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1. Introduction
Healthcare organizations are increasingly forced to adapt to developments in medical information, technologies and relationships with other (healthcare) systems (Brandao de Souza and Pidd, 2011). In consequence, the healthcare sector is subject to continuous change (Adler et al., 2003; Dahlgaard et al., 2011). Simultaneously with these changes, healthcare organizations are forced to maintain and improve performance, quality of care and patient satisfaction (Brandao de Souza and Pidd, 2011). Patient safety is also a focal point, as is clear from one of the most influential reports in healthcare of the last two decades: “To err is human: building a safer health system” (Kohn et al., 2000). This report by the Institute of Medicine ensured that patient safety became a primary concern in the healthcare sector.
Healthcare organizations can improve patient safety, quality of care, efficiency, patient satisfaction and performance by applying lean principles (Brandao de Souza and Pidd, 2011; Dickson et al., 2009; Jimmerson et al., 2005; Womack and Jones, 2003; Young et al., 2004). Lean principles stem from the Japanese manufacturing industry and are centered on creating more value with less work by enhancing existing organizational processes and structures (Kim et al., 2006; Womack and Jones, 2003). Lean can be described as “an integrated system of principles, practices, tools, and techniques focussed on reducing waste, synchronizing work flows, and managing variability in production flows” (Koning et al., 2006, p. 5).
Business management techniques such as lean were traditionally seen as a discipline distinct from healthcare management. This has changed over the last ten years as the value of integrating business management techniques into healthcare management has gained recognition as a means of delivering higher quality and more efficient care (Trisolini, 2002). In this context, Ben-Tovim et al. (2008) stress that the basics of process improvement, and therefore the lean principles (value, stream, flow, pull and perfection) are as appropriate for healthcare as they are for other service and manufacturing industries.
The term “lean healthcare” has emerged in recent years, reflecting the stronger focus on efficiency and patient satisfaction within the healthcare environment (Dahlgaard et al., 2011). Patients should be considered as primary customers, and the obvious application seems to lie in eliminating delays, repeated...