Applying Lean Thinking to Hospitals is a Band-Aid Solution

Victorian-era hospital, London

St. Thomas Hospital, London. A recent version of the Victorian hospital. There’s less of a difference than we think.

There’s no doubt that improving healthcare is an important, difficult challenge (to say the very least). Many organizations, or teams within organizations, are trying (and some casing succeeding) to apply lean principles to healthcare, such as empowered frontline teams conducting root cause problem solving, the use of visual management techniques, and developing multi-disciplinary teams to provide “patient-centric” care that brings the resources to the patient at the same time and place rather than shuttling the patient down an “assembly line” of discrete and disconnected procedures by one department after another.

But for the most part, the efforts to apply lean thinking in healthcare have focused largely on hospitals. The problem is that the very existence of hospitals as we know them is un-lean. Yes, in the short-term improvements to a hospital’s operations is a benefit, but if we are to realize the full benefits of lean flow thinking in healthcare then it starts with understanding that the concept of large-scale, centralized factories (a.k.a. hospitals) is the essence of un-lean thinking.

In traditional operations, the emphasis is on economies of scale. The results are large, centralized factories, warehouses or, in the case of healthcare, hospitals. Lean flow focuses on the economies of time. Resources are decentralized to better provide service where and when needed. The time that is most precious is that of the customer, or in this case, the patient. This is expressed both as a reduction of the time patients waste waiting as well as the total lead time for their consultation or treatments.

In lean flow, the focus is also on prevention rather than fixing things reactively. So too, lean healthcare would focus most of its resources on health maintenance and early preventative measures rather than heroic efforts to “find and repair” health defects.

Healthcare advocates who push for more decentralized models such as home care, the use of empowered, community-level health practitioners, as well as the use of preventative approaches such as better access to healthier food may not think they are preaching a “lean flow” message, but they are.

To be sure, moving away from the doctor-centric, hospital-centric model is itself an enormous change challenge. Whereas today billions of dollars from governments (and sometimes billionaires) go towards the building of more healthcare “factories” or their expansion by building a new wing, in this future-state the money would go towards decentralized, preventative processes. The public at large and not just the medical professions and the medical-pharma industrial complex would need to change expectations and habits. In some cases medical professionals and firms in the medical industry won’t want to change, given the dollars at stake. Voters will need to empower politicians to make policies in the face of intense lobbying for an unlean system.

The good news is that technological advances are on the cusp of providing the ability to move decisively from our 19th century mental model of healthcare to a truly lean healthcare system. Hospitals would evolve from a place for the batching and queuing of patients, to a place where scarce medical expertise advises local care-givers and patients through tools such as virtual reality, telepresence, smart wearables and other internet-enable capabilities. AI-driven robots could further enable the decentralization of care.

Improving hospitals is not a waste of time. We will have these monuments to traditional process thinking around for some time to come and if the people who work in them understand lean flow then this will help enable change. But if we can convince stakeholders that our current concept of hospitals is un-lean regardless of how well those hospitals run, it might help us to move to a vastly better healthcare model rather placing most of our efforts in trying to improve our centralized, assembly-line approach to healthcare.