinking is not typically associated with health care, where waste — of time, money, supplies, and good will — is a common problem. But the principles of lean management can, in fact, work in health care in much the same way they do in other industries.
 

The core idea of lean involves determining the value of any given process by distinguishing value-added steps from non-value-added steps, and eliminating waste (or muda in Japanese) so that ultimately every step adds value to the process. To maximize value and eliminate waste, leaders in health care, as in other organizations, must evaluate processes by accurately specifying the value desired by the user; identifying every step in the process (or “value stream,” in the language of lean) and eliminating non-value-added steps; and making value flow from beginning to end based on the pull — the expressed needs — of the customer/patient.
 

Glossary of Lean Terms
5-S: Sort, Simplify, Sweep, Standardize, Self-Discipline: a visually-oriented system for organizing the workplace to minimize the waste of time.
Adequate: In value stream mapping, the capacity for any given step in a process is adequate if the process is not delayed at that step.
Available: In value stream mapping, a step in a process is available if it produces the desired output, not just the desired quality, every time.
Capable: In value stream mapping, a step in a process is capable if it produces a good result every time.
Cycle time: The time required for completing one step of a process.
Kaizen: Continuous, incremental improvement of an activity to create more value with less muda.
Lead time: The total time a patient must wait to receive a service after requesting the service. In service sectors, it is the time from the beginning of the process to the end (e.g., from when a patient arrives until he or she leaves the hospital).
Muda: Waste.
People distance: The distance staff must travel to accomplish their tasks.
Product distance: The distance products must travel to meet the customers’ needs.
Set-up time: All time spent getting ready to add value (e.g., time preparing a room for an office visit).
Trystorm: To generate and quickly try ideas, or models of ideas, rather than simply discuss them, as in brainstorming.
Value: A capability provided to the customer [patient] at the right time at an appropriate price, as defined in each case by the customer.
Value stream: The specific activities required to design, order, and provide a specific service — from concept launch to order to delivery into the hands of the customer [patient].
Value stream mapping: Identification of all the specific activities occurring along a value stream for a service.
Valuable: In value stream mapping, a step in a process is valuable if it creates value for the customer [patient].
Waste: Anything that does not add value to the final service, in the eyes of the patient; an activity the customer wouldn’t want to pay for if they knew it was happening.

One Response to “LEAN Basics”

1. beechhold Says:
   June 11th, 2007 at 12:41 pm

   Although statistics and the analysis of empirical data play a big role in LEAN thinking, the essence of LEAN is really communication. Deming’s seminal work, Out of the Crisis, brings better communication to the forefront of the transformation going on at LEAN companies. For example, when Deming says “drive out shame and blame,” he is clearly not referring to a statistical analysis. Of course, one could use low production numbers or high error rates, as information to berate one’s employees, but negative communication is the exactly the form of bad communication Deming seeks to eliminate. LEAN is all about working as a team to identify waste and errors, and focusing on the processes that produce waste. We should blame the process NOT the people, and constantly work to improve processes. Whether we rely on new semiotic systems or simply compose friendlier emails, we will be well on our way to building a truly LEAN system within our respective organizations.

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