Tuesday, 13 July 2010

Lean Healthcare

Believe it or not, before writing my rabid rantings, I often engage in a little research on the subject in hand, and during this process one of the phrases I keep coming across is “lean thinking” or “lean healthcare”.
Lean thinking is a managerial approach, first devised by Toyota, and defined here. I can see how these objectives might suit manufacturing industry but is it really suitable for healthcare delivery. To start with the phraseology, I have previously had a go at management jargon and I am afraid the phrase “improving flow and eliminating waste” sounds to me distinctly urological. And the phrase“ the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination” leaves me feeling distinctly uneasy.

The concept of lean thinking as applied to manufacturing industry, and some of the potential pitfalls are fully described here, but there is one phrase that for me stands out in this article. Waste (earmarked for elimination) is defined as “any (human) activity that absorbs resources but creates no value”. Now healthcare consumes vast amounts of resources, but creates absolutely nothing of value, as manufacturers understand the word. Value, in the context of healthcare is a nebulous and ill defined concept and may mean different things to different people.

This NHS web site is very positive about lean healthcare but the jargon runs thick. Just read points 1 to 5. What a load of shite, written by the NHS Institute for Innovation and Improvement. This quango is a prime example of an activity that absorbs resources but creates no value.

So lets have a look at one or two places where NHS Trusts have applied this philosophy. Bolton is one such. Just read this page, written by Ms Heather Edwards, head of communications in Bolton, extolling the virtues of lean healthcare. She seems not to have noticed that since they introduced lean healthcare Bolton has become one of the most lethal places for patients in Britain, with a 22% excess mortality. How do these people get away with such brazen mendacity.

Similarly deluded are these grinning fools trumpeting the success of lean healthcare at that shining example of success Airedale. Compare this with a more impartial view.

It seems to me that applying lean thinking to Healthcare is a recipe for disaster. Management do not seem to understand that that they are not running a factory for profit. The concept of lean healthcare is simply used as an excuse to slash staffing numbers to levels where patients can not properly be cared for. Because after all caring for patients creates nothing of value and is therefore a wasteful activity.


  1. We have had 'lean thinking' applied to our store room, now we have plenty of space. Unfortunately we do not actually have what we need when we need it and have to run around borrowing.
    We have also had a centralised stores foisted on us ( I think this is Scotland wide). Delivers once a week and if you have a rush on one particular item, tough. We end up haggling between wards, if you give us x we will give you y. No way to run a hospital.

  2. Babies and bathwater. I am persuaded that some elements of lean thinking are relevant.

    Many out-patient appointments and follow up home visits by nurses/health visitors result in no change from before to after the visit. If we're having these clinical contacts but they don't change anything in any meaningful sort of way, it's kind of obvious that they're not the best use of patient or staff time.

    Of course there's always the chance for opportunistic health promotion, carer support, information sharing etc but if purposeful activity isn't being progressed, there's a lot of contacts that seem to be "of poor value" in lean-speak.

    I think we can work smarter but I think paring everything back to a reductionist minimum defined human activity, in health, is madness.

    I've pink forms for folk who talk like that ;-)

  3. You say you did some research? Not every example of lean in healthcare is a disaster.

    Did you see this article in the NY Times?


    What GrumpyRN describes isn't a good example of Lean - read the NY Times piece and you'll read about how it's EASIER for nurses to find what they need. You shouldn't be running around borrowing things... that's not an improvement at all.

    You and I share frustration that people do all sorts of stupid things (like getting rid of supplies or mindless slashing staff) and they call it Lean, when it's really "bad thinking" instead of truly "lean thinking."


  4. I'm not a nice as Mark. What's full of shite is you. Your thinking is typical of far too many physicians who are only trained in medicine and don't understand basic management.

    The days of non-price competition are over. Whether a system is government controlled or private payer, the out of control rising cost is no longer acceptable. If you can't live with that, then you need to find another profession because it's not going to change in your lifetime.

    Surgeons can no longer insist on a dozen different suture materials being available in every OR when clinical data clearly shows there is no benefit. Nor can physicians demand 10 different kind of gloves for their personal preferences. Those are two examples of material waste among 1000's of similar inventory problems in hospitals. Poor work design and lack of systems thinking accounts for even more.

    Less than half of hospital physicians wash their hands before patient contact, yet they are the bastions of only doing what is right for the patient. Yeah, okay.

    It doesn't matter whether a hospital embraces "Toyota's" version of lean or another version. Waste in healthcare is costing far far too much.

    Didn't your Mum tell you when you were a kid, Waste not, want not. Or waste and want--save and have!

    Want a hospital to work in? Then you had better bother yourself with learning how to help it stay financially sound. If Bolton has 22% excess mortality, that has nothing to do with lean. It has everything to do with the government being in charge and doctors who don't give a shite enough to follow best practice protocols. That's probably the shite you're smelling.

    Well, Doctor Zorro, it sounds like you're part of the problem and intend on staying a roadblock! Good luck with that.