What if Everyone in Healthcare Applied the First Five Principles of Lean?

Posted on by CATALYSIS

Would healthcare be better if everyone understood and applied the five lean principles described in the book Lean Thinking? As part of our team development at the ThedaCare Center for Healthcare Value, several of us have embarked on the process of taking the Lean Bronze Certification examination. To prepare, we are studying the various books that are required reading. As I was reading Lean Thinking I was struck by how much of our current healthcare system goes against these five simple principles. 

Those workers that are enrolled in a company sponsored healthcare program have just experienced the annual open enrollment period when they learn the details of the costs and medical benefits that will be in effect for the next year. Each employee has to measure the Value of the benefits (Value = Quality / Cost) and how they will fit their individual circumstances. According to CMS, for 2016, the average cost will increase 7.5% for people in the healthcare exchanges while increases for employer sponsored insurance are higher, depending on your plan. But if you are paying more, will you receive better quality of care? Can you be 7.5% healthier, or will the healthcare industry continue to add costs without any additional value?  In the end, Value can only be defined by the customer, it needs to be something they are willing to pay for.

Value Stream
No one can view the patient experience as well as the patient. No one feels the pain, the waiting, the confusion, or the financial burden as the patient does. Healthcare leaders have worked hard measuring, simulating, and optimizing each step of the process, but better planning of the entire value stream would result in smoother flow throughout the healthcare system. Like the saying goes, you can learn a lot when you look from end to end.  For most Value Streams, waste usually occurs between process steps because of the legacy of our silo mentality.

This could be one of the more difficult lean principles to apply in healthcare. Patients are unpredictable. Sometimes you have an outbreak of health. And the opposite will clog up even the best designed system. To improve Flow one must look at ways to improve communication at each step of the patient process. Are there changes that can be made to eliminate waiting, rework or wasted motion?  Flow can also be improved when the patient experiences standardized processes and each care team uses the same approach. One modern issue with Flow is that we hide much of our information in computers – where it is difficult to see the flow!

In healthcare, Pull can refer to both patients and all the supplies that are needed for patient care. Much of our healthcare today is pushed – we tell the patients what to do and when, independent of their ability to comply. To create Pull for patients, some healthcare systems have made improvements by making sure that patients are able to get to appointments and that they are reminded not to miss them.  Having additional options available for patient visits like virtual or e-visits will help health systems meet patient demand.

On the supply side, many hospitals have a pull-to-demand system of supplies in place, but may lack a way to move those supplies to the point of use.

No healthcare worker wants to make a mistake. But the Journal of Patient Safety reported in 2013 that the number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. But for now, this crisis is not front page news. What would perfection look like in healthcare? Is it possible to have systems in place to catch errors before they occur, or have policies that prevent errors from happening in the first place?

Just because we are seeking perfection does not mean we will ever achieve it. The biggest gains in patient safety will be in the trying. Trying every day to eliminate waste, improve value, create flow, and improve pull, will keep getting us closer to perfection.

Radical changes are required and can save thousands of lives every year, and we now have many outstanding healthcare organizations to learn from. To help you learn about how to improve healthcare, John Toussaint, MD., has published a new book that outlines 11 healthcare organizations that have had success with these five and other lean principles.  Please read Management on the Mend available at Amazon, bookstores and at

Steven Bollinger
Product Director
ThedaCare Center for Healthcare Value

2 Responses to What if Everyone in Healthcare Applied the First Five Principles of Lean?

Mickey says: 12/16/2015 at 5:48 pm

The idea of incorporating these five lean principles into healthcare requires that we carefully examine what could be considered distinct manufacturing processes – in this case distinct processes in how medical services contribute to the production of health. One fundamental that seems to be common among these lean principles would seem to be consistency – a consistent process will produce a consistent outcome and by getting rid of inefficiencies and variability we can create reliable and consistent outcomes. For example, healthcare systems are already working to put into place practices that result in identifying appropriate individuals to vaccinate and then vaccinating each and every one of those individuals. We might rather consider that individuals undergoing diagnostic processes may be confronted with different diagnoses and thus be faced with a range of next options. If healthcare systems did not have to take into account the individual patient, which may include limitations the individual may possess in terms of the complexity of their health that may not allow for a single (standard) form of treatment or personal choices of the individual about the relationship of health to quality of life, then we could create a consistent response to each diagnostic outcome. What seems important to consider is not whether it is possible or desirable to apply the five lean principles to healthcare, rather we are likely to be most successful in recognizing where consistency is most desirable and focusing on the application of lean principles to those components of the overall healthcare system first.

Gerald Linnnins, Sr. Principal Consultant, Kaiser Permanente says: 03/07/2017 at 11:09 am

It is actually the sixth Lean Principle – RESPECT FOR PEOPLE DOING THE WORK – that has the greatest potential for improving healthcare. Learning to listen to frontline workers, clinicians, and support team members has a huge potential to impact the efficacy and efficiency of Healthcare. Patient centered care is only possible when those most patient-facing of our workforce are listened to, empowered to act, and supported/rewarded appropriately.


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