A Methodology for Supporting Lean Healthcare

  • Daniela Chiocca
  • Guido Guizzi
  • Teresa Murino
  • Roberto Revetria
  • Elpidio Romano
Part of the Studies in Computational Intelligence book series (SCI, volume 431)


This article focused on application of Lean techniques in healthcare service. In this context, the aim of this work is to demonstrate that the problems associated with the application in the world services of the rules governing production processes are only apparent. In fact, the provision of a service search, like industrial production, to implement value-added processes and also an appropriate use of resources consumption, although until now it was considered that the service management should use management strategies completely different from those used in the industrial sector. The service sector is backward compared to the manufacturing industry in terms of efficiency, automation, repeatability and quality. The reason is very simple: the design and implementation of the process of service delivery have always been much less expensive than the corresponding activities of the manufacturing sector. In particular, we will analyse as case study, vaccination service in the City District in the South of Italy. It will, therefore, applied the techniques of "lean" philosophy to a specific activity of this service in order to improve performance. In particular we are going to focus on the processes of vaccines delivery among the various activities within the District. We have used a new study approach based on simulation : using a software (Powersim), we have developed a model of the current state and, basing on suggestions for improvement; then, after this research, have noticed an improvement of critical performance parameters developing a model of the future state.


Health care service management Lean Technics System Dynamics Value Stream Mapping 


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  1. 1.
    Melton, T.: The Benefits of Lean Manufacturing: What Lean Thinking has to offer to Process lndustries. Chemical Engineering Research and Design 83(A6), 662–673 (2005)CrossRefGoogle Scholar
  2. 2.
    Holweg, M.: The Genealogy of Lean Production. Journal of Operations Management 25, 420–437 (2007)CrossRefGoogle Scholar
  3. 3.
    Davis, M.M., Heineke, J.: Operations Management: integrating Manufacturing and Services, 5th edn., pp. 349–367. Mc-Graw Hill (2004)Google Scholar
  4. 4.
    Spear, S., Bowen, H.K.: Decoding the DNA ofthe Toyota Production System. Harvard Business Review 77(5) (September/October 1999)Google Scholar
  5. 5.
    Ohno, T., Bodek, N.: Toyota Production System: Beyond Large-Scale Production. Productivity Press, Portland (1988)Google Scholar
  6. 6.
    Saaksvuori, A., Immonen, A.: Product Lifecycle Management, 3rd edn. Springer (2008)Google Scholar
  7. 7.
    Arbòs, L.C.: Design of a Rapid Response and High Efficiency Service by Lean Production Principles: Methodology and Evaluation of Variability of Performance. Intemational Journal of Production Economics 80, 169–183 (2002)CrossRefGoogle Scholar
  8. 8.
    Ben-Tovim, D.I., Bassham, J.E., Bolch, D.M.M.A., Dougherty, M., Szwarcbord, M.: Lean Thinking Across a Hospital: Redesigning Care at the Flinders Medicai Centre. Australian Health Review 31(1) (2007)Google Scholar
  9. 9.
    Dickinson, E.W., Singh, S., Cheung, D.S., Wyatt, C.C., Nugent, A.S.: Application of Lean Manufacturing Techniques in the Emergency Department. The Journal of Emergency Medicine 37(2), 177–182 (2009)CrossRefGoogle Scholar
  10. 10.
    Reitel, D.R., Rudkin, S.E., Malvehy, M.A., Killeen, P., Pines, M.: Improving Service Quality by Understanding Emergency Department Flow: A White Paper and Position Statement Prepared for the American Academy of Emergency Medicine. The Journal of Emergency Medicine 38(1), 70–79 (2010)CrossRefGoogle Scholar
  11. 11.
    Ben-Tovim, D.I., Bassham, J.E., Bolch, D.M.M.A., Dougherty, M., Szwarcbord, M.: Lean Thinking Across a Hospital: Redesigning Care at the Flinders Medicai Centre. Australian Health Review 31(1) (2007)Google Scholar
  12. 12.
    Jones, D., Mitchell, A.: Lean Thinking for the NHS. NHS Confederation (2006)Google Scholar
  13. 13.
    Fillingham, D.: Can Lean Save Lives? The Journal of Leadership in Health Services 20(4), 231–241 (2007)Google Scholar
  14. 14.
    DeMaria, A.N.: The department of cardiac/ vascular medicine and surgery. J. Am. Coll. Cardiol. 46, 728–729 (2005)CrossRefGoogle Scholar
  15. 15.
    Institute of Medicine: Crossing the Quality Chasm: a new health system for the 21st century. National Academy Press, Washington, DC (2001)Google Scholar
  16. 16.
    Laursen, M.L., Gertsen, F., Johansen, J.: Applying lean thinking in hospitals; exploring implementation difficulties. Aalborg University. Center for Industrial Production, Aalborg (2003)Google Scholar
  17. 17.
    Young, T.P., McClean, S.I.: A critical look at lean thinking in healthcare. Qual. Saf. Health Care 17, 382–386 (2008)CrossRefGoogle Scholar
  18. 18.
    Elkhuizen, S.G., Limburg, M., Bakker, P.J., Klazinga, N.S.: Evidence-based re-engineering: re-engineering the evidence - a systematic review of the literature on business process redesign (BPR) in hospital care. Intern. J. Health Care Qual. Assur. Inc. Leadersh Health Serv. 19, 477–499 (2006)Google Scholar
  19. 19.
    Braithwaite, J., Westbrook, M.T., Hindle, T., Iedema, R.A., Black, D.A.: Does restructuring hospitals result in greater efficiency? – an empirical test using diachronic data. Health Serv. Manage Res. 19, 1–12 (2006)CrossRefGoogle Scholar
  20. 20.
    Joosten, T., Bongers, I., Janssen, R.: Application of lean thinking to health care: issues and observations. Int. J. Qual. Health Care 21, 341–347 (2009)CrossRefGoogle Scholar
  21. 21.
    Harrison, M., Henriksen, K., Hughes, R.G.: Improving the health care work environment: a sociotechnical systems approach. Jt Comm. J. Qual. Patient Saf. 33(suppl. 11), 3–6 (2007)Google Scholar
  22. 22.
    Aiken, L.H., Clarke, S.P., Sloane, D.M., et al.: Nurses’ reports on hospital care in five countries. Health Aff. 20, 43–53 (2001)CrossRefGoogle Scholar
  23. 23.
    Aiken, L.H., Clarke, S.P., Sloane, D.M.: Hospital restructuring: does it adversely affect care and outcomes? J. Nurs Adm. 30, 457–465 (2000)CrossRefGoogle Scholar
  24. 24.
    Berwick, D.M.: Developing and testing changes in delivery of care. Ann. Intern. Med. 128, 651–656 (1998)Google Scholar
  25. 25.
    Winch, S., Henderson, A.J.: Making cars and making health care: a critical review. Med. J. Aust. 191, 28–29 (2009)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Daniela Chiocca
    • 1
  • Guido Guizzi
    • 1
  • Teresa Murino
    • 1
  • Roberto Revetria
    • 2
  • Elpidio Romano
    • 1
  1. 1.Dipartimento di Ingegneria dei Materiali e della ProduzioneUnivertisty of Naples “Federico II”NaplesItaly
  2. 2.Dipartimento di Ingegneria MeccanicaUniversity of GenoaGenoaItaly

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