When I heard the hoof beats of hundreds of lean manufacturing consultants as they stampeded out of dying factories into vulnerable medical
centers, my antenna went up. Sure, there’s money in them there emergency rooms and pharmacies, but who ever said a doctor is the same as a production manager, or that a nurse thinks talks and works the same way as a machine operator? And could you expect an organizational philosophy that cared about making profits out of inventories and time cards to graft well onto a massively wounded human services delivery system? I was suspicious of the results we would see. After all, doctors and medical staffers grew up, we think, with a different philosophy…. Or did they….? But as anyone who has chilled in that great and painful leveler, the Emergency Room, knows, there is always room for improvement! So here’s why this latest offering in the tall stack of medical and hospital lean offerings is different from and better than the others --- it has credibility. This is not just a lean tools rehash of industrial engineering a la Toyota. It is a real and genuine attempt to systematically address the critical issues in any human service operation today.
Authors Grunden and Hagood came together with previous healthcare work, although neither is a healthcare professional. Because of their work around the Toyota Production System, we would expect to find the staples of this system embedded in their healthcare resources – and in fact, the authors include the usual lean rules and tools – Liker’s 14 Management Tools, The Eight Wastes of Healthcare, leadership, etc. But where this book has usefulness is in its treatment of facility design and redesign, a subject that Blue Heron Journal covered in a piece called “Healing Healthcare,” with Cindy Jimmerson, a nurse by training who immersed herself in lean principles to transfer lean’s basic values and tools.
Take a look at Chapters 2 and 3 for examples of implementation of this approach with tools to bring teams of staffers together at the design and concept stages. The authors briefly cover 3P, the critical design process that I first saw at Maytag and Pella about 20 years ago – and they contrast this approach with kaizen, a puzzling approach to these two important techniques. The authors recommend value stream mapping in advance of 3P, an idea that is not always strictly adhered to, but one that can have great value for teams first coming together to redesign any process in any facility.
The book contains the usual pages on lean culture and lean leadership. I would have preferred an in- depth of review of the day to day experience of facility redesign from the expert’s perspective. I would have liked color photos of the tools the teams used to discover their new flows, key opportunity areas and impediments. There could have been many more pages and color photos dedicated to visual systems – for more in depth leaning on Visual there are other books available, including Gwen Galsworth’s. Perhaps Lean-led Hospital Design will be followed up by a hands-on workbook taking ordinary healthcare practitioners step-by-step through a basic process and facility redesign. That would be an outstanding tool in the midst of hundreds of lean and kaizen offerings.***