152 ◾ Karl Kraebber
Figure 17.10 (Continued ) Example Visual Controls from St. John’s Hospital main operating
room.
Lean in Healthcare ◾ 153
Figure 17.11 St. John’s Hospital Birth Center Medication Room: 5S before and after.
154 ◾ Karl Kraebber
Figure 17.12 St. John’s Hospital Birth Center Clean Utility Area: 5S before and after.
Lean in Healthcare ◾ 155
4. Timely: 50% to 100% productivity improvement
5. Patient or customer centered: Increased patient satisfaction
6. Equitable: Standard work; reduce rework
Lean allows for continuous improvement, waste reduction, error proong, and employee
engagement in healthcare. Other benets of Lean in healthcare include improved patient and
provider satisfaction; shorter wait times for patients; elimination of delays for all stakeholders;
increased patient admissions and diagnoses; faster bed turn around; improved workplace orga-
nization, improved cleanliness and facility upkeep; better space and supply management; more
streamlined administration processes; more ecient patient record and appointment processes;
and timely delivery of care. Additional benets to the application of Lean to healthcare include
increased prots, increased time at the bedside for clinicians, reduction in errors and rework, and
inappropriate procedures are reduced. In short, Lean helps improve the quality and safety of care,
while reducing costs.
Lean systems are tried and true manufacturing and industrial engineering methodologies for
process improvement and waste elimination. e healthcare industry in the United States contin-
ues to be inecient and costly because of the large number of wasteful processes (e.g., redundant
registrations steps, patient transportation, and inventory management) found within hospitals
and health systems. e Lean methodology, under the watchful eyes of management engineers,
provides healthcare organizations with cost-eective and customer-focused strategies and tools for
waste reduction and quality improvement. e diculty with Lean systems in healthcare is not
the identication of Lean as a viable solution; it is the implementation of sustainable Lean systems.
A system is a network of interdependent components that work together to try to accom-
plish the aim of the system. A system must have an aim. Without an aim, there is no sys-
tem. A system must be managed. e secret is cooperation between components toward
the aim of the organization. We cannot aord the destructive eect of competition.
—W. Edwards Deming, e New Economics
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156 ◾ Karl Kraebber
Suggested Reading
Aherne, J. (2007). “ink Lean.” Nursing Management 13 (10): 13–15.
Allway, M, and Corbett, S. (2002). “Shifting to Lean Service: Stealing a Page from Manufacturers’ Playbooks.”
Journal of Organizational Excellence 21(2): 45–54.
Bhasin, S., and Burcher, P. (2006). “Lean Viewed as a Philosophy.” Journal of Management Technology 17(1):
56–72.
Black, J., and Miller, D. (2008). e Toyota Way to Healthcare Excellence: Increase Eciency and Improve
Quality with Lean. Chicago: HAP.
Chalice, R. (2007). Improving healthcare suing Toyota Lean production methods: 46 Steps for improvement (2
nd
Ed.). Milwaukee, WI: ASQ Quality Press.
Fry, H. M., ed. (2008). Advanced Lean inking: Proven Methods to Reduce Waste and Improve Quality in
Health Care. Oakbrook Terrace, IL: Joint Commission Resources.
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nd
ed. New
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Healthcare Performance Partners, “Kaizen,” http://leanhealthcareperformance.com/page.php?page=Kaizen
(accessed October 1, 2012).
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at Intermountain Healthcare.” Joint Commission Journal of Quality and Patient Safety 31(5): 249–257.
Kim, C.S., Spahlinger, D.A., Kin, J.M., and Billi, J. E. (2006). “Lean Health Care: What Can Hospitals
Learn from a World-Class Automaker?” Journal of Hospital Medicine 1(3): 191–199.
Liker, J. K. (2004). e Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer.
Chicago: McGraw-Hill.
Liker, J. K., and Morgan, J. M. (2006). “e Toyota Way in Services: e Case of Lean Product Development.”
Academy of Management Perspectives 20(2): 5–20.
Nelson-Peterson, D. L., and Leppa, C. J. (2007). “Creating an Environment for Caring Using Lean Principles
of the Virginia Mason Production System.” Journal of Nursing Administration 37(6): 287–294.
Porché, R. A., ed. (2006). Doing More with Less: Lean inking and Patient Safety in Health Care. Oakbrook
Terrace, IL: Joint Commission Resources.
Savary, L. M., and Crawford-Mason, C. (2006). e Nun and the Bureaucrat: How ey Found an Unlikely
Cure for America’s Sick Hospitals. Washington, DC: CC-M Production, Inc.
Varkey, P., Reller, M. K., and Resar, R. K. (2007). “Basics of Quality Improvement in Health Care.” Mayo
Clinic Proceedings 82(6): 735–739.
Zidel, T. G. (2006). “A Lean Toolbox: Using Lean Principles and Techniques in Healthcare.” Journal for
Healthcare Quality (Web Exclusive) 28(1): W1-7–W1-15.
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