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4 Major Barriers in Implementing Lean Thinking in Healthcare Organisations

Posted on December 1, 2015 in Articles

Healthcare providers are under tremendous pressure to enhance their competitiveness. The demand for healthcare services and provision is on the upward trend, but the same cannot be said of its’ financial health – as most providers are heading in the opposite direction.

In the new millennium, healthcare providers face the tough challenges of meeting the need to be effective, efficient and cost prudent. Therefore, there is an urgent need to search for relevant, new and effective approach of providing healthcare. Numerous providers have turn to adopt Lean Thinking approach for their service and operational performance enhancement. The Lean approach seeks enhancements by focusing on the organisation’s current structures, systems and processes. Also, it does not require significant upheaval changes which require huge and heavy investments, but rather, it is an optional approach to attain enhancements without huge investments.

Lean Thinking in Healthcare has been around for more than a decade or so now since the Virginia Mason Medical Centre in Seattle, Washington pioneered the implementation. Many more healthcare providers in the USA have since followed suit. On the local front, Lean Thinking approach to have been relatively new.

Irrespective of the country and its work culture, there are common barriers that healthcare providers encountered when implementing Lean Thinking. The 1st major barrier that needs to be addressed in Lean implementation is to obtain healthcare associates buy-in, that Lean Thinking is applicable in healthcare environments. During discussion on Lean in healthcare, the popular response is that “customers are not physical “products and healthcare providers have completely different operational and service structures of the manufacturing industry. However, after the due diligence of training is done, staff awareness gets better and they realized for themselves that there exists a significant amount of waste and non value-add activities in the systems and processes. By applying Lean Thinking principles, they could see the great potential benefits.

The 2nd major barrier is the lack of clarity on the definition of the healthcare customer. The 1st Lean Thinking principle states that it is vital to grasp the concept of value as defined by the customer. However, in healthcare term, the “customer” is not well defined. The main “customer” in healthcare is the patient, but the patient is not a customer from the market perspective. The patient usually doesn’t pay directly for the service. Other customers, such as family members, caregivers, insurance companies and taxpayers, also need to be considered. Thus, to grasp what value is, a clear articulation of the customer without confusing, conflicting requirements and priorities from different stakeholders must be well thought out.

The 3rd major barrier perceived as resisting Lean implementation is the organisational structure of healthcare. Professional, specialized knowledge and skills-set wields considerable organisational power and authority. The healthcare structure is still very hierarchical, with physicians having much say in almost everything, being the dominant decision makers. Physicians are highly skilled person and they have been trained to act with much independence. However, Lean implementation requires teamwork, collaboration and good communication, skills that traditionally have not been emphasised in physicians’ professional training. Thus, in Rapid Improvement Projects (RIPs) team, their involvement can be compromised and rendering the RIPs team ineffective. 

The 4th major barrier has to do with cooperation with other departments. Healthcare systems have a complicated structure one with numerous interdependent units. The toughest challenge, therefore, is to enhance the entire system holistically, and not just focus on each department respectively. Enhancing operational processes may require involvement of several healthcare sub units. Enhancement work may very well run into issues in these sub units in the form of not being ready to recognise, understand and acknowledge changes or even lack the required resources to perform the change. The risk is also that an enhancement activity may resolve some concerns at one unit, but may cause another issues at a different unit. The resolution then is not systems oriented but silo or spot oriented – improvement at the localized level.

In summary, implementing lean in healthcare requires considerable and deliberate planning and intervention in order for the implementation and execution to be effective and sustainable over the long term. Without vision, there will be confusion; without action plan there will be false starts.

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