29
Batching vs. Lean Thinking
andFlow
BATCHING VS. LEAN THINKING AND FLOW
The current cost and quality pressures hospitals are facing provide a natural burning platform for
Lean introduction. 10 years ago, I had to convince the leadership teams change was necessary, and
those opportunities existed. This is no longer the case… the ‘pull’ for Lean is evident
1
Tom Chickerella Corporate VP & Program Management Ofcer
Vanguard Health Systems, Nashville, Tennessee
Lean thinking is the continual and relentless pursuit of eliminating waste in our systems and pro-
cesses. To think Lean is to think of how we can eliminate waste in every activity we do. The term
Lean was coined by John Krafcik in is his paper “Triumph of the Lean Production System” for his
Master’s thesis at MIT Sloan School of Management in 1988
2
. Lean is described as: the ve-step
thought process for guiding the implementation of Lean techniques as easy to remember, but dif-
cult to achieve:
1. Specify value from the standpoint of the customer.
2. Identify all the steps in the value stream for each product family, eliminating those steps
which do not create value.
3. Make the value-creating steps occur in tight sequence so the product will ow smoothly
for the customer.
4. As ow is introduced, let customers pull value from the next activity.
5. As value is specied, value streams are identied, wasted steps are removed, and ow and
pull are introduced. Begin the process again and continue it until a state of perfection is
reached in which value is created with no waste.
Learning to develop how to “think Lean” is more difcult than it sounds. One must learn to recog-
nize waste in order to clearly see it. In order to see it we must rst understand how waste is dened.
3
As you walk around the workplace, do you see any waste? Waste surrounds us every day and
results in lost time and frustration. But lost time is very difcult to see or track. Once trained in
Lean, we are actually able to see the lost time and the lost output as it occurs. Lean is a different
way of thinking and philosophically approaching how we work and manage our organizations. By
1
Personal correspondence from Tom Chickerella, Corporate VP & Program Management Ofcer, Vanguard Health
Systems, Nashville, TN.
2
http://rk2blog.com/2010/03/08/the-etymological-origin-of-Lean/ “In fact, it is well known that LEAN was coined by
John Krafcik in his 1988 SLOAN MANAGEMENT REVIEW article “Triumph of the Lean production system.” that
It is less well known that Krafcik adopted the term late in his academic career. In his early academic papers, including
“Learning from NUMMI” (1986 ), an internal working paper of MIT’s International Motor Vehicle Program, through his
1988 MIT masters thesis, he didn’t call it LEAN. He called the production system used by Toyota and a small number of
other Japanese automakers FRAGILE”.
3
Inuenced by Mark Jamrog, principal, The SMC Group.
2

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