Application of lean thinking in health care: a role in emergency departments globally

Abstract

Lean management principles were first developed in the 1950s in the industrial setting of car manufacturing, and the first laboratory was the Toyota manufacturing plant. Further, Womack and Jones are credited in developing the field [1]. Over the past half a century, lean thinking has become more widely embraced, particularly in manufacturing and industrial settings. More recently, it has been recognized that other entities, including the service industries and health care, may be able to benefit substantially from the implementation of lean and other related methodologies, often broadly described as a “systems engineering” approach to health care [2]. Several years ago, the National Health Service of the UK began deploying lean thinking to hospital management, and this issue has a report from Banerjee et al. entitled “The impact of process re-engineering on patient throughput in emergency departments in the United Kingdom” [3]. Lean thinking has been characterized as “[seeking] to provide what the customer wants, quickly, efficiently, and with little waste” [4]. Womack and Jones have identified five key concepts of lean thinking, outlined below [1]. Value Products should be designed for and with customers, should suit the purpose, and be set at the right price. Value stream Each step in production must produce value for the customer, eliminating all sources of waste. The concept of waste is far-reaching and may include waiting, travel, mistakes, or inappropriate processing. Flow The system must flow efficiently, ideally without intermediate storage. Among other things, flow depends on materials being delivered, as and when they are needed, to the quality required. Pull The process must be flexible and geared to individual demands – producing what customers need when they need it. Perfection The aim is perfection. Lean thinking creates an environment of constant review, emphasizing suggestions from the “floor” and learning from previous mistakes. With the application of these principles to the health-care environment and specifically to emergency medicine, some reflection is required [5].