What is “Lean”?

… for healthcare, manufacturing, and other settings.

“Lean Healthcare” Overview:

Download the 1st Chapter of Lean Hospitals

There’s a reason that dozens of books have been written about Lean. It’s not easy to fully understand all in one night. I have been learning about it since 1994. Not that I’m holding myself up as the #1 expert on the topic. I learn about Lean every day and I try to get better by “Practicing Lean.”

The Typical Goals of Lean

The goals of organizations that are practicing Lean are pretty consistent across industries. Their goals are to simultaneously improve:

• Safety
• Quality
• Delivery (reducing delays & waiting through a process)
• Cost
• Morale

The goal is to provide long-term success for an organization and for everybody involved — customers, employees, owners, suppliers, and other stakeholders.

In manufacturing, “delivery” might mean on-time delivery, or shipping the right product in the right quantity at the right time. In healthcare, it means providing the right care at the right place at the right time, which means reducing waiting times for appointments and reducing waits and delays when in a healthcare facility.

What Lean Is and Is Not

Lean is not about being skinny and it’s not about “cutting to the bone.” Lean is about having the right resources in place to do the right work for the customer, with the right quality, at the right time.

Lean is not “mean” (although the words rhyme, unfortunately). Lean is respectful toward everybody who participates in a system, including customers, employees, suppliers, the community, etc.

Lean does not mean cutting heads in the name of cutting costs (see “Lean is not mean”). Lean is probably the best alternative strategy to the old approach of layoffs and “cost cutting.“

Lean is not an acronym (“LEAN”).

Lean is NOT…

• NOT just a few tools to use
• NOT a group of best practices to copy
• NOT just a bunch of projects to conduct
• NOT experts telling you what to do
• NOT a way to drive layoffs
• NOT just a process improvement methodology
• NOT just for frontline staff
• NOT “part of Six Sigma”
• NOT just about speed & efficiency
• NOT pressuring people to hit certain metrics
• NOT a silver bullet or an easy transformation

Lean is…

“Lean” is the set of management practices based on the Toyota Production System (TPS). The phrase “Lean Production” was coined by a group of MIT researchers who wrote the book The Machine That Changed the World.

Lean Production is basically the same thing as:

Lean has been applied in manufacturing (factories, product design, and administrative functions) as well as service industries (including healthcare, banking, and government). The U.S. Army has an active “lean” program underway, as of 2006.

See my article on LinkedIn: “Lean” is Not Just for Manufacturing — It Applies to Knowledge Work of All Types, Too

The Toyota Production System, a.k.a. Lean is defined as having two primary pillars:

1. Just-in-Time (improving flow)
2. Quality at the source

See how Toyota defines TPS at their TSSC.com website.

One way of defining Lean (“The Toyota Way” management system) has two parts:

The opposite of waste is value-added, which has a special lean definition. An activity is “value added” if, and only if, these three conditions are met:

1. The customer must be willing to pay for the activity
2. The activity must change the “form, fit, or function” of the product, making it closer to the end product that the customer wants and will pay for (in healthcare, this can mean moving the care process forward, such as comfort, diagnosis, treatment, education, prevention)
3. The activity must be done right the first time.

We aren’t just reducing waste, we’re also trying to provide the most value to customers through Lean methods.

In healthcare, I generally think of “value” in a patient care process to be the work that involves things like:

• Comforting the patient
• Examining them
• Diagnosing them
• Treating them
• Educating them
• Preventing future illness

Respect and Leadership

“Respect for people” is much more complex to define than it might seem. Lean isn’t about “being nice” and smiling all of the time. Respect means you challenge people to do their best because you believe in them and it also means that you collaborate and work together with them in improvement (the practice of “kaizen“). See this article about “respect for people in healthcare,” as well.

Lean leadership is about enabling and empowering people. Lean leadership is about helping people grow professionally and personally, allowing to take pride in their work. Lean leadership recognizes how a system operates (represented by the gears in the upper left). Lean leadership doesn’t set targets for people, go back to their office, and then yell at people when they don’t hit those targets. Lean leaders spend time coaching people. They spend very little time in their office. They lead people and see what is actually happening rather than managing metrics and reading reports.

Much of the “people side” of lean was adapted from the teachings of the American professor and consultant W. Edwards Deming, who taught Toyota and other Japanese companies after World War II. Lean was also adapted from Toyota’s study of the early practices of Henry Ford and the Ford Motor Company. Note the emphasis on “early.” Lean is not strictly a Japanese invention or is its use limited to Japan or Japanese companies.

Lean Resources and Reading

If you’re new to Lean, welcome. I hope you’ll enjoy learning more about it.

Also, check out the Lean Enterprise Institute and their “What is Lean?” pages.

Toyota’s Georgetown plant has a nice Toyota Production System definitions page. Toyota’s corporate website has a nice set of TPS pages with an illustration that shows more.

I also invite you to check out my series of LeanBlog Podcasts, which include interviews with leading Lean thinkers and writers.

Originally published at www.leanblog.org.