Lean principles in Healthcare: an overview of challenges and improvements

The Institute of Medicine (IOM) estimates that, on average, hospitalized patients are subject to at least one medication error per day. Patient safety and service quality systems have been developed in order to establish barriers to medical errors. One method to reduce errors is continuous process improvement through relentless waste reduction and its origin lies in the Japanese car industry. The Toyota Production System (TPS) was capable of increasing reliability and reducing costs. Manufacturers and academics went to Japan to learn the range of concepts later called as lean. The Lean approach, based on Toyota's concepts, relates to the complete elimination of waste (called ‘muda'), by focusing on improvement and flow control techniques. A process or activity is considered value-added if it is aligned to the customers’ interests, who are considered the firm's final judges. In a healthcare service, the patient seeks for cure or pain relief and that is what defines value in healthcare. Regarding the application of Lean Thinking in healthcare, this article aims to analyze international studies on this field, discussing challenges faced and success factors during its application, in order to guide future implementations in healthcare. The studies were organized within the following topics: ‘Lean Healthcare implementation and the Toyota's Rules'; ‘Experience in hospitals worldwide’ and ‘Challenges in the implementation: overcoming barriers'. Among the studies, many positive outcomes were registered, but a few have succeeded on implementing lean principles in an organizational level. Therefore, this article concludes that to deliver world-class healthcare in face of constrained resources and greater demand, a long-term vision and world-class leadership should be developed to sustain the initiative and insert Lean in the DNA of healthcare organizations.