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In this way, Lean management can work when care and administration are recognized as complementary, Lean-able components of health care. Continuous improvement in care means ongoing monitoring and evaluation of processes and outcomes. With care interactions, the measures of success are subjective and individualized. Relationship- or person-centered philosophies, which make a deliberate effort to keep the patient as the focus of every interaction in care, fall well under the umbrella of Lean systems.

Healthcare Delivery in the Information Age: Lean Thinking for Healthcare (2013, Hardcover)

Dignity in Care, for example, is one Canadian quality of care movement that safeguards core values like kindness, humanity and respect, and supports a culture of compassion [ 23 ]. The language of this philosophy is remarkably similar to Lean. At its core, it encourages health care providers to ask a simple question at every patient encounter: What do I need to know about you as a person in order to give you the best care possible? Tools for enhancing care interactions clearly support respect for persons and continuous improvement, and generally meet the principles of Lean.

Hospital Home Teams, also known as Virtual Wards [ 25 ], clearly reflect the application of the traditional Lean toolkit on care interactions. These are care teams assigned to patients with complex needs. Regular evaluation provides opportunities to understand and work toward the ideal set of services for that individual perfection. This model has been shown to improve outcomes for some patients, and avoid hospital admissions for others [ 25 ].

Each of these tools supports the inherent worth of each patient by empowering them to determine what constitutes value, and then marshaling the system to deliver that value. The net benefit is that the patient as the customer receives the value they have defined. The individuality of value streams in care interactions ensure care is personalized rather than standardized. Standard care may make administration more efficient, but it runs the risk of the patient having a dehumanizing experience.

The outcome of Lean, when it is applied in ways that are faithful to the philosophy of respect and improvement, will result in better experiences, and better health outcomes. In this way, the continuous improvement pillar is operationalized in caring interactions while maintaining the improvement and efficiency required for hospital administration.

Administration is task oriented and transactional when compared with the caring side of health care. The impersonal nature and generality of administrative value streams makes them amenable to broad and diffusible improvement, and particularly attractive for Lean practitioners. For many administrative processes in health care, the patient-as-customer is distant, and admittedly somewhat irrelevant. For many administrative elements of health care, the customer is staff, caregivers, budgets, and boards.

Lean Sigma in Health Care: Engaging Frontline Staff

The creation of processes that flow from one value-added activity to the next can transform labor-intensive and wasteful activities into choreographed efficiencies. In Lean terms, inputs like surgical supplies, linens, intravenous pumps and operating tables add value by being available and in working order when needed. As discussed above, there is a complementarity of process and relationship-focused applications of Lean.

Table 1 depicts the major pillars and principles of Lean applied to administrative processes and to care encounters. One can readily see how the mindful address of administration AND care encounters meet the Lean principles and offer the formula for a more humane and caring health care system, while ensuring efficiency and effectiveness in administrative matters. Systematic application of relationship-centered care approaches are consistent with Lean philosophy.


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Systematic application of Lean principles in the administrative realm arguably reduce waste by saving both time and money, but without consideration of an improved patient experience, a full consideration of the goals of health care are not met. The simultaneous application of Lean management to both administration and person-centered care will also demonstrate respect for the patient, and yield a better experience—both of which are preferred outcomes for policy-makers and especially for patients and health care professionals.

The singular focus on the low-hanging fruit of tasks and processes for improvement do not and have not produced sustainable health care systems.

Wickramasinghe, Nilmini

It seems that the conflation of Lean with efficiency has essentially exempted the relational, care interactions from Lean projects. There are tools and techniques that have been shown to work well in these contexts. Care, on the other hand, is cluttered and complex, and it requires individualization, which often needs more time, not less.

In this way Lean management means that success is measured differently for administration than for care. In this paper we have argued that for Lean to succeed in health care practice as it is theoretically intended to do, the two distinct but interrelated sides of health care must be recognized in any Lean approach to health care reform. Lean principles applied with careful recognition of patient care as separate from administrative processes uphold the pillars of respect for people and continuous improvement. For administrative tasks and processes, Lean management gives rise to efficiency through the elimination of non-value-added steps.


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While this is good for public sector quantitative measures, it does not provide the caring and relationship at the core of public health purposes. However, patient care encounters, which indirectly benefit from administrative applications of Lean thinking, can themselves be directly improved with relationship-focused strategies and tools that are consistent with Lean philosophy.

While the technical administrative focus of Lean origins may be a reason that Lean has not traditionally been used to directly target improvements in the relational side of health care, patient-centered care is compatible with Lean thinking and will benefit from and reflect its core principles.

We argue simply that Lean thinking, while applicable to both administrative processes and patient care encounters must be applied differently for each, because these are fundamentally different health care processes. Then, and only then, Lean and its principles of respect for people and continuous improvement will leverage the strength of health care professionals to deliver the improved health systems that patients, practitioners, policy-makers, and politicians seek.

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Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Relationship-centered health care as a Lean intervention. Applying Lean management in health care.

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Value streams in health care. Relationship-centered care in action. Relationship-centered health care as a Lean intervention Jennifer Dunsford. Joint Master of Public Administration Program. E-mail: jdunsford gmail. Oxford Academic. Google Scholar. Laura E Reimer. Cite Citation. Permissions Icon Permissions. Abstract Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success.

Lean management , health care , health reform , quality improvement , patient experience , health care policy. Table 1. Search ADS. Lean interventions in healthcare: do they actually work? A systematic literature review. Should Lean replace mass organization systems? A comparative examination from a management coordination perspective.

Service improvement in the English National Health Service: complexities and tensions. Google Preview. A qualitative research study. Sustainable public service organizations: a public service-dominant approach. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Canadian Foundation for Healthcare Improvement.

Lean Thinking for Healthcare

A feasibility study of the provision of a personalized interdisciplinary audiovisual summary to facilitate care transfer care at hospital discharge: Care Transfer Video CareTV. Health services should collect feedback from inpatients at the point of service: opinions from patients and staff in acute and subacute facilities.

Canadian Harm Reduction Network. All rights reserved. The module deals with practical issues such as standardisation, security, barriers to adoption and the professional challenges in developing clinical data standards for shared electronic healthcare records. The overall aim of this module is for students to have a sufficient understanding of the fundamental nature of health record information and the ways in which such information might formally be represented and managed and shared electronically, to equip students to play an active role in the design, development, procurement or adoption of EHR systems in their future careers.

Students should know about the requirements for rich interoperability between EHR systems, and the extent of maturity in this discipline towards achieving this. Anyone with a direct or supportive role in healthcare clinicians, nurses, etc , healthcare managers, health informaticians, IT staff. A minimum of an upper second-class Bachelor's degree in a relevant discipline from a UK university or an overseas qualification of an equivalent standard. Students who do not meet these requirements but have appropriate professional experience will also be considered. Students who have previously undertaken CPD may apply for accreditation of prior learning.

Blended learning: web-based distance learning in the UCL Virtual Learning Environment plus a 3-day face-to-face teaching session, webinars, self-study, tutorials, seminars and workshops including substantial use of examples of real clinical systems. Chao, C. Int J Med Inform 94, — Han, J. Lammers, E. Health Care Markets, Health Serv Res. Lowes, L.