Chapter 6 Lean

Chapter 6 Lean
6.1 LEAN PHILOSOPHY AND METHODS
Taichii Ohno, an industrial engineer and businessman considered to be the

father of the TPS, stated that: “The most important objective of the Toyota
system has been to increase production efficiency by consistently and
thoroughly eliminating waste. The concept and equally important respect for
humanity that has passed down from the venerable Toyoda Sakichi are the
foundations of the Toyota production system”
6.2 DRIVERS FOR LEAN HEALTHCARE
SYSTEM
SYSTEM
Driver 1: Define Value Based on the Voice of the
Patient (Customer)
SYSTEM
Driver 2: Create an Environment That Supports the
Staff
SYSTEM
Driver 3: Eliminate All Forms of Waste
SYSTEM
Driver 4: Deliver Excellent Clinical Quality
1. Safe: Care should be as safe for patients in healthcare facilities as in their

homes.
2. Effective: The science and evidence behind healthcare should be applied and
serve as the standard in the delivery of care.
3. Efficient: Care and service should be cost effective ,and waste should be
removed from the system.
4. Timely: Patients should experience no waits or delays in receiving care and

service.
5. Patient centered: The system of care should revolve around the patient, respect
patient preferences, and put the patient in control.
6. Equitable: Unequal treatment should be a fact of the past; disparities in care

should be eradicated.
6.3 A TOOLSET FOR ELIMINATING WASTES
The 3Ms of waste in lean are muda, mura, and muri.
Eliminating muda deals with eliminating processes or activities

that add cost but do not add value.
Eliminating mura deals with eliminating unevenness so as to

achieve production or system leveling.
Eliminating muri deals with eliminating overburdens or

unreasonableness so as to avoid difficulties and achieve
standardized work and a logical workflow with repeatable
processing steps, in a reasonable time/takt time.
6.4 VALUE STREAM MAPPING
There are five key VSM principles as follows:
1. Specify value from the stand point of the end

customer.
2. Identify the value stream for each product family.
3. Make the product flow.
4. So the customer can pull.
5. As you manage toward perfection

6.4 VALUE STREAM MAPPING
6.5 A3
A3 is a structured problem-solving and continuous

improvement approach that systematically leads the
user toward solutions. It is based on the Plan-Do-
Check-Act (PDCA) cycle and gets is name from the
ISO A3 (11′′ × 17′′) size paper used for completing the
worksheet.
6.5 A3
6.6 5S
Seiri :: sort means to remove unnecessary or unwanted

material from the workplace and dispose of it properly.
Seiton :: systematic arrangement :: set in order means

to arrange all items so they can be easily found and
selected for use.
Seiso :: shine means to clean the workplace so that it is

safe and easy to work in.
Seiketsu:: standardize means to have the best practices

in each work area.
Shitsuke :: sustain means to keep the workplace in

good working order.
6.7 KANBAN
Kanban means signboard or billboard in Japanese;

more precisely, “kan” means “color” and “ban” means
“card” or “ticket.” A kanban provides a visual signal
that an item requires replenishing or replacement.
Beyond the board or card, kanban is a system to
control inventory that was developed by Ohno in the
1950s.
6.7 KANBAN
6.7 KANBAN
6.8 LEAN IMPLEMENTATIONS
The success of lean in manufacturing made it a natural

approach to turn to as healthcare organizations
worldwide started to answer the call to improved
healthcare delivery and safety.
6.9 LEAN THINKING
6.9 LEAN THINKING
An IHI report, “Going Lean in Health Care” (IHI,

2005), summarized it this way:
Implementing lean thinking requires major change

management throughout an entire organization, which
can be traumatic and difficult. Strong commit- ment
and inspiring leadership from senior leaders is
essential to the success of an effort this challenging.
The CEO must be a vocal, visible champion
How Can “Lean” Can Address Healthcare Management
Issues

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Chapter 6 Lean

6.1 LEAN PHILOSOPHY AND METHODS

Taichii Ohno, an industrial engineer and businessman considered to be the

1. Safe: Care should be as safe for patients in healthcare facilities as in their

4. Timely: Patients should experience no waits or delays in receiving care and

6. Equitable: Unequal treatment should be a fact of the past; disparities in care

The 3Ms of waste in lean are muda, mura, and muri.

Eliminating muda deals with eliminating processes or activities

Eliminating mura deals with eliminating unevenness so as to

Eliminating muri deals with eliminating overburdens or

There are five key VSM principles as follows:

1. Specify value from the stand point of the end

2. Identify the value stream for each product family.

3. Make the product flow.

4. So the customer can pull.

5. As you manage toward perfection

A3 is a structured problem-solving and continuous

Seiri :: sort means to remove unnecessary or unwanted

Seiton :: systematic arrangement :: set in order means

Seiso :: shine means to clean the workplace so that it is

Seiketsu:: standardize means to have the best practices

Shitsuke :: sustain means to keep the workplace in

Kanban means signboard or billboard in Japanese;

The success of lean in manufacturing made it a natural

An IHI report, “Going Lean in Health Care” (IHI,

Implementing lean thinking requires major change

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