Lean thinking in a healthcare system – innovative roles
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Division of Physiology, Faculty of Health, Birmingham City University, 704 Baker Building, Franchise Street, Perry Barr, Birmingham B42 2SU, UK
Division of Heath Policy & Public Health, Department of Community Health and Social Work, Faculty of Health, 713 Baker Building, Birmingham B42 2SU, UK
Corresponding author
Ross Cooper   

Division of Physiology, Faculty of Health, Birmingham City University, 704 Baker Building, Franchise Street, Perry Barr, Birmingham B42 2SU, UK.
J Pre Clin Clin Res. 2008;2(2):110-117
This review article is based on an extensive literature search incorporating aspects of lean thinking in a healthcare setting. The rationale of the problem considered is seeking ways to minimise waste, improve efficiency, and create a harmonious working environment within a health care setting. Five hospital specialities were utilised to emphasise the importance of cost-effectiveness of function. Healthcare organizations, through its doctors, nurses, radiographers, pharmacists and other allied professions, the need to be placed in the driving seat by applying equally powerful vectors of change, including choice or commissioning leading to improved patient care. Lean adds value to patient needs, identifies the value stream for every patient group, ensures a continuous patient journey flow; pulls in response to the rate of demand of patients, manages toward perfection, and follows clearly defined steps for assessing patients via assessment, investigation, treatment and discharge. Just in Time, pull production, mistake proofing and six sigma are useful elements. Lean thinking, as a tool, is important strategically to effect a reduction in costs and achieve a high turnaround using the same staff and processes, but in a more effective manner. It requires strong, determined leadership to drive its successful implementation.
Boaden R: Quality improvement in healthcare. In: Walshe K, Smith J (eds.). ‘Healthcare Management’, Berkshire, Open University Press 2006, 454-478.
Ben-Tovim DI, Bassham JE, Bolch D, Martin MA, Dougherty M, Szwarcbord M: Lean thinking across a hospital: redesigning care at the Flinders Medical Centre. Aust Health Rev 2007, 31, 10-15.
Kelly AM, Bryant M, Cox L, Jolley D: Improving emergency department effi ciency by patient streaming to outcomes-based teams. Aust Health Rev 2007, 31, 16-21.
King DL, Ben-Tovim DI, Bassham J: Redesigning emergency department patient fl ows: application of Lean Thinking to health care. Emerg Med Australas 2006, 18, 391-397.
Jones D, Mitchell A: Lean thinking for the NHS. NHS Confederation, London 2006.
Cowper A: In the driving seat. Health Manag 2006 (July/Aug), 20- 21.
Ben-Tovim DI, Bassham JE, Bennett DM, Dougherty ML, Martin MA, O’Neill SJ, Sincock JL, Szwarcbord MG: Redesigning care at the Flinders Medical Centre: clinical process redesign using ‘lean thinking’. Med J Aust 2008, 188(6 Suppl), 27-31.
Ieraci S, Digiusto E, Sonntag P, Dann L, Fox D: Streaming by case complexity: evaluation of a model for emergency department Fast Track. Emerg Med Australas 2008, 20(3), 241-249.
van Lent WA, Goedbloed N, van Harten WH: Improving the effi ciency of a chemotherapy day unit: Applying a business approach to oncology. Eur J Cancer 2009, 45(5), 800-806.
Young TP, McClean SI: A critical look at Lean Thinking in healthcare. Qual Safe Health Care 2008, 17(5), 382-386.
Cooper RG, Mohabeersingh C: Lean thinking for medical practices. JPCCR 2008, 2(1), 1-10.
Carvel J: Straight to the specialist: Johnson cuts GP referrals. The Guardian 2008, 21 Oct. Available at: society/2008/oct/21/health-health/print.
Lau EWL, Leung GM: Is the Hospital Authority’s drug formulary equitable and effi cient? Hong Kong Med J 2008, 14(5), 416-417.
