Application of lean thinking to health care: issues and observations
Application of lean thinking to health care: issues and observations
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DOI：
10.1093/intqhc/mzp036
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发表时间：
2009-10-01
影响因子：
2.6
通讯作者：
Janssen, Richard
中科院分区：
文献类型：
--
作者：
Joosten, Tom;Bongers, Inge;Janssen, Richard
背景。事故和质量问题是医疗保健领导者呼吁重新设计医疗保健服务的主要原因，其中一个使用的概念是精益思维。然而，精益常常导致抗拒。此外，也缺乏支持精益前提的高质量证据。在本文中，我们介绍了精益思想的概述及其在医疗保健中的应用。精益思维在卫生保健中的发展、理论和应用。精益思维从一种旨在提高汽车制造商车间运营绩效的工具演变为一种兼具运营和社会技术方面的管理方法。直到最近，社会技术动力学还没有受到太多关注。同时，平衡的办法可能导致业务改进和社会技术改进相辅相成的局面。在卫生保健方面的应用有限，主要集中在使用原始精益工具的业务方面。更综合的方法是更多地关注精益实施工作的社会技术动态。此外，使用原始精益工具的需求可能是有限的，因为医疗保健可能已经使用了符合精益思维原则的不同仪器和工具。我们相信精益思维有潜力改善医疗保健服务。同时，还需要考虑到方法和实际方面的考虑。否则，精益的实施将是肤浅的和失败的，增加了现有的阻力，使其更难以长期改善医疗保健。
Background. Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.Development, theory and application of lean thinking to health care. Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles.Discussion. We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.