Organisational, group and individual lean health stakeholders: adapting lean thinking's customer focus to health services settings

BACKGROUND: Adaptations of Lean manufacturing process techniques appear more frequently in health services than any other public service context. The core of Lean manufacturing philosophy is to make value (as perceived by the customer) the key concern of all employees. While the paying customer is easily located in manufacturing, in health services a variety of funding groups exist. Furthermore, the health consumer, in the role of patient, is relatively passive and often excluded from process decisions. This paper reviews and compares the Lean manufacturing and Lean health services literature. It then demonstrates the use of Stakeholder Analysis as a tool to identify and manage the fluctuating salience of different health customers and explicitly identifies organisational, group and individual stakeholders in a recent lean health project. METHOD: Systematic reviews of Lean manufacturing and Lean health literatures were conducted to identify the frequency of reference to customers in article abstracts. The insights gained from the systematic literature review were then applied to an Australian hospital to assess the applicability of theoretical insights to an actual Lean health project. Semi-structured interviews and internal hospital documents were used to gather individual, group and organisational stakeholder perceptions of recent changes to sonography scheduling. RESULTS: The systematic review of the existing Lean Health literature displays a myopic focus on patients as the only customers in health settings. Stakeholder analysis applied to Emergency and Imaging Departments in a public hospital demonstrates the utility of identifying and prioritising a more complete set of process customers in Lean Health projects. CONCLUSIONS: The range of customers revealed by applying stakeholder theory to the health context exposes requirements to assess the needs and influence of different customer groups. Practical and theoretical implications of the multiplicity of health customers, ways in which prior analysis of organisational change efforts using stakeholder analysis can improve outcomes of Lean health services initiatives and directions for future research are discussed