The Lean Post / Articles / Lean Management Case Studies Library

row of books on a shelf with spines showing

Lean Management Case Studies Library

By Chet Marchwinski

May 16, 2014

Learn how a variety of businesses and organizations used lean management principles to solve real business problems. We’ve arranged the examples in 16 categories to help you find the ones right for your environment.

Lean Management Examples from a Variety of Businesses

The following case studies of lean management principles in action show you how a variety of real businesses solved real business problems under diverse conditions.

We’ve arranged the stories in 16 categories to help you find the examples you need. There is some overlap. For instance, a “Lean Manufacturing” case study may also appear with “Privately Held Companies.”

Lean Manufacturing

  • Logistics, Supply Chain, and Warehousing
  • Lean Material Handling
  • Job Shops (Low-volume, High-mix Manufacturing); Tool and Die
  • Lean in Government
  • Lean Healthcare
  • Lean Accounting
  • Lean Construction
  • Lean in Office and Service Processes
  • Lean in Education

Problem Solving

Pull Systems

Culture Change

People Development

Privately Held Companies

Maintenance

Many of the executives who took part in these transformations are interviewed in LEI’s Senior Executive Series on Lean Leadership . After reading the case studies, be sure to get their personal perspectives on leading change. (Feel free to link to this page, but please respect the copyrights of LEI and journalists by not copying the articles.)

Are you doing something new or notable in the practice of lean management? Let us share what you learned with the lean community. For more information, contact LEI’s Director of Communications Chet Marchwinski at cmarchwinski at lean dot org

Thrustmaster Turns Around

Learn how Thrustmaster of Texas successfully adopted lean thinking and practices to make sustainable improvements in a short period of time, and how other manufacturers of highly engineered, low-volume products can follow their lead using the Lean Transformation Framework.

Lean + Circular Principals = a New True North for Manufacturer

SunPower’s lean journey resembled most others until it defined a new mission, a new True North by combining lean principals with those of the “circular economy” to launch what it is calling a CLean Transformation.

Sustain Your Lean Business System with a “Golden Triangle” After a medical device maker took a hit to margins to fight off global competition, it rebuilt them by lifting its lean operating system to a higher level and keeping it there with a “golden triangle” of sustainability.

Followup Story:

Manufacturing Balancing Act: Pull Versus ERP

In this follow-up to “Sustain Your Lean Business System with a ‘Golden Triangle,’” a case study about Phase 2 Medical Manufacturing, the company needs warehouse space to keep pace with sales growth spurred by the lean transformation. Instead, it expands a pull system by connecting the plan-for-every-part database that underpins one-piece flow production with ERP, typically associated with big batch production.

Cultivating a Lean Problem-Solving Culture at O.C. Tanner If you are in the “appreciation business”, you have to live it in your own workplace. For O.C. Tanner that meant a lean transformation had to show the company appreciated and wanted people’s problem-solving ideas. Here’s a report on that effort, including what worked and what didn’t.

Lean Partnership with Dealer Network Helps Vermeer Reduce End-to-End Inventory on Top Sellers

A lean transformation had taken heavy-equipment manufacturer Vermeer away from batch manufacturing, but batch ordering by dealers was delaying how quickly they got equipment like brush chippers. Learn how it  began converting its domestic industrial-line distribution network to lean replenishment, improving service to end customers and improving cash flow for Vermeer and its dealers.

Herman Miller’s Experiment in Excellence At Herman Miller, the lean management effort helps it build problem solvers as well as world-class office furniture. And as this case study shows, lean practices also helped it weather a brutal recession.

Build Your “House” of Production on a Stable Foundation Rigorous problem solving creates basic stability in a machining intensive facility.

A Journey to Value Streams: Reorganizing Into Five Groups Drives Lean Improvements and Customer Responsiveness An approach to creating a value -stream culture centered on autonomy, entrepreneurialism, and lean principles.

Change in Implementation Approach Opens the Door at EMCO to Greater Gains in Less Time A relatively quick, intensive project accelerates the rate of improvement and creates a showcase facility for spreading lean concepts.

Creating the Course and Tools for a Lean Accounting System A lean accounting implementation fills the frustrating disconnect between shop-floor improvements and financial statements.

For Athletic Shoe Company, the Soul of Lean Management Is Problem Solving After taking a lean tools approach to change, management re-organized the transformation around problem solving and process improvement to create a culture that engaged people while boosting performance.

Knife Company Hones Competitiveness by Bucking the Status Quo An iconic family-owned company turns to lean manufacturing to reduce costs by at least 30% to keep its U.S. operations open.

Lean Transformation Lives and Dies with Tools and Dies After a failed first try at just-in-time production , a company transforms tool maintenance, design, and fabrication to create a solid foundation for a second attempt.

Seasoned Lean Effort Avoids “Flavor-of-the-Month” Pitfall A look at how one company’s approach to what new tools it introduced, in what order, and how it prevented each new technique from being viewed as a “flavor of the month” fad.

Shifting to Value-Stream Managers: a Shop-Floor Revolution Leads to a Revolution in Plant Organization

Two years into a lean transformation, the low-hanging fruit has been plucked and progress has started to slow. Read how a Thomas & Betts plant recharged the transformation and reached higher levels of performance by using value-stream managers to span functional walls.

