University of Michigan, Industrial & Operations Engineering

Ph.D. Dissertation: Integrating People, Process, and Technology in Lean Healthcare

Abstract: Healthcare organizations in the U.S. are experiencing unprecedented challenges with delivering care to increasingly sick patients and decreasing resources. Various approaches have tried to address challenges without success; better approaches must be identified. One methodology, referred to as lean or the Toyota Production System (TPS), has resulted in significant improvements in safety, quality, delivery, cost, and morale. 

While this methodology was developed and refined in the context of manufacturing, it has also been translated into product development, re-manufacturing, and other service industries. This dissertation focuses on the use of lean/TPS in the context of healthcare, providing insight into how to integrate lean/TPS effectively. Three primary chapters (1) People, (2) Processes, and (3) Technology in healthcare organizations, describe ways to integrate lean into healthcare. 

The primary research questions and findings follow. (1) People – Research Question: What is a practical methodology for immature lean organizations to use hoshin planning effectively? Finding: An organization must progressively improve foundational stability to attain the intended outcomes of hoshin. 

(2) Process – Research Question: What approaches to knowledge management are effective in a healthcare context for achieving integration of evidence-based practices with care provided to patients? Finding: An enabling Plan-Do-Check-Act (PDCA) approach to knowledge management is essential to decreasing the time and improving the effectiveness of bringing evidence-based best-practice care to patients. 

(3) Technology – Research Question: Can lean thinking increase the effective use of technology in healthcare? Finding: The approach to selecting and deploying technology needs to be based on PDCA thinking. Once a technology has been selected, the deployment approach should be substantially organic due to the high variability healthcare environment. 

Cross-chapter finding to the unifying research question: Can a lean approach to integrating people, process, and technology prove more effective than previous approaches? Finding: A lean approach can be highly effective, but it requires a significant organizational investment in developing people first (before investing in technology), long-term organizational thinking, and engaged and committed leadership. The discipline and leadership required to be successful on the lean path will manifest itself in few healthcare organizations, but these organizations and their patients will benefit significantly.