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International Journal for Quality in Health Care Advance Access published online on August 19, 2009
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzp036
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© The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Application of lean thinking to health care: issues and observations

Tom Joosten1,2, Inge Bongers1,2 and Richard Janssen1

1 Tranzo, Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
2 GGzE, Institute of Mental Health Care Eindhoven, Centre for Research and Development, Eindhoven, The Netherlands

Background. Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.

Development, theory and application of lean thinking to health care. Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles.

Discussion. We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.

Keywords: lean thinking, lean production, quality, health care, organizational climate, business process redesign

Address reprint requests to: Tom Joosten, Tranzo, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. Tel: +31-13-4662094; Fax: +31-13-4663637; E-mail: t.c.m.joosten{at}uvt.nl or tcm.joosten{at}ggze.nl

Accepted for publication July 26, 2009.


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