As per the estimation the Institute of Medicine

As per the estimation the Institute of Medicine (IOM) is of the view that on average
hospitalized patient are prone to atleast one mediaction error per day (Radley et. Al, 2013).
Medication error are harmful for patient, it cost much to the patient and contradicts the most
basic element in healthcare i.e. ‘safe practices’ (Grout and Toussaint, 2009). Safety of patient
and quality of services ensures barrier to medical flaws. To mitigate such flaws the ideas that
are followed is through improving the process through relentless waste reduction also known
by the name ‘Lean’.
The origination of the concept of ‘Lean’ was coined in Japan, during the era of 70’s when the
automobile sector in USA struggled with the high maintenance cost levied on the consumer
front. Japanese giant ‘Toyota’ excelled in reducing the maintenance of thier cars by relying
on the less expensive models in comparision to American manufacturer (Ohno, 1988). The
manufacturer and academics from USA visited Japan to learn the new concept ‘Lean’. The
concept of Lean incorporates the combined concept taken from TQM and Friedrick W.
Taylor’s “Principle of scientific management”. Through the concept of TQM, Lean
deliberated the company culture of satisfying customer needs through relentless
improvisation in which all the employee are onboarded. Since then the concept of Lean has
been practiced in the service industries such as ‘healthcare’.
The first intervention in reducing waste is to identify steps in every process, as has been
discussed in the below given flowchart. For example, the customer would not hesitate to pay
for the gadget to be assembled and painted blue but not for the storage of items and for
overproduction. These are considered waste as illustrated in the chart below.

The Seven Waste:
Ohnos seven waste Defination Healthcare example from
reviewed studies
Waste of time Unnecessary queues and wait
for the material, resources
and services that is just in
opposite to JIT delivery
In Canada through the
application of visual
reminders and worksheet
quality control team ensures
reduction in the time taken
for reassessment by the
physician. Such improvement
does not require additional
resources with minimal cost
Waste of movement Unnecessary movement of
patient or misaligned
movement as required to the
service demand. Too quick or
too slow.
Reduction in the movement
of people by 44% in Virginia
mason centre
Waste of inventory High inventory increases
waste that also includes
patient
Keeping patient on the roll
which should otherwise be
sent home or ordering too
high to compensate for
misalignment in supply
Waste of processing Unwanted processing Reprocessing diagnostic test
of patient because of error in
the readings, fulfillment of

similar form in different
department for the same
patient and rescheduling the
missed appointment
Waste of making defective
product
Defective process and
services
Recieving complaints about
the service quality and
hospitality that does not meet
the customer expectation
(lack of value for customer)
Waste in transportation Unnecessary movement of
staff and material
The lean implementation in
the Virginia mason centre
helped to bring reduction in
72% of product travel
distance within 2 years
Waste of overproduction Production must match to
time and amount of requested
order
Unnecessary referral test,
hospitalization, acquiring
material in access
These waste can be identified and reduced using Lean principle and tools as described in the
table below (Virtue and Chaussalet, 2013). There is a several case stories on Lean thinking
intervention in the healthcare that demonstrate positive outcome on productivity, cost, quality
and JIT delivery services due to Lean principle applied throughout the organization. The
patient comes to the hospitals for either relief or cure and this is what value is in healthcare.
The process to achieve this final goal is known as patient flow in healthcare. It not only

relates to the drugs, pharmaceutical or emergency items but encompasses all those activities
that ensures the full recovery of patient.
Lean principles:
Value As per the customer view and waste identification
Value stream
map
1. Product service defination: Planning in detail and introduction
2. Information management: From taking order, scheduling to
delivery
3. Physical transformation: From basic ideas to product delivery to
consumer
Flow By eliminating obstruction and reframing of process, introducing different
organization and technologies, eliminating interruptions and detours,
backflows or waiting
Pull Identifying customers need i.e. what he wants and when he wants. The
service is tailor made so as to make the customer pull the services which
would prevent wastage such as production of unwanted or junked goods,
overproduction and extension of not required inventory tracking system
Perfection Continuous effort to achieve zero defects, lesser time, steps and waste on
customer service
According to Womack and Jones (2003), implementation of Lean and its implication is
measured by the time and comfort to the patient. To deal with this multi skilled teams and
increased participation of the patient is advocated. Quality improvement can be emphasized
by the front end staff dealing directly with the patient and their associates and should deal
accordingly as to what should be changed, and what increases work satisfaction by the

provision of instant feedback. Thus it represents work with new responsibilities rather than
eliminating jobs for the sake of efficiency (Womack and Jones, 2003). The focus on zero
defects, continuous improvements and JIT in healthcare makes lean production especially
applicable.
Customer Focus
Continuous improvement
6s
7 Waste
Value
stream
map
Standardi
sed work
Visual
Managem
ent
Eliminate
Waste
Kaizen
Problem
solving
Performa
nce
managem
ent
Collabora
tive work
Takt time
JIT
Heijunka
Pokayoke
Kanban
Respect for
people
Create flow

‘House of quality’ for lean principle and tools. The basic idea of the lean management
depends upon the core principles i.e. waste reduction, create flow and dignity for people, the
change agents. Therefore these tools are applied keeping in mind patient satisfaction need as
the main objective.
Conclusion & Recommendation:
Lean principles and tools for the healthcare industries in US, UK and other European
countries are increasingly adopted that are making headway in improvization and service
quality. Toyota has mastered this concept with ages of experience and are of late reaping the
benefitand therefore the same benefit of change and adaptation could be very well be
practiced in the healthcare industry to realize the similar benefit of change.
Secondly the waste elimination also brings in the attributes of efficiency in the organization
rather than only focusing on reducing steps of process that helps the organization to become
more agile and adaptable.
Managing knowledge to eliminate the similar mistakes that are done again and again in the
organization that paves the way for relentless improvisation with growth.

References:
Grout, J.R. and J.S. Toussaint (2009) ‘Mistake-proofing healthcare: Why stopping processes
may be a good start’, Business Horizons, 53, pp.149-156.
Radley, D.C., M.R. Wasserman, L.E.W. Olsho, S.J. Shoemaker, M.D. Spranca and B.
Bradshaw (2013) ‘Reduction in medication errors in hospitals due to adoption of
computerized provider order entry systems’, Journal American Medical Information
Association, 1, pp.1-7.
Ohno, T. (1988) The Toyota Production System: Beyond Large Scale Production.
Productivity Press, Portland (USA). 152 pp.
Virtue, A. and T. Chaussalet (2013) ‘Healthcare planning and its potential role increasing
operational efficiency in the health sector’, Journal of Enterprise Information
Management, 26 (1/2), pp. 8-20.

Womack, J.P. and D.T. Jones (2003) Lean Thinking: Banish Waste and Create Wealth in
Your Corporation, Simon & Schuster, London (UK). 396 pp.