Lean thinking consists of a systematic approach that enables the identification and elimination of waste in production processes, focusing mainly on aggregate quality and delivering to the customer only what he considers to be of value 15 . In other words, lean is the maximization of value for the client by means of an efficient process without waste. In health, this means providing services that respect and meet the needs and preferences of the patients 10 . use evidence based lean management to improve the flow of work to eliminate delays for patients, wasted effort for staff and unnecessary costs
Another principle is the elimination of activities that do not generate value, along with any waste (long waits for care, duplicated actions, conflicting advice regarding treatment). Such waste does not allow that the process of care and treatment occur without interruption, detours, returns or delays. Thus, with the elimination of these issues, the efficiency of activities and quality of service simultaneously increase
Quality and lean are two sides of the same coin. They need to be used in tandem. One would use the scientific method for prioritizing which problems to work on, eliminating the generic root causes of these problems and carefully planning how to implement countermeasures that will stop the problem ever occurring again. One would also use lean principles and tools to link best practice activities into integrated patient journeys from initial consultation to discharge and beyond. One would use visual management to establish stability in the work flow, to see variances and to reveal problems. And one would develop the problem solving skills of staff through learning by doing.
These aren’t an exact match for what occurs in frail care centres around the country but it does point out a few key lessons.