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Surplus supplies and medications, superfluous equipment, extraneous data, or stockpiles of pre-printed forms all translate to inventory waste. Moreover, excessive inventory increases the risk of loss from being stolen or becoming obsolete. Employees throughout the organization can be trained to recognize excessive inventory and find novel ways to decrease it. Healthcare-acquired conditions such as blood clots and infections, medication or surgical errors , avoidable readmissions, preventable allergic reactions, incomplete or erroneous medical records all illustrate defect waste in healthcare.

Transportation — Decrease the Movement of Patients, Supplies, and Equipment to Improve Patient Flow Transportation waste in healthcare involves moving people, supplies, and medical equipment unnecessarily. Transporting patients to different departments and running around to gather supplies also increase the risk of patient or caregiver injury defect waste and create delays in care waiting waste.

Lean thinking can be used to analyze patient and caregiver movement through the hospital facility to save time, reduce injury, and improve patient flow. Prevent Injuries and Save Time by Reducing Motion Waste in motion occurs whenever hospital workers perform movement within their workspace that does not add value for patients. Reaching or stooping for frequently used supplies and equipment, increased walking due to poor building design, or non-ergonomic patient transfers between beds, wheelchairs, or operating tables are potential instances of motion waste.

Maximize Resources by Minimizing Healthcare Overproduction Overproduction waste entails redundancies, creating too much of something, or creating it at inappropriate times.


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Preparing medications for a discharged patient, duplication of tests, or extending hospital stays beyond medical necessity are all examples of overproduction that healthcare organizations can tackle. Remove Waste from Over-Processing Over-processing occurs when unnecessary work goes into treating patients.

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Needless tests, filling out different forms with the same information, and performing data entry in more than one system are examples. When time, effort, and resources do not add to the quality of care or improve patient outcomes, it has the potential to be changed or eliminated through lean analysis. By viewing all processes through the lens of lean healthcare, staff can help identify repetitive, redundant, or less than valuable processes to save time and money.

Waste in healthcare detracts from time that employees could use for educational pursuits, building relationships with patients, or implementing systems-based improvements. Adopting a lean culture not only leads to improvements in care quality and decreased cost, it also leads to improved employee morale and commitment. Lean Healthcare Examples Improving patient satisfaction, scheduling appointments, decreasing overtime work, processing paperwork, and increasing clinic revenues are just a few of the areas where hospitals and other healthcare facilities are implementing lean principles.

Additionally, patient safety was improved by equipping rooms with ceiling lifts, beds with alarms and scales, and other equipment. Reported concerns are quickly investigated, and interventions are promptly implemented. Implementing Lean Principles in Healthcare Since the first pioneers shared their learnings at the Global Lean Healthcare Summit in , more and more healthcare organizations have implemented lean methods in their mission to gain control over costs while improving care quality and outcomes.

NEJM Catalyst. Sorry, comments are closed for this item. Call for submissions: Now inviting expert articles, longform articles, and case studies for peer review. More From Care Redesign. Do Hospitals Still Make Sense?

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Wiler, Nir J. Zane The future is here: moving care out of the hospital and into the home and community. Frustrated with Your EHR? Sittig Two informatics experts urge individuals and organizations to work together toward safer EHR-enabled patient care. Article by Mark R. Depman Will applying the RCA rubric to hospital admissions better help define and manage care?

Twaddle What are the overlapping provider skill sets needed to care for homebound patients? Dale, Kedar S. Population Health Management Articles. Wilson A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease…. Coordinated Care Articles. Following the case selection, the overall information for the three hospitals was summarized Exhibit 2. The date of the beginning of LP implementation, among others, is presented in this table. A multiple case study approach was adopted, because it provides more convincing results than single case ones Yin, The cases acted similarly to multiple experiments, presenting similar results, permitting literal replication and, therefore, external validation Yin, The results were also based on data obtained from multiple sources semi-structured and unstructured interviews; documents such as magazine news stories and internal documents; and in loco unsystematic observations , leading to construct validity Yin, To increase reliability, a protocol was developed using the data collection tools adopted and other general information Yin, ; the research categories were used to develop the interview script Exhibit 1.

Interviews were administered to managers, as presented in Exhibit 3. Other details of data collection are also presented in Exhibit 3. All interviews were recorded and transcribed. Data were analyzed within-case how each hospital implemented LP and cross-case different cases were compared and contrasted; the results were compared with the theory; and lessons learned were identified. Yin, The data were synthesized and interpreted using content analysis, which enabled the identification of study categories based on the theoretical framework.

Motivation for LP implementation emerged when a consulting company contacted the hospital director and offered free services for one year in exchange for experience with lean healthcare implementation.


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  • The hospital accepted, and after one year, hired the consulting company, which had remained in service until February Lean culture is currently developed by the hospital employees under the supervision of quality management. LP implementation was linked to strategic planning, with lean targets compatible with strategic ones. In the beginning of LP implementation, a balanced scorecard BSC was developed and focused on outpatient and specialized medical services OSMS , chemotherapy, radiotherapy, and tests.

