Commentary

Lean management in healthcare: Reflections from Singapore

Hsien Chih Low

Alexandra Hospital, Transformation Matters, Singapore 159964, Singapore

Corresponding author:

Hsien Chih Low, E-mail: lowhsienchih@gmail.com

For reprints contact: reprints@sppub.org

Received 25 February 2022; Accepted 04 June 2022; Available online 25 July 2022

The challenges facing healthcare are rather universal. Over-reliance on Hospitals and Tertiary care, limited resources, high workloads and spiraling costs are but just a few challenges that all healthcare managers need to face. Lean management is one of the many tools that many have used to try to tackle these challenges in Singapore in the 90s and it is now very hard to find any healthcare organization within Singapore that do not use lean thinking or methodology to help improve their operations. When Singapore first started looking to use lean thinking to help improve healthcare, many hospitals sent healthcare managers to Japan and America to learn about Toyota Production System and the Henry Ford’s Flow Production System. Most people will agree that it was the Japanese and the Americans who first documented and popularized the lean think and lean management concepts^[1] but you can trace the origins of lean thinking to further back in history. However, principles of lean thinking can be seen in human history. From the rigorous process thinking in 1450s demonstrated from an arsenal in Venice,^[2] to further back in 105 AD when Cai Lun started a paper making industry under the Han Dynasty.^[3] Where lean thinking comes from is not as important as how we in healthcare should leverage on its benefits to the healthcare system.

As a practitioner of lean management in healthcare for more than 15 years, I have been asked many times how lean management, which is often associated with production and manufacturing, is applied to a ser vice industr y like healthcare industr y. Over the years, with a g reater understanding of lean thinking, my answer to that question has evolved to be more and more succinct. In my opinion, lean management is a natural match to healthcare because central to both, is this common core value of respect for humanity. One of the best definitions of lean that I have come across is that Lean is about helping someone go back home to their loved ones at the end of their work day to say “I had a good day at work”. This definition has always acted as my compass whenever I am facilitating a process improvement lean project myself or when I am invited to appraise a lean project. The success of any lean project should not only be measured by the amount of costs savings that the organization has achieved or the amount waste reduced from a new process. If lean has been implemented, the staff should feel that their work is more meaningful and of more value. No staff in the hospital likes to do rework, let patients wait unnecessarily, walk around looking for things and do work that they are not proud of.

One may argue that I have got my priorities wrong and the goal of every healthcare manager is to make sure that patients who use our services has a good experience instead. My counter argument to this is based on my belief that the vast majority of healthcare professionals who toil in this tireless and sometimes thankless industry, are in this industry because they enjoy helping people and all intuitively know how to take good care of their patients, provided they had more time and resources. All we have to do as healthcare managers is to remove the many waste and frustrations from their work and most times, you will see that doctors, nurses and all the other healthcare professionals intuitively know how to give good care.

If you ask healthcare managers/leaders this question and that is “What is the most important resource that you are responsible for that help you achieve your department’s objectives?”, I think most insightful managers/leaders will unanimously reply that it is their people or their staff. Despite the leaps in technology in healthcare over the past decade, healthcare remains a very people centric industry that is high in human touch. No clinic, hospital or treatment centre can truly achieve their all of their objectives and deliver excellent clinical outcomes without a good team of staff working hard together. So, if people are the most importance resource in most healthcare organisations, then shouldn’t all healthcare managers/leaders focus most of their attention into uncovering the potential of every one of their staff and removing all obstacles that prevent them from performing their best?

One of the most understated and common waste in lean that exist in healthcare is that we are not fully not utilising staff talent. It is also the one waste that most healthcare organisations grew most accustomed to and over time just accept it as part of the norm. After all, there is nothing criminal about staff nurses doing some administrative work or doing stock take or re-ordering supplies. I use the example of nurses because in a typical hospital, they make up the majority of the workforce. They are the bedrock to most hospital services and maybe because there are so many of them, it is easy to forget that they are highly trained professionals and asking them to do anything else rather than clinical work, is a great waste of their talent and their training. This would be akin to hiring highly trained and professional sculptors and painters to restore a national monument and getting them to do administrative work, do stock take of their supplies instead of the real preservation and restoration work. It is easy if not almost convenient to forget that most of the staff who are working in the hospitals are highly trained professionals and any time spent by them not doing what they are trained to do, is a big waste. A recent study in my hospital, which is a typical 300-bed acute hospital, we showed that our inpatient nurses spent a combined total of 225 days a year on documentation for new patient admissions alone. A healthcare administrator should always question if all these documentation is necessary and if they can be automated to help protect our nurses time to allow them to spend more time with patients a day.

Along the same vein, when a healthcare organization fails to tap on to the ideas of their staff, this is also another wasted opportunity. As healthcare managers, one of our key roles is to manage our staff and bring the most out of each one of them but in the midst of the daily hustle, it is easy to forget too that our staff are all intelligent beings who are capable of ideation. Not allowing an avenue for staff to contribute their ideas to improve the processes around them is hardly seen as a cardinal sin in most healthcare organizations. For too long, the onus of innovation and improvement has been put solely on the shoulders of the leaders and managers in healthcare but for the whole industry to improve, we need to tap on every single one of our staff in the organization and unleashing their potential. It is my belief that there are many tools and techniques out there now to help managers do so and it remains my conviction to help introduce and expound these to my fellow colleagues in Singapore and beyond.

Source of Funding

None declared.

Conflict of Interest

None declared.

REFERENCES

1. Young T, mcclean S. Some challenges facing Lean Thinking in health- care. Int J Qual Health Care 2009;21:309–310. DOI: 10.1093/intqhc/mzp038
2. Helmold M. [Lean Management and Kaizen: Fundamentals from Cases and Examples in Operations and Supply Chain Management.] Switzerland: Springer, 2020.
3. Cartwright M. Paper in Ancient China. 2022. Available at: https://www.worldhistory.org/article/1120/paper-in-ancient-china/. Accessed April 2 2022.