# Lean

Lean

Lean improvement methodologies originated in industrial settings among frontline workers and were pioneered in Japan, - giving rise to much of the terminology used. Kaizen is the Japa - nese word for improvement. A single ‘cycle’ of  kaizen activity - is defined as requiring similar steps to a PDSA cycle. The same application can be used in health care, with many sequential cycles growing to ‘continuous improvement’. The essential philosophy behind lean methodologies is the elimination of waste through continuous improvement. Lean identifies seven forms of  waste, each of  which is relevant to health care ( 15.6 ). Identifying waste leads inevitably to the need to define value from the perspective of  the patient, a factor that is central to the Choosing Wisely initiative (https://www .choosingwisely . org). 

Overproduction
Example: ordering unnecessary preoperative tests
Solution: implementation of evidence-based preassessment pathways
Inventory
Example: storing excessive medication or supplies in ward storage with a risk of them going out of date
Solution: alphabetically ordered medication cupboards with small amounts of commonly used drugs in conjunction with an ef
/f_i
cient
replenishment system
Waiting
Example: patients waiting long periods to come to theatre
Solution: staggered admission times aligned to operating theatre schedule
Waste of transportation
Example: using trolleys to bring ambulatory day patients to the operating theatre
Solution: better design of the admissions process to enable patients to walk to theatre
W
aste of overprocessing
Example: using computed tomography scans to assess children with possible appendicitis
Solution: consider whether ultrasound could be used instead
Defect
Example: patients arriving for surgery with incomplete or inappr
Solution: more robust checking systems before patients come to theatre
Motion
Example: frequent sear
ching in theatres and the anaesthetic room to
/f_i
nd necessary drugs and equipment
Solution: an ef
/f_i
cient theatre layout, common to all operating theatr
minimal movement and always in the same place