Value Stream Mapping and Lean Thinking in Developing Patient Care

The earliest pioneers in the manufacturing industry who developed the concept of lean thinking were Kiichiro Toyoda, Taiichi Ohno, and others in Toyota who looked at the vehicle manufacturing production lines available in the 1930’s and invented the Toyota Production System. They essentially shifted the focus of the manufacturing engineer from individual machines and their utilisation to the flow of a product through an entire process.

Simply put, “Lean Thinking” implies, using less to do more. This concept of lean thinking has led to the great success of Toyota which is the world’s largest car manufacturer in terms of overall sales. The success of Toyota has lead to the concept of lean thinking to spread across the world. It is a management strategy that is applicable to all organizations, as it is to do with improving processes. Leaders in fields such as construction, maintenance, retail, services, Information technology, logistics and distribution, healthcare and even government, have adapted and applied these tools and principles to improve their own fields. This concept is taking root among senior managers and leaders in all sectors today.

Lean thinking is already being applied to various aspects of health care. Although they appear very different, there are remarkably many similarities between manufacturing and healthcare. Whether building a car or providing healthcare to a patient, the people involved must rely on a variety of complex processes to accomplish tasks and provide value to a customer or a patient.

By identifying all the steps in these complex processes and removing the steps that do not add value, one can create lean processes. In essence, the aim of lean thinking is to identify value-added steps in any process, retain them and remove all non-value-added steps, so as to reduce waste.

In essence, the aim of lean thinking is to identify value-added steps in any process, retain them and remove all non-value-added steps, so as to reduce waste

Waste can be of many forms – money, time, supplies or good will. This will lead to a positive impact on quantity and quality of providing healthcare by improving productivity, reducing cost, improving quality and timely delivery of services. When applied in an entire healthcare organization lean thinking can have a dramatic impact on productivity, cost and quality.

Value Stream Mapping (VSM)

To develop lean healthcare, as in manufacturing, it involves, a methodology of value stream mapping – diagramming and analyzing services (value streams) into their component steps and eliminating any steps (or even entire groups of steps or value streams) that do not deliver value.

Flow is one of the fundamental concepts of value stream where waste is eliminated and where processes merge into each other, so that there is a smooth flow in the system. The focus is not on waste, but, on waste reduction and flow. The concept is applied to the system as a whole, so that, the benefits are optimised.

The concept of lean thinking and value stream mapping are very much suited for pull systems (or demand-driven systems), as is healthcare. Here, the initial request for a service is initiated by the patient and that in turn initiates pull in the system. For example, a patient is sent to the surgeon with a problem requiring surgery. This in turn initiates requests for investigations and other consultations.

This is in contrast to a push system where, the manufacturer estimates the demand and produces goods. This creates a stockpile in anticipation of customers needs. In healthcare this is the concept on which services are largely, still provided, based on estimates i.e, demand driven or push systems.

Implementing “Lean Thinking” in Healthcare

Implementing a value stream in healthcare depends first on identification of the various steps or processes involved in any service provided. Then a value stream map is constructed – a pictorial representation of steps starting with the initial request (demand or pull) and progressing up the value stream. After mapping out one or more value streams in the process, the map is analysed by managers and service providers (doctors/nurses/non-clinical staff) to identify sources of waste. By this one can identify all value added and non-value-added steps. This will lead to process re-design eliminating waste.

Importance of Lean Healthcare Today

  • Pressures of recession and costs

The pressures of recession have changed thinking around the world and individuals, organisations and governments are all wanting to get more for less. By lean processes one can deliver more for less and ensure sustainable development within organisations, therefore, enduring value-added growth.

  • Patient Safety

Many tools of Lean Thinking enable smoother and predictable way of work and create safe environment for staff and patients. VSM helps building up smoother, more predictable patients’ pathways. 5s tools has been widely used in Hospitals and Medical Laboratories to create leaner surfaces of work and safer for patients and staff.

  • Green initiatives and healthcare

By reducing wastes in healthcare such as with energy efficiency, lean IT processes and improving efficiency one can reduce carbon footprints.

Challenges of Implementing “Lean Thinking” in Healthcare

  •  Visualisation of value stream

As the entire process is reliant on identification of value streams and the waste in it, it is paramount that the entire process is identified. Unlike manufacturing, the healthcare industry is a complex service industry with very fluid, ever changing services, it is difficult to always visualise the entire value stream.

  • New Concept in Healthcare

As this is a relatively new concept in healthcare, there are very little reference projects to base this on.

  • Resistance to change

Lean initiatives in any industry are likely to demand organisational, operational and/or behavioural changes. In healthcare these may meet with resistance from nurses, doctors, managers and other non-clinical staff. These may be driven by beliefs in existing work practices, fear of being overworked or even job losses. There may also be no incentive for change.

  • Fragmented implementation of Lean processes

Application of lean thinking in parts of the organisation only can lead to less benefit as it does not integrate processes and eliminate cumulative waste across the entire system.

  • Lean Healthcare related to lean consumption

The entire concept best derives and best benefits when lean healthcare concepts are embraced by their consumers – patients.

The entire concept best derives and best benefits when lean healthcare concepts are embraced by their consumers – patients