Lean is an improvement approach to improve flow and eliminate waste originally developed by Toyota. Lean thinking focuses on what the customer values: any activity that is not valued is waste.

If you remove the waste, the customer receives a more value added service. For example, in healthcare this could mean any activity that helps patients get better and / or manages their symptoms and comfort.

Lean focuses efforts:
On getting the right things, to the right place, at the right time, in the right quantity whilst minimising waste and being flexible and able to change.

Lean relies on:
People at all levels in an organisation systematically and continuously identifying and eliminating things that waste time, cause blockages to flow and generally add no value to the customer.

Lean transformation, across an organisation moves from understanding tools to understanding systems through to aligning all work strategically. The strategic alignment focuses on aligning work along workflows or pathways that are interdependent.

Healthcare systems are complex; there are a lot of stages in a patient pathway for example that cross organisational structures: this means that the work of one team is dependent upon the work of another. A Lean way of thinking would be to align the organisational structures along the workflows.

Five principles

Lean thinking is specific to each organisation’s underpinning values and beliefs and unique circumstances. However, Womack and Jones (1996) observed five generic elements which were present in all the Lean organisations which they studied. These are:

  1. Value
  2. Value stream
  3. Flow
  4. Pull
  5. Perfection


Eight wastes

Lean is about improving flow and eliminating waste. Once a process has been mapped several types of process waste can be identified.

TIMWOODS is a useful pneumonic that identifies the eight areas of waste that need to be eliminated. The example table illustrates the potential waste in a healthcare environment.