Contemporary Writings on Lean in Healthcare
Some of the more contemporary areas and issues emerging from the literature are summarised below.
Improved Patient Satisfaction
Some advocates of lean propose it helps to improve patient satisfaction in several ways: it helps to pursue the “perfect patient experience” (Kenney 2010), increases value (Wellman et al. 2010) and improves quality and safety of care (Graban 2008). However, Poksinska et al. (2016) propose there is no clear evidence to link implementing lean with improved levels of patient satisfaction. From a mixed-method investigation of patient satisfaction surveys and primary care case analysis they conclude lean healthcare implementation primarily targets efficiency and little attention is paid to the patient’s perspective. This is interesting given that the first principle of lean is understanding value from the viewpoint of the consumer. It is unclear whether this “consumer” focus has been lost in translation from the manufacturing form of lean or the lack of clarity in relation to who occupies the jurisdiction of being the “consumer”. There is much discussion of healthcare being viewed from a multi-stakeholder perspective and often this is lack of clarity in terms of who is the customer (internal) and who is the consumer. When viewing a patient pathway it might be concluded there are internal customers (e.g. next part of the process - A&E to ward) and external customers (e.g. GP referal to Outpatient clinic) customers and then the consumer of the care which is the patient. Within the literature there does not appear to be any consensus in relation to the narrative customer or consumer. The proposal put forward here in relation to internal and external customer does lend itself to a supply chain context.
DiGioia et al. (2015) report on the interest expressed by healthcare organisations that have invested time and resources in the Patient and Family Centered Care Methodology and Practice (PFCC M/P). They propose that interest is fuelled by the need to address the challenge of keeping the patient (and family) as the primary focus of improvement activities and to add patient experience as an equal focus with eliminating waste. They note the difficulties some healthcare organisations have in maintaining the patient focus required to support lean implementation and suggest the combination of lean and PFCC M/P can accelerate the pace of improvement. The additional features of the PFCC M/P are reported to be:
- • voice of patient to include family members,
- • shadowing of patients and family members to identify all touch points within the patient journey,
- • heightening staff autonomy, engagement and empowerment and
- • integrating lean with PFCC M/P bridges “top-down” and “bottom- up” approaches to change and helps to move from transactional to transformational change.
One of the key recommendations from DiGioia et al. (2015) is the need for the shadowing of the process. Again this is an interesting observation. If we refer to the original forms of lean, it advocated the need to “walk the process” or “go to the gemba”. It is possible that the authors here are suggesting a more detailed observation of the patient journey but it is unclear whether the integration of these approaches will provide any value, except the reinforcement of the patient-centredness required for healthcare improvement and redesign efforts.