Can we lean healthcare? developing and evaluating a lean assessment tool in healthcare settings

Extensive staff shortages and increasing cost of healthcare services require providers to consider ways of making their processes more efficient without adding extra resources. A growing number of healthcare providers are using Lean methodology to liberate existing resources and allocate them for further improvements. 'Lean' is a process-improvement tool that eliminates waste to improve flow. 'Waste' is anything that adds to cost or time without adding value, while flow refers to the movement of material, information or patients from one step to another. In healthcare, there are eight identified wastes: waiting, over-production, re-work, motion, processing, inventory, intellect, and transportation. Thus, eliminating waste is expected to improve flow so that every step in the process adds value to the customer or patient. Few published reports have evaluated Lean initiatives in healthcare settings, partly due to a lack of standardized tools available to objectively measure desirable outcomes. The purpose of this study was to develop a standardized assessment tool that measures the impact of a Lean initiative in a healthcare setting. Drawing upon the literature and a panel of experts, a brief assessment tool was developed that focused on evaluating a Lean initiative against the eight wastes. Using a pre- and post-test design, the tool was piloted on five Lean initiatives in five departments across five hospitals in Alberta, Canada. While Lean initiatives may not specifically address each of the eight wastes, the tool proved to be an objective, standardized method to evaluate the impact of a Lean initiative.