Going lean ihi

Innovation Series 2005

Going Lean in Health Care

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We have developed IHI’s Innovation Series white papers to further our mission of improving the quality and value of health care. The ideas and findings in these white papers represent innovative work by organizations affiliated with IHI. Our white papers are designed to share with readers the problems IHI is working to address; theideas, changes, and methods we are developing and testing to help organizations make breakthrough improvements; and early results where they exist.

Copyright © 2005 Institute for Healthcare Improvement All rights reserved. No part of this paper may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage orretrieval system, without written permission from the Institute for Healthcare Improvement.
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Innovation Series 2005

Going Lean in Health Care

This paper is based on presentations made by thefollowing experts during an IHI Calls to Action Series in January and February 2005:
James P. Womack, PhD: Founder and President, Lean Enterprise Institute Arthur P. Byrne, MBA: Operating Partner, JW Childs Associates LLC Orest J. Fiume, MS: Co-author, “Real Numbers: Management Accounting in a Lean Organization” Gary S. Kaplan, MD, FACP, FACMPE: Chairman and CEO, Virginia Mason Medical Center JohnToussaint, MD: President and CEO, ThedaCare, Inc. Editor: Diane Miller, MBA:

Director, IHI

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Innovation Series: Going Lean in Health Care

Executive Summary Lean management principles have been used effectively in manufacturing companies for decades, particularly in Japan. The Institute for Healthcare Improvement believes that lean principles can be — indeed, already are being —successfully applied to the delivery of health care. Lean thinking begins with driving out waste so that all work adds value and serves the customer’s needs. Identifying value-added and non-value added steps in every process is the beginning of the journey toward lean operations. In order for lean principles to take root, leaders must first work to create an organizational culture that is receptive to leanthinking. The commitment to lean must start at the very top of the organization, and all staff should be involved in helping to redesign processes to improve flow and reduce waste. Although health care differs in many ways from manufacturing, there are also surprising similarities: Whether building a car or providing health care for a patient, workers must rely on multiple, complex processes toaccomplish their tasks and provide value to the customer or patient. Waste — of money, time, supplies, or good will — decreases value. Examples in this paper of lean thinking in health care demonstrate that, when applied rigorously and throughout an entire organization, lean principles can have a positive impact on productivity, cost, quality, and timely delivery of services.

© 2005 Institute forHealthcare Improvement

Institute for Healthcare Improvement Cambridge, Massachusetts

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Introduction The concept called “lean management” or “lean thinking” is most commonly associated with Japanese manufacturing, particularly the Toyota Production System (TPS). Much of the TPS way of thinking is based on the work of quality guru W. Edwards Deming, who taught, among other things, thatmanagers should stop depending on mass inspection to achieve quality and, instead, focus on improving the production process and building quality into the product in the first place. So what is meant by “lean thinking”? Simply put, lean means using less to do more. Lean thinking is not typically associated with health care, where waste — of time, money, supplies, and good will — is a common...