    The BSC goals were related to LP from four perspectives: clients, internal processes, knowledge and apprenticeship, and financial. LP implementation was performed using the define, measure, analyze, improve, and control DMAIC methodology it was used in Six Sigma projects for improvement project management , beginning with the chemotherapy patient flow key-service for cancer treatment and profitability.

    TXM Lean Case Study - Branach Manufacturing

    The targets for the first lean project were: to decrease waiting time, increase process capacity, and structure the sector. The project was later extended to radiotherapy processes. Awareness and training sessions were performed for three months, with the employees involved in chemotherapy patient flow. Initially, the manager and chief nurse were trained, and subsequently the remaining employees.

    Training sessions were performed in one day or one week, and included both theoretical and practical components the practical component consisted of improvement projects. The training sessions did not have a set periodicity but were performed as further adjustments, or new improvement projects were needed. The first methods implemented were VSM and kaizen. Losses were identified in chemotherapy and radiotherapy processes through VSM, and lean techniques were applied to eliminate them Exhibit 4.

    After LP implementation, chemotherapy treatments at the hospital started to be scheduled adequately: the patients that required longer chemotherapy duration began being assigned to the first hours of the day, which decreased the waiting time from four hours to one hour. Regarding radiotherapy processes, before LP implementation the employees had to perform bureaucratic and administrative functions and monitor the radiotherapy treatments, which increased the time of application cycle and the patient waiting time.

    After LP implementation, a reception room and dressing rooms inside the treatment rooms were created so that, as one patient is leaving the machine, another is already changing to enter it - reduced setup. These changes decreased the patient waiting time from 50 min to 20 min.

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    Improvement sustainability was obtained through standardization of activities, definition of responsible staff and project targets, and monitoring of performance indicators established before the interventions. DMAIC enabled improvement sustainability as the improvements were implemented and subsequently analyzed, beginning a new improvement cycle. The motivation for LP implementation came from the senior management, which realized the need for revising processes and hired an employee to implement LP quality coordinator.

    The set targets were the provision of health services of excellence and reduction of internal costs, thereby increasing operational efficiency and market competitiveness. LP is currently developed by the hospital employees under the supervision of the quality management.

    LP implementation was linked to strategic planning, which was developed by the senior management and operational managers, and inscribed within the Enterprise Resource Planning ERP. LP was linked to strategic planning by being included as an action to achieve the set goal increase productivity of all processes, and thus decrease costs.

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    Several awareness sessions were initially conducted with the managers, and the flow of patients subjected to a video-assisted elective surgery was subsequently selected as the scope of the first project, because it is a high-volume surgery. The professionals involved in this flow needed to be trained and capacitated to implement LP techniques. The hospital has a continued education sector that plans training sessions for lean project execution. The quality management administers these theoretical and practical training sessions using lean projects and a pasta factory simulation using robots made out of assembly toys.

    The initial focus was 5S and the seven wastes of LP overproduction, transportation, over-processing, defects, inventory, motion, and waiting. The first improvement project was composed of 12 subprojects, encompassing the whole flow of patients subjected to an elective video-assisted surgery from surgery scheduling to patient discharge. Each project was executed by a multidisciplinary team that worked on surgical flow process to develop the following projects: surgery scheduling; patient reception; bed management; patient admission at the admissions unit; patient discharge from when the doctor prescribes the discharge to the patient exiting the hospital, room cleaning, and room release to a new patient ; surgery center: sterilization center, post-anesthesia recovery; lean room; improvement of patient transportation transportation from the reception to the admissions unit, from the admissions unit to the surgery center, and from the admissions unit to the laboratory for tests ; information flow; supply redesign; orthoses, prostheses, special material OPSM flow, considered a high-cost flow; overall maintenance focused on scheduling preventive equipment maintenance ; and visual management.

    The scope of all projects, participants, and targets was defined previously, and an annual gain of BRL Supplier, input, process, output, and customer SIPOC , which consists of the description of these features for a macro-understanding of processes, was used before LH implementation.

    Lean Management Case Studies

    Subsequently, it was applied the Voice of Customer VOC , which involves talking with the main clients regarding the quality of the goods or services provided. Kaizen and VSM were then implemented, followed by 5S after 5S, five tons of waste equipment and paper were removed. The relationship between the implemented techniques and the results obtained for the flow of patients subjected to an elective video-assisted surgery is presented in Exhibit 5.

    When the traditional surgery room was used, the pharmacy supplied a cart with the basic drugs, and a nurse was required to fetch the necessary drugs and materials. Among the improvements in the surgical process was the development of a lean room containing a supermarket cabinet where the drugs and materials necessary for the five surgeries were stored. This decreased the setup time from min to 16 min. Markings in the surgical room were also created, which facilitated the easy cleaning process, and cleaning started during the surgery decreasing the setup time between surgeries.

    LP implementation was supported by the management although there was resistance from the employees, with nurses being the most resistant, especially in the ICU. This resistance was overcome through training sessions and daily supervision. Performance indicators were also established to evaluate the results achieved and sustain the improvements. Between and , the hospital underwent certification by ONA, and the preparations to meet the certification requirements increased the lead times, costs, and volume of documentation.