Page 54 - How To Implement Lean Manufacturing

Lean Manufacturing and the Toyota Pr oduction System 35

right way, he could use it as a way to get reelected and promote Lean in government
along the way. Waste reduction is so sorely needed in the U.S. government. Quite
frankly, it is a Lean opportunity well past its time. The key will be how to apply it and
by whom?
The Health Care Industry
Some possibilities in using Lean tools exist for health care companies, but not as many
as I would like to see. In the small doctor’s office, with one or two doctors and a small
staff, Lean should work fairly well. These offices are usually customer sensitive, inter-
ested in making money, and focused on the long haul.
However, in the hospital, serious issues are present that prevent Lean applications.
The first problem is… “Exactly who is the customer?” The hospital will tell you it is the
patient. But that is only partially true—and is more untrue than not. So why is the
patient not really the customer? Well, think of what makes a customer a customer. Gen-
erally, to be a customer you:
• Are courted or otherwise sought out by the provider
• Use whatever they are selling
• Pay for it
• Can complain about a problem and get action
Well, in the hospital situation, seldom do I hear about someone shopping around
like you would for a present or a new car. If the typical patient needs an MRI or knee
surgery, it is rare that they shop about to find a low-cost provider. Rather, most people
just go where their doctor sends them, unless their insurance will not pay for that
location, then they instead go where their insurance will cover the cost. So guess who
the hospital’s customer is by this measure? Here, they are courting the doctors and
insurance companies, so by this measuring stick, you are not the customer. You use the
service, but who pays for it? Well, here comes the insurance company. Guess who
qualifies as the customer in that instance? In fact, I have never been to a health care
facility where they didn’t first check my insurance before they checked me—emergency
room service included. So, just who is the customer by this measure? Well, I guess you
see my point. The large providers are mostly disconnected from the patient as being the
customer. If they claim the patient is the customer, they are confused, at the very least.
Hence, there is little hope here to apply Lean as a business philosophy until some
dramatic changes occur.

But Lean Can Apply ….. Just Less Broadly
In the cases just listed, the primary driving forces of the business are so distant from the
driving forces behind Lean that I cannot envision Lean principles becoming the guiding
philosophy of the business or entity.
However, do not lose hope. In every case I have mentioned here, there are a series of
processes, within the business, where Lean process tools still have some limited applica-
tion. In many processes internal to these entities, the customer is much better defined
and quality characteristics can be determined, measured, managed, and improved.
For example, we see the best as well as the worst applications of Lean principles in
professional sports. While the removal of waste is not important in most sports, watch