Lean Process helps improve patient health care

The Lean Process was first developed and implemented by the car manufacturer Toyota, during the period 1945–1970.
The idea behind Lean principles is to work with continuous improvement to achieve efficient processes in production or the provision of services. Toyota’s successful business has been recognised all over the world and the Lean Process has gradually spread to other industrial sectors. In recent years the Lean Process has also entered American and European health care. General Electric, a provider of hospital medical applications, is nowadays considered as a ‘gold standard’ company for education and certification of the Lean Process in health care.
  “Health care can learn from industry and vice versa,” says Carol Beehler.
  “We are just at the beginning and the sharing and learning from each other will continue to grow. I am looking forward to going deeper into this field and developing Lean principles further in health care. I have recently started a Lean project in pharmacy and nursing with a focus on medication delivery and administration.”


Research organisations, so called think tanks, have become the link for the Lean Process between Toyota and American health care providers. Innovators in health care have been impressed by Toyota’s progress and have pushed development forward. “One of the hospitals in my own community which worked with an innovator think tank in Chicago, Illinois, has been very successful,” adds Carol Beehler. “New, efficient processes at hospitals have got a lot of attention in literature and the media. The ball has started rolling and in my experience the Lean Process first became clearly visible in American health care around 2004.”

The first step towards introducing the Lean Process involves “confronting reality”. It is necessary to clearly identify existing problems in order to make changes. The starting point for hospitals, according to Carol Beehler, must be a realisation of the need to lower their costs and improve patient satisfaction. There could, for example, be issues with long waiting times and difficulties in getting an efficient flow of patients through an operating room or an emergency department.
  Recently, in a northern Florida hospital, patients were waiting up to twelve hours before they received treatment in the emergency department. It was identified that the longest waiting time was in triage, where nurses sort patients according to the level of urgency and then send them back to the emergency department. After using the Lean Process, the triage team pinpointed improvements in communicating directly with physicians about less urgent patients who could be directed to the correct area of the emergency department. By doing this, valuable emergency department treatment rooms were opened for higher priority patients. This was a win-win for all parties. The emergency department charge nurse was able to concentrate on treating and moving more acute patients, while bringing triaged patients back for treatment within 30 minutes of their arrival on average. This was a considerable improvement compared to the previous average waiting time of six hours.

In general, it is regarded as a stamp of quality for hospitals to work with the Lean Process. A hospital in Seattle, Washington, implemented Lean and used this in its communications to reinforce the hospital’s image as an innovative, quality-oriented institution that is attractive for health care workers.
  Carol Beehler emphasises that the most important benefit of the Lean Process is that it helps health care workers take better care of patients.
  “Patient satisfaction and quality always go hand in hand with cost efficiency when you work with Lean principles in health care. It is built into the system.”
  Once the Lean Process has been implemented it can be an ongoing process. Today many hospitals use the Lean principles in their quality improvement programmes without even calling them ‘Lean’.
  “You can take parts of the Lean principles and include them in other improvement processes. That is how it is being developed. I experience a lot of that,” Carol Beehler explains.
  She encourages people to share how they are improving processes, as this would help health care to develop more quickly. It could be any processes, not just Lean. One option could be the creation of a forum on the Internet.

It is necessary to have a clear picture of the goals of the business or the organisation when you start working with Lean. The next step is to identify the problems in a specific unit or parts of the operations that need to be solved. The team responsible for Lean should work in a very structured way, including mapping out and measuring the impact of changes throughout the process. The work should be followed up in monthly cycles with adjustments made as they are identified.
  “Choose a few measurements that you can use to sustain the improvement. And don’t forget to celebrate steps toward success! It is very important to encourage people when they do things right,” Carol Beehler emphasises.

Many teams can work in parallel with different processes, coordinated by a steering group. However, managers should not be involved in the working groups, she says, as it is essential that employees themselves are committed to driving process forward by using their own knowledge and experience. Carol Beehler also feels that measurement methods traditionally used in other sectors are becoming increasingly accepted in the health care field.
  “Specialists who concentrate on improvement processes in health care are now emerging,” she adds. “The next step will be to look more at quality improvement throughout an entire hospital, not just within individual departments. Think tank organisations, such as the Institute for Health Care Improvement in Boston, Massachusetts, are very visible right now because they are concentrating on decreasing the amount of errors in health care. It helps push quality improvements further.”

Carol A. Beehler

Lives and works: Recently moved from Indiana to Charlotte, North Carolina, to join PricewaterhouseCooper. She was previously Senior Operations Nurse Consultant for Galloway LLC in Atlanta, Georgia.

Family: Two adult children, four grandchildren and a husband who currently lives in Indiana but will move to Charlotte when they have found a house. Also, a golden labrador dog named Molson, the grandchildren’s special darling!

Leisure interests: California wine tasting. She is also trying to learn more about European wines, especially French and Spanish. The main focus right now is on dry Rosé. She has two cases of very high quality wines that have been cellared since the 1990s. The wine is usually stored for consumption, rather than as an investment. For a balanced lifestyle, Carol also makes time for cardiovascular health exercises, preferably outdoors.

Literature: Enjoys reading novels. Read eight novels on vacation last summer. Tries to catch up once a year. Romance and mystery are favourites. Also enjoys a few biographies.

Music: Has played the accordion since she was five and, in her teens, achieved third place in an international competition in New York City. Plays classical music in a group of musicians.