Lean system is an approach focused on eliminating waste in organization processes. It focus is on examining the system or processes to identify value adding activities to be optimized and non-value adding activities to be eliminated. The main goal is to produce what is needed, when it is needed with no waste. Lean Operating Systems are premised on four basic principles. Namely, elimination of waste, increased speed and response, improved quality, and reduced cost. Principles of lean thinking originating from Toyota Production System but have been successively applied in different organizations and industries. Lean systems are customer or patient focused, such that decisions are geared towards meeting the patient's needs and expectations. For example, when patients complain of unnecessary delays in accessing care or long wait times or errors in scheduling, an organization applying lean principles will look for ways to identify the causes of patient care delays and long wait times then eliminate or the reorganized activities to streamline the process so as to reduce the waste times. Lean principles have also been applied in ambulatory care to improve preventive screening and other patient care processes. Many healthcare institutions have adopted Six Sigma and lean principles and I've rearranged significant improvement, including reduced wait times, reduced number of errors by clinical staff, cost savings, improved turnaround time, improved patient outcomes, greater patient satisfaction, and improved staff morale. One example of successful lean system application in healthcare is the Virginia Mason Medical Center in Seattle. In 2002, the hospital adopting the basic tenets of Toyota Production System to create the Virginia Mason Production System. Faced with financial loss for the first time in history and declining staff morale, they implemented several small scale ideas and long-range planning that resulted insignificant improvement in their care. Specifically, they implemented several initiatives based on three principles of Toyota Production System. Heijunka, which refers to leveraging flow. Jidoka, which refers to detecting and correcting abnormalities or errors as they occur, and Kaizen, which refers to continuous improvement. To achieve this, they adopted several initiatives. They did value stream mapping to map the flows and understand processes throughout the organization. They held rapid process improvement workshops in which they identified a process and set a target for an improved fashion. Then discuss, mentioned and proposed ways to achieve the new target. They also implemented a patient safety alert system in which employees were empowered to stop processes whenever a safety hazard was detected until they determined the cause and develop remedial measure. They also adopted 5S, which refers to sort, simplify, sweep, standardized, and self-discipline, and it is a visual system to organize workspace into a clean, orderly, and safe work environment. They also adopted 3P referring to production, preparation and process, where they redesign the workspace according to flow. They adopted everyday lean in which they encourage staff to suggest creative ideas to improve processes, reduce waste, and value, and so on. They also engaged patients and their families regarding the experiences through interviews, questionnaires, and listening sessions, which provided new insights on areas to improve. These changes resulted in very impressive improvement. For example, they were able to reduce wait times at an on-site pharmacy from 2 hours to 20-30 minutes, and at the lab delivery system from 20 minutes to one minute. They improved productivity by 44 percent, reduced walking distance within the hospital by 38 percent or 34 miles, and reduced travel distance for paths within the hospital by 76% or 70 miles. The success of the Virginia Mason Production System led to the establishment of Virginia Mason Institute, which offers training and consulting services to other healthcare providers on how to implement the lean principles. Overall, successful adoption of lean principles leads to benefits such as reduced cost, improved quality, increase throughput, higher productivity, and better capacity utilization among others. However, being too lean can be problematic because the organization might not be able to respond effectively to certain supply disruptions on demand changes. There's also potential for burnout given the persistent focus on improvement.
