Leading Lean: A Canadian Healthcare Leader's Guide

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Abstract:
Canadian healthcare organizations are increasingly asked to do morewith less, and too often this has resulted in demands on staff tosimply work harder and longer. Lean methodologies, originating fromJapanese industrial organizations and most notably Toyota, offer analternative - tried and tested approaches to working smarter. Lean,with its systematic approaches to reducing waste, has found its way toCanadian healthcare organizations with promising results. This articlereports on a study of five Canadian healthcare providers that haverecently implemented Lean. We offer stories of success but alsoidentify potential obstacles and ways by which they may be surmountedto provide better value for our healthcare investments.

                                                                                                            Virtually all healthcare systems face the same challenge: improving thequality of patient care, increasing the number of patients served andreducing wait times, while keeping spiralling costs in check. For many,it is difficult to imagine finding new opportunities to do more andbetter with less; yet such demands persist, and many organizations, infact, continue to succeed. Oneproven approach is Lean. As we show, once an organization is familiarwith Lean methodology, it takes no more than a few hours of observationon the front lines to uncover opportunities for improvement, such asrepeated laboratory orders, staff walking miles to find equipment andforms produced and never read. These non-value-added steps, called muda in Japanese and wastein English, impede the quality of care, increase wait times and costthe public money. Toyota pioneered Lean and has led the world indemonstrating its benefit. Lean thinking has propelled Toyota to becomethe world's most profitable automobile manufacturer and a leader inquality (May 2007).
While Lean was developed originally in theautomotive sector, it has spread across the manufacturing and theservice industries to companies such as Southwest Airlines, Alcoa andVanguard Insurance (Spear 2005). Recently, the healthcare industry hasdemonstrated success using these principles in the United States,United Kingdom, Australia and now Canada (Royal Bolton Hospital 2009;Bush 2007; Ben-Tovim et al. 2007; Foster 2007; Kim et al. 2006;Institute for Healthcare Improvement 2005). In healthcare, there is anopportunity to do more with less - if we can eliminate that waste. Thisopportunity is found in supporting front-line staff to identify andremove unnecessary steps from their everyday work. This is the essenceof Lean, and it has been employed in manufacturing industries fordecades. It is now becoming a critical tool for healthcare leaders(Macleod et al. 2008).
This article is intended to serve as apractical guide for healthcare leaders who may be considering usingLean approaches to value creation. We first introduce the concepts ofLean applied to healthcare and then document the Lean experiences andlessons of five Canadian hospitals.