Using Plan-Do-Check-Act as a Strategy and Tactic for Helping Suppliers Improve

At Medtronic’s Neuromodulation business unit, the plan-do-check-act cycle is used on a strategic level to guide overall strategy for selecting and developing key suppliers as well as on a tactical level for guiding lean transformations at supplier facilities.

back to top

Logistics, Supply Chain, and Warehousing How a Retailer’s Distribution Center Exemplifies the Lean Precept “Respect for People,” and Reaps the Benefits

To make sure training engaged and resonated with people after previous attempts at a lean transformation faltered, LifeWay matched lean management tools and principles to its Bible-based culture and language.

Lean management case study series: Lean in Distribution: Go to Where the Action Is!

Starting with daily management walkabouts and standard work , this distributor had laid the groundwork for steady gains for years to come, just two years after its first kaizen workshop .

Putting Lean Principles in the Warehouse

Executives at Menlo Worldwide Logistics saw an opportunity to leapfrog the competition by embracing lean in its outsourced warehousing and receiving operations.

Lean Thinking Therapy Spreads Beyond the Shop

A company expands the lean transformation from the shop floor to international distribution, domestic shipping, and product development.

Sell One, Buy One, Make One: Transforming from Conventional to Lean Distribution

Large inventories to cover fluctuations in demand once characterized Toyota’s service parts distribution system — but no more. Here’s how one DC made the switch.

Material Handling

Following Four Steps to a Lean Material-Handling System Leads to a Leap in Performance

Creating the critical Plan for Every Part was one step in a methodical four-step implementation process to replace a traditional material-handling system.

Low-volume, High-mix Manufacturing; Tool and Die

The Backbone of Lean in the Back Shops

Sikorsky managers apply the lean concept of “every part, every interval” (EPEI) to level the mix in demand and create flow through a key manufacturing cell .

Landscape Forms Cultivates Lean to Fuel Growth Goals

With single-item orders 80% of the time, a low-volume, high-mix manufacturer decided single-piece flow cells were the best way decided the best way to add new products without having to constantly reconfigure production.

Lean Transformation Lives and Dies with Tools and Dies

After a failed first try at just-in-time production, a company transforms tool maintenance, design, and fabrication to create a solid foundation for a second attempt.

Canada Post Puts Its Stamp on a Lean Transformation

The “ inventory ” of mail already is paid for, so moving it faster doesn’t improve cash flow as in lean manufacturing. But Canada Post discovered that traditional batch-and-queue postal operations could benefit from lean principles.

Lean Thinking in Government: The State of Iowa

This story examines a kaizen event at a veterans home and more broadly at the lean effort in Iowa government.

Lean Thinking Helps City of Chula Vista with Budget Crunch

Goodrich Aerostructures’ Chula Vista plant introduces city government to lean thinking and practices so in order to maintain municipal services without resorting to further cuts in the workforce.

Using Lean Thinking to Reinvent City Government

Grand Rapids, MI, turns to lean principles to consolidate operations, eliminate wasted time and effort, and streamline to improve productivity while providing the quality of service that residents want.

Transforming Healthcare: What Matters Most? How the Cleveland Clinic Is Cultivating a Problem-Solving Mindset and Building a Culture of Improvement

The Cleveland Clinic reinvents its continuous improvement program to instill a problem-solving mindset and the skillset to solve everyday problems among the clinic’s thousands of caregivers.

View from the Hospital Floor: How to Build a Culture of Improvement One Unit at a Time

In order to do more and improve faster, the Cleveland Clinic is rolling out a methodology for building a “culture of improvement” across the 48,000-employee hospital system as this followup to the above story shows. Here’s how it works according to the people making the changes.

Dentist Drills Down to the Root Causes of Office Waste

Dentistry is a job shop that Dr. Sami Bahri is out to improve fundamentally for the benefit of patients through the application of lean principles.

Lean management case study series: Pediatric Hospital in Tough Market Pegs Growth to Lean Process Improvement

Lean improvement projects at Akron Children’s Hospital have saved millions of dollars, increased utilization of expensive assets, and reduced wait times for patients and their families.

Lean Design and Construction Project an Extension of Lean Commitment at Akron Children’s Hospital

Input from nurses, doctors, therapists, technicians, and patient parents heavily influenced design decisions..

“Pulling” Lean Through a Hospital

A thoughtful rollout of lean principles in the ER and eye-opening results created a “pull” for lean from other departments.

Best in Healthcare Getting Better with Lean

Mayo Clinic, Rochester, MN, stresses to doctors that the lean effort is aimed not at changing the moment of care, the touch moment between doctor and patient, but the 95% of the time when the patient is not in the doctor’s office

Fighting Cancer with Linear Accelerators and Accelerated Processes

Cross-functional team design and implement a lean process to dramatically increase the number of patients with brain and bone metastases receiving consultation, simulation, and first treatment on the same day without workarounds or expediting.

Massachusetts General Looks to Lean

A proton therapy treatment center, for many adults and children the best hope of beating cancer, applies lean principles to increase capacity.

New Facility, New Flow, and New Levels of Patient Care: The wait is over for patients at the Clearview Cancer Institute in Alabama

Physicians and staff have tirelessly reengineer processes and patient flow to eliminate as much waiting and waste as possible.

The Anatomy of Innovation

