Designing for Lean

We have seen amazing technical advancements in medicine in recent years. New drug regimens, minimally invasive surgeries, advanced imaging technologies, and electronic medical records are all increasing healthcare effectiveness. It is also threatening old ways of doing business. With advancing technologies comes increased complexity, and that complexity requires specific knowledge and greater specialization of labor. The primacy of the patient-doctor relationship has given way to an army of healthcare workers, including primary care and specialist physicians, technicians, mid-levels, therapists, and personal care representatives.

Our model of healthcare delivery is insufficient to guide us into the future. In this model, we have relied primarily on our doctor's personal training and knowledge to lead us back to health. As the knowledge base grows beyond the reach of an individual, the customized quality of the patient-provider relationship model does not scale up very well. Henry Ford could build a car in his garage, but it meant nothing to the world until he figured out the concept of the assembly line.

So what will the new model be? Lean management concepts developed in the Japanese auto industry are beginning to have serious influence on our large healthcare systems. This culture of management was born out of an environment of complex technologies and processes embedded in complex organizations-much like our modern day healthcare systems.

Toyota's influence on Lean

The history of Lean is really a story of the evolution of manufacturing techniques over the last 100 years in the United States and Japan. At the turn of the 19th century, about the same time that Henry Ford was building his first automobile factory, Sakichi Toyoda was building weaving looms. He invented a powered loom that would automatically stop whenever a thread broke. This feature saved material and time. The idea grew into a successful enterprise, and from this his son Kiichiro Toyoda started the Toyota Motor Company in 1930.

From that time and into the 1950s, Kiichiro Toyoda made many trips to the United States to observe and learn from Ford's moving assembly line and many other innovations. He realized that his small company and country could not afford the capital outlay and space required for the production equipment and the large inventories that they produced. During these trips he also observed the American supermarket. There, he saw that products were readily available to customers. As soon as a package was removed from the shelf, it was quickly restocked. From these observations, he conceived the idea of just-in-time delivery, also known as a “pull” system. He used these ideas to develop very efficient methods for building cars and trucks.

The rest became history, as Toyota became the world's largest car maker with a solid reputation for cost, quality, and value. The lessons learned beginning with Sakichi Toyoda's loom grew into the universally admired Toyota Production System, an intricately woven web of policies and practices. Key concepts include the ideas of continuous improvement, elimination of waste, and intelligent use of people and machines. Its methods have been adapted by other manufacturing industries across the globe.

Supporting Lean in healthcare design

Healthcare organizations that have embraced Lean recognize the parallels between making cars and providing complicated medical services. Both entail numerous complex processes done repetitively. Moreover, healthcare providers understand that these methods can work only if patient safety and quality of care is their top priority. For these organizations, the relentless self-examination of Lean practice will result in the continuous reinvention and retooling of medical processes and environments.

So how does the design community support this new model of care?