Anonymous: Five principles can encourage organisations to ‘think lean’. Perform Improv Advis 2004, 8, 94-95.
Long JC: Healthcare Lean. Mich Health Hosp 2003, 39, 54-55.
Jackson PR, Mullarkey S: Lean production teams and health in garment manufacture. J Occup Health Psychol 2000, 5, 231-245.
Goree M: Thinking strategically. Mich Health Hosp 2002, 38, 8-11.
Womack JP, Jones DT: Lean consumption. Harvard Bus Rev 2005, 83, 58-68.
Ben-Tovim D: Seeing the picture through ‘lean thinking’. BMJ 2007, 334, 169.
Vincent C: Incident reporting and patient safety. BMJ 2007, 334, 51.
To Err is Human: building a safer health system. National Academy of mSciences, Washington 2000, 8 pp.
Jones DT, Filochowski J: Lean healthcare. Think yourself thin. Health Serv J 2006, 116 (Suppl. 6-7).
Mathieson S: Lean healthcare. Wait watchers. Health Serv J 2006, 116(Suppl. 4-5), 7, 9.
Crompton P: Modernizing medical photography, part 2. J Vis Commun Med 2005, 28, 6-12.
Panning R: Using data to make decisions and drive results: a LEAN implantation strategy. Clin Leader Manag Rev 2005, 19, E4.
Hill B: Lean and mean. 2007. Available at: http://www.labnews. Accessed 27 Jan 2009.
Womack JP, Jones DT: Lean Thinking. Simon & Schuster, New Yor 1996.
Berger A, Kramarz P, Kopperud G S, Edelsberg J, Oster G: Economic impact of shifting the locus of care for neuropathic pain from specialists to general practitioners. Eur J Health Econ 2007, 8, 245-251.
Vitale MG, Roye BD, Ruchelsman DE, Roye DP: Preoperative use of recombinant human erythropoietin in pediatric orthopedics: a decision model for long-term outcomes. Spine J 2007, 7(3), 292-300.
Bozic KJ, Morshed S, Silverstein M, Rubash HE, Kahn JG: Use of costeff ectiveness analysis to evaluate new technologies in orthopaedics: the case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surgery 2006, 88(4), 706-714.
Thomas NJ, Hollenbeak CS, Lucking SE, Willson DF: Cost-eff ectiveness of exogenous surfactant therapy in pediatric patients with acute hypoxemic respiratory failure. Pediatr Crit Care Med 2005, 6(2), 160- 165.
Mullins CD, Philbeck TE, Schroeder WJ, Thomas SK: Cost eff ectiveness of kinetic therapy in preventing nosocomial lower respiratory tract infections in patients suff ering from trauma. Managed Care Interface 2002, 15(8), 35-40.
Lucioni C, Ravasio R, Concia E: Cost-eff ectiveness of various antibacterial therapies in hospitalised patients with lower respiratory tract infections. Pharmacoeconomics – Italian Res Articles 2001, 3(1), 37-47.
Thomas M: Sensitivity analysis of the DiDACT cost-eff ectiveness model. M.Sc. Student Placement, Lancaster University. York Health Economics Consortium, York 2006, pp. 32, appendices i-xiv.
Clar C, Waugh N, Thomas S: Routine hospital admission versus out-patient or home care in children at diagnosis of type 1 diabetes mellitus. Cochrane Database Systemic Reviews 2007, 2, CD004099. DOI: 10.1002/14651858. CD004099.pub2.
‘The College of Optometrists Member’s Handbook’, revised April, amended August, NHS, UK 2008, 02.17.1-02.17.2.
Banerjee S, Tran K, Li H, et al.: Short-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of cost-eff ectiveness. Canadian Agency for Drugs and Technologies in Health, Ottawa 2007, 67.
Tran K, Banerjee S, Li H, et al.: Long-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of cost eff ectiveness. Canadian Agency for Drugs and Technologies in Health, Ottawa 2007, 62.
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