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Mark Graban

Mark Graban: Same Misunderstanding Occurs in Hospitals

By Mark Graban, - Last updated: Thursday, April 29, 2010 - Save & Share - Leave a comment

There’s a fallacy in the question as stated – that “lean” means there’s a major risk of not having what you need to get your work done. This is one way the word “lean” is sometimes misunderstood (going back to the  1980s book “Zero Inventories,” the title of which was taken too literally by some). During my graduate school studies in the 1990s, I worked with a manufacturer who had taken “zero inventories” and what they thought was “lean” to an extreme. They slashed finished goods inventory and very soon after couldn’t make shipments to customers! They had a process with long lead times and highly variable quality – they NEEDED inventory because of all of that variation. The lean approach would have been to attack the variation first, not just slashing inventory.

In a hospital setting, there’s also a risk of this misunderstanding about lean occurring. If a laboratory absolutely must provide a certain testing service 100% of the time, then it seems reasonable that you need two pieces of equipment. Just getting rid of one, in the name of lean, would be foolish. We have to keep patient needs in mind first. The same holds true with supplies and inventory. If there is variation or unpredictability in the demand, we need some inventory. When it’s sometimes a matter of life or death, it’s better to have a little too much inventory instead of not having enough.

A “lean hospital,” to me, is one that meets patients needs nearly 100% of the time with high quality, not one that has the lowest inventory levels. I recently toured a hospital where their inventory turns numbers weren’t meeting their goal. They understood this was OK because there was a special cause – H1N1. They had to stock up “just in case” the pandemic was out of control. Luckily, we were spared a major H1N1 catastrophe and the inventory became waste. It’s better to throw out a bit of excess vaccine than it would have been to not be able to treat sick patients. Taking care of patient needs shouldn’t become a blanket excuse to let inventory explode in an uncontrolled way. There needs to be balance, but the balance should fall on the side of making sure patients get care.

Lean isn’t primarily about inventory, it’s about engaging staff members and leaders in continuous improvement and problem solving. That’s good stuff. If you know what lean is really about, there’s never “too much lean.” There’s sometimes, unfortunately, misguided decision making in the name of what somebody calls “lean.”

This answer was in response to this question.

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