Lean Principles for Healthcare

Abstract

Lean thinking, which developed from lean manufacturing or the Toyota Production System, is centred around elimination of waste and preserving value. Lean became especially important, some may go so far to say a fad, in manufacturing in the 1990s. So why in the twenty-first century might the principles of lean be relevant to healthcare? In order to understand this, we need to recognise that healthcare delivery today is facing many pressures much like much of the manufacturing industries in the 1990s. The following serves to introduce key concepts that fall within taking a lean philosophy and explore how/why they might be relevant to healthcare.

1 Introduction

Healthcare delivery today throughout the world is in a conundrum. Escalating costs, ageing populations, increase in chronic diseases and growth in medical technology solutions are some of the major challenges with which all healthcare systems must contend. Governments, policy makers and clinicians are all in agreement that healthcare reform is necessary and new strategies, protocols and procedures are required if healthcare delivery is to in fact provide appropriate access, quality and value to patients and the community at large. Most are turning to ICT (information communications technologies) as the silver bullet. However, this is only part of the solution. The other part of the solution lies in the embracement of leading management principles and techniques which support and enable lean thinking and value creation and generation. The following serves to introduce the key concepts in lean thinking as relevant for healthcare.

2 TQM and Kaizen

Integral to lean manufacturing are the concepts of total quality management (TQM) and Kaizen. Both concepts focus on continuous improvements, the importance of process and performance to achieve positive outcomes and the key role of people. TQM is a philosophy (Deming 1986) while Kaizen is a technique. The later tends to focus on quality and customer satisfaction, while the latter takes a top-down approach and focuses on small incremental stages.

2.1 TQM

While there are many definitions of TQM, simply stated TQM is a continuous quality improvement approach (Nawar 2008). It has also been described as a total organisation approach (Oakland 1993), an effort to improve the whole organisation’s competitiveness, effectiveness and structure (Dale 1999) and requires the mutual co-operation of management, employees, suppliers and customers (Dale 1999). Many scholars and proponents (Deming 1986; Juran 1993; Scholtes 1992) have noted that TQM and more especially a quality focus are important for long-term success.

TQM can be thought of as having a soft side and a hard side or the tools of TQM. Table 1.1 depicts the soft aspects of TQM while Table 1.2 summarises the key tools which make up the hard side.

Table 1.1 Soft aspects of TQM

Table 1.2 Hard aspects of TQM (adapted from Saleem et al. 2012)

2.2 Kaizen

In contrast to TQM Kaizen is a technique (Imai 1986, 1997). Kaizen means continuous improvement and assumes managers and employees work together to achieve this and such efforts do not require tremendous resources.

The key elements of Kaizen include:

• 1. Team work

• 2. Personal discipline

• 3. Improved morale

• 4. Quality circles

• 5. Suggestions for improvement

• 6. Elimination of wastes and inefficiency

• 7. The 5S framework (Saleem et al. 2012): (1) Seiri (sorting out), (2) Seiton (systematic arrangement), (3) Seiso (spic and span), Seiketsu (standardising) and Shitsuke (self-discipline)

These aspects are all captured in Fig. 1.1.

Fig. 1.1

Elements of Kaizen

In addition to the elements of Kaizen, Kaizen techniques can be applied at three different levels:

• 1. Individual vs. team

• 2. Day to day vs. special events

• 3. Process level vs. subprocess level

Finally, there exist several tools that can be employed in order to ensure the Kaizen technique ensues. Table 1.3 provides a comprehensive list of these tools.

Table 1.3 Kaizen tools and techniques

3 Six Sigma and Constraints Management

In addition to the philosophy of lean and the techniques of Kaizen, other complementary management methodologies and theories include six sigma and constraints management. The following briefly looks at each in turn.

3.1 Six Sigma

Six sigma has emerged as a primary vehicle for improving both manufacturing and service processes (Inozu et al. 2012). Specifically, “six sigma is a rigorous and systematic methodology that utilises information (management by facts) and statistical analysis to measure and improve a company’s operational performance, practices and systems by identifying and preventing ‘defects’ in manufacturing and service-related processes in order to anticipate and exceed expectations of all stakeholders to accomplish effectiveness” (Inozu et al. 2012, p. 20). A five-step define-measure-analyse-improve-control (DMAIC) methodology is used where each step outlines distinct and key activities that must be performed as follows:

• 1. Define the business issue.

• 2. Measure the process.

• 3. Analyse the data and verify root causes of variation.

• 4. Improve the process.

• 5. Control the process and sustain improvements.

Six sigma has the power to save healthcare millions of dollars. Usually this is achieved by combining the key components of six sigma with one of the major principles of lean, namely, the seven deadly wastes. Table 1.4 outlines the deadly wastes and how they relate to healthcare.

Table 1.4 The seven deadly wastes of lean

3.2 Constraints Management

The last complementary methodology that will be presented in this chapter is that of constraints management. Constraints management is made up of a suite of techniques used in operations and supply chain management. The key being to enable a systematic approach to manage complex organisations by identifying and controlling key leverage points within the system. Some of the basic constraint types include:

• 1. Market

• 2. Resources

• 3. Materials

• 4. Supplier/vendor

• 5. Financial

• 6. Knowledge/competence

• 7. Policy

For healthcare this involves looking at the five focussing steps. These steps are presented in Table 1.5.

Table 1.5 Focusing steps of constraints management (adapted from Inozu et al. 2012)

4 Discussion and Conclusions

Healthcare delivery today is under pressure to deliver high-quality outcomes, contain costs as well as contend with other challenges such as increase in chronic diseases and the impact of technology advances on healthcare delivery. All are agreed that healthcare reform is necessary, and we are witnessing in all OECD countries a focus on healthcare reform with a key enabler being e-health. The preceding has introduced the principle of lean thinking and other complementary concepts all aimed at effecting more efficient and effective operations to ensue. These tools and techniques have proved their value in the manufacturing sector. It is the thesis of this book that they are as important for and can facilitate the attainment of superior healthcare delivery. It is therefore essential that practitioners and researchers alike try to embrace lean principle and related concepts as they set about designing and developing new healthcare initiatives.