The Lean Process in Healthcare

At the Maine Hospital Association (MHA) Conference in February in Newry, Maine, PDT designer Joan Klein attended educational sessions about how the lean process can help transform healthcare. Lean Specialist Mark Graban, along with representatives from various hospitals, spoke about what lean is and how it is helping improve their working environment. According to Graban, lean is a technique that grew out of Toyota’s business model in the 1980s to increase customer value by maximizing the flow of products and services. The process begins by identifying the value of a product or process and then identifying the steps needed to create that value. Lean looks at the whole organization as a system and looks at all the steps individuals are taking to solve a problem.

A popular misconception is that lean is only suited for manufacturing. Not true. Lean applies in every business and every process. It is not a tactic or a cost reduction program, but a way of thinking and acting for an entire organization. (Source:

A few key principles of the lean process are:

  • Look inside the box first. (Collect data. Ask why.)
  • Identify what the problem really is. (Avoid jumping to conclusions. Add value.)
  • Communicate clearly. (Avoid silos. Set clear goals.)
  • Each situation has its own unique solution. (Lean is not a one-size-fits-all approach. The most obvious solution may not be the correct one.)

Solving the spaghetti diagram (aka, The answer is not always what you think.)

Source: Redington-Fairview General Hospital

At the MHA conference, John Comis of Redington-Fairview General Hospital talked about how the hospital staff used the lean process to improve patient wait time in the emergency room. The average wait time was almost three hours. The original proposed solution was to add more exam rooms.

The hospital staff decided to step back and think in a lean way to assess the problem. They analyzed a patient flow diagram (see spaghetti diagram above), which showed that patients were seeing a nurse, a physician, and the head RN in three different locations, and giving their information several times before being given a diagnosis and being treated. They were able to simplify the flow so that the patient gives the information only once to the physician and RN, who are in the same room (spaghetti diagram solved).  The waiting time for patients was reduced to less than 1 hour without adding any additional rooms.