Taking the Toyota
approach to brain surgery
Japanese vehicle manufacturer, Toyota, is well-known for developing the
principles of so-called “lean manufacturing”. Research published in the
International Journal of Technology Management suggests that the lean
approach might also be beneficial to medical procedures, making
hospitals more efficient and cut waiting lists.
Management Engineer Kasper Edwards of the Technical University of
Denmark in Lyngby and colleagues first reviewed the research literature
on lean practices. Lean manufacturing based on the Toyota Production
System is founded on the idea of “preserving value with less work”. It
is perhaps the natural extension of the Ford Motor Company’s original
production line approach and involves avoiding any expenditure or costs
that do not create value for the end customer. From the consumer
perspective, this means offering products or services at a price the
customer is willing to pay.
The team hoped to discover whether the same values of lean, value and
efficiency might be applied to healthcare systems. Their research
demonstrates that within the Danish public healthcare system, “lean” can
work very effectively for some parts of healthcare provision, such as
surgical wards but not necessarily for others. Lean could thus help
address the problem of not only financial constraints on public health
services but also help hospitals cope with the problem of a lack of
doctors, nurses and healthcare professionals in general.
The researchers point out that until recently, lean projects in
healthcare have focused only on peripheral activities to improve patient
flow through wards and reduction of turnover times. Numerous hospitals
have implemented lean in these contexts with varying degrees of success.
Likewise, administrative procedures have also benefited from a lean
approach. The team has now studied the case of a major hospital outside
Copenhagen with 200 employees and ten operating rooms. Surgery was split
into two streams: one following normal procedures, the other running
“lean” for elective operations. Ultimately, the programme was initiated
to create more effective working procedures, and ensure a total
continuity of care to the benefit of both staff and patients in the
light of absenteeism and morale problems at the hospital.
As part of the lean approach, two “turbo” rooms were set up that would
carry out only elective and routine surgical procedures and would be
staffed by only senior employees and have no educational functions.
Teamwork was also encouraged with a fixed team in which, for instance,
the anaesthetist might assist the surgeon by holding a patient’s arm
The results were overwhelming, Edwards and colleagues report: “What was
previously done in three operating rooms can now be done in two and the
teams are finished within their shift,” the researchers explain. This
has had a significant effect on employee morale as well as increasing
patient turnover by a third and eliminating waiting times for the
routine procedures carried out in the turbo rooms.
The researchers point out that for the remaining operating theatres at
the hospital that were not made lean, there has been no change other
than that there are fewer, efficient senior staff available. Staff
morale in the non-lean rooms may be somewhat compromised, which
highlights the need to investigate further the benefits for patients of
a lean approach to surgery and to consider the overall impact on a
hospital should lean be implemented in only certain areas. Lean works in
healthcare but mixing lean and normal mode surgery in the same ward is
not recommended, the team adds.
Ref: “Implementing lean in surgery - lessons and implications” in Int.
J. Technology Management, 2012, 57, 4-17
of upload: 21st Jan 2012