Application of Lean thinking to health care: issues and observations
Open accessAbstract
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 sociotechnical 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.
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Desirable patient care effects of Lean dominate both in the presently reviewed ED literature and in health care more generally.
“Desirable patient care effects of Lean dominate both in the presently reviewed ED literature and in health care more generally [93].”
From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [93]
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- Authors
- Joosten, T., Bongers, I., & Janssen, R.
- Affiliations
- Tilburg University (NL)
- Corresponding author
- Joosten, T.
- Venue
- International Journal for Quality in Health Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-08-19
- Volume
- 21
- Issue
- 5
- Pages
- 341-347
- ISSN
- 1353-4505 (ISSN-L)
- 1464-3677
- PMC
- PMC2742394
- OpenAlex
- W2152515782
- Cited by
- 420
- References
- 32
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 18 · 2023: 13 · 2022: 12 · 2021: 33 · 2020: 21 · 2019: 42 · 2018: 43 · 2017: 34 · 2016: 33 · 2015: 42 · 2014: 36 · 2013: 33 · 2012: 19
- FWCI
- 25.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- International Journal for Quality in Health Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research portal (Tilburg University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Universiteit van Tilburg
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Keywords
- lean thinking, socio-technical dynamics, operational improvement, implementation resistance, lean tools, quality improvement
- MeSH terms
- Hospital Administration, Humans, Organizational Culture, Efficiency, Organizational, Total Quality Management
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