Achieving and maintaining a Lean health care organisation

There are no silver bullets for complex problems – they require discipline, persistence, precise execution and hard work. The crucial question is: How can a hospital want to engage in a methodology that requires even more from them?

Achieving and maintaining a Lean health care organisation

Where we come from

The inherent desire for quick results drives organisational leaders to attempt to “purchase” Lean and forgo the critical steps necessary for successful implementation of Lean management.

In our articles “Lean hospital Management” and “Flow efficiency in hospitals”, we focused on the methodology and the principles to implement Lean hospital management. In this article, we want to emphasise the importance of a balanced “journey” to successfully implement Lean hospital management as a culture and a system derived from the hospital’s strategy.

Where problems occur

As commonly agreed on, Lean can help the organisation to overcome challenges and build a patient-centred organisation that provides better quality care in a more efficient and cost-effective way. But contrary to what some organisational leaders have led to believe, Lean hospital management is not (a) a quick fix or a fire-fighting methodology, (b) just a set of tools or a practice of conducting a series of Kaizen events nor (c) a task that can be delegated to some “Lean team” in the company. Rather it is a philosophy that needs to be embedded in the culture and the “system” of the organisation.

Especially in medicine, just addressing symptoms and ignoring the cause of a disease could result in irreparable damage or death. Likewise, with the implementation of Lean, addressing just the symptoms rather than the causes doesn’t help the organisation overcome the challenges it faces.

What we recommend

Lean has the potential to substantially transform your organisation if it is implemented successfully. Therefore, key to a successful Lean transformation is proper implementation

An essential prerequisite for becoming “Lean” is an organisation’s “Lean operations strategy”. This strategy consists of values, principles, methods and tools and sets the basis for the two crucial paths for the implementation of Lean hospital management; the (1) “culture-creating path” and the (2) “system-creating path”, which are interdependent (see figure 1).

1. Creating a Lean culture

A primary goal for any organisation focusing on Lean must be the development of a Lean culture. Organisational culture is the behaviour of humans within an organisation and the meaning that people attach to those behaviours. As people are often reluctant to change behaviour, cultural change is extremely difficult and requires time, patience and commitment. The culture-creating path in figure 1 identifies four elements necessary to affect cultural change in an organisation:

a) A properly planned launch of the “Lean journey” helps staff members to answer questions like “what does Lean mean to our organisation?”, “why is our organisation adopting this methodology?” and “how will we proceed?”

b) Appropriate training should enable staff members to solve problems or to know what action to take if they realise that a process is not following the organisation’s strategy. Seeing that Lean is best learned through application, the staff must apply the tools and principles themselves.

c) The implementation in waves should empower staff members to develop a certain level of comfort with and witness the benefits of Lean first hand. It also helps the organisation to digest the change.

d) A culture of continuous improvement helps staff members cultivate a blameless environment in which they feel comfortable reporting errors. For a sustained development, maintenance and improvement must become inseparable.

Without a solid cultural foundation, a Lean initiative is prone to outside forces and will not be sustainable.

2. Creating a Lean system

Ohno defines Lean as “a system for the absolute elimination of waste”. Therefore, a Lean implementation has to change the system. Departmental boundaries must come down so that all hospital functions focus on the patient and the patient’s needs.

Long-term success is directly proportional to the ability to adapt to an ever changing environment. An agile organisation is therefore a prerequisite for successful adaption. If Lean is implemented in a holistic way, it supports the agility of an organisation.

The system-creating path in figure 1 consists of the following four elements:

a) A properly deployed and communicated strategy supports Lean implementation. Un-less you communicate the strategic plan to the staff, establish individual objectives and make individuals accountable for accomplishing the strategic objectives in their areas of influence, little progress will be made. Hoshin Kanri is an excellent Lean tool to supports this element.

b) Focus on value streams is needed, as they are one of the most important tools to change the care delivery system to more focus on the patient and the patient’s needs. Because every value stream involves many departments, much coordinated effort is required to accomplish the given objectives.

c) A work plan ensures that a desirable future state is not only being described but is being implemented. It is important to divide big implementation projects into smaller, more manageable tasks. It also helps to have two horizons of the future state map that identify a destination to support the controlling of the measures taken. There are numerous tools to be applied in this phase.

d) The establishment of flow in every value stream through the entire organisation is the main goal of the system-creating path. Applying the Lean principles is essential to achieving flow and enhancing the care delivery system. There are many Lean tools supporting this element, the most prominent is hejunka, the Japanese word for “levelling”.


We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way.

Atul Gawande (surgeon, writer, and public health researcher)

How we tackle the challenge

The most important prerequisite for a successful Lean transformation is the commitment of the senior leadership team. Furthermore, you have to make sure to provide the whole “Lean initiative” with enough resources and shape it in a way that ensures that relevant insights can be gained rapidly. Last but not least it is crucial to design strategic projects dynamically to allow continuous adjustments.

Implement Consulting Group, we help organisations establish the appropriate processes and instruments for a successful implementation of Lean hospital management at all three levels of the organisation. Only with a balanced approach you will succeed in building a Lean organisation.