President's Message - The LEAN Transformation

by Chris Rivers, ICHP President
March 20, 2012

As part of health care reform and transformation, organizations will be asked to do more with less, including adapting to changes in the regulatory and reimbursement environment. Many health-system pharmacy leaders have embraced lean concepts and have applied them as a means of improving workflow and safety and minimizing waste.

What is the definition of lean? Merriam-Webster defines lean:

lean adj
1     a: lacking or deficient in flesh
    b: containing little or no fat <lean meat>
2:     lacking richness, sufficiency, or productiveness <lean profits> <the lean years>
3:     deficient in an essential or important quality or ingredient: as
    a of ore: containing little valuable mineral
    b: low in combustible component —used especially of fuel mixtures
4:     characterized by economy (as of style, expression, or operation)

Lean process improvement techniques are applied by pharmacy leaders to improve departmental workflow, reduce waste, and achieve cost savings. In the world of manufacturing, Toyota Production Systems (TPS) epitomizes the lean enterprise when the company revisited the processes developed by Henry Ford by providing continuity in process flow and a wide variety of product offerings. TPS shifted the manufacturing focus from the utilization of machines to product flow through the total process. By having machines for the actual needed volume, machines that ensure product quality, and others, Toyota assured low cost, high quality and variety, and quick throughput times to respond to consumer demands.   

Gary Convis, Managing Officer of Toyota and President, Toyota Motor Manufacturing, Kentucky, was once quoted, “Management has no more critical role than motivating and engaging large numbers of people to work together toward a common goal. Defining and explaining what that goal is, sharing a path to achieving it, motivating people to take the journey with you, and assisting them by removing obstacles – these are management’s reasons for being.”

The thought process of lean was thoroughly described in the book The Machine That Changed the World (1990) by James P. Womack, Daniel Roos, and Daniel T. Jones. In a subsequent volume, Lean Thinking (1996), James P. Womack and Daniel T. Jones distilled five lean principles:
  • Specify the value desired by the customer
  • Identify the value stream for each product providing that value and challenge all of the wasted steps (generally nine out of ten) currently necessary to provide it
  • Make the product flow continuously (and smoothly) through the remaining value-added steps
  • As flow is introduced, let customers pull value from the next upstream activity.
  • Manage toward perfection so that the number of steps and the amount of time and information needed to serve the customer continually falls
The Toyota success in the past few decades has created a demand for greater knowledge of lean thinking. Multitudes of books and papers have been published about this subject. As this thinking expands throughout the world, the tools and principles are adapted by leaders in healthcare, construction maintenance and including the government.   

When the basics of Lean are understood, pharmacy leaders are being challenged to take these efforts beyond the framework. Many health-system pharmacy leaders have embraced lean concepts and have applied them as a means of improving workflow and safety and minimizing waste. New projects require meticulous planning and assessment. When assessing the merits of potential lean projects, pharmacy leaders need to know what questions to ask, how success will be measured, and how to implement and sustain those efforts. Each project needs to be analyzed in terms of what will and will not work in a particular practice environment. Process improvement methodologies are employed as a means to create a culture of constant change within which both large projects and day-to-day problems can be addressed. The goal of these methodologies is to change the culture such that the various departments in the organization are connected through their efforts in process improvement.

The Spring Meeting is approaching. Keynote speaker, Dr. Kyle E. Hultgren, in his leadership role at the Center for Medication Safety Advancement, pursues the development of innovative safe medication use practices as well as engages methods to educate healthcare practitioners and student pharmacists. Dr. Hultgren is a co-author of a certification program in partnership with Purdue University and the Veterans Health Administration on Lean Healthcare and Systems Redesign that he is currently providing to health systems nationwide.  Dr. Hultgren will be discussing Lean principles and how to incorporate them into your workplace.

  1. ASHP Foundation. Clinical Microsystems: Transformational Framework for Lean Thinking (Accessed 2012 Feb).
  2. Lean Enterprise Institute. Home Page. (Accessed 2012 Feb).
  3. Liker JK.  The Toyota Way: 14 Management Principles From the World’s Greatest Manufacturer. New York: McGraw-Hill; 2004.
  4. Merriam-Webster.  Definition of lean. (accessed 2012 Feb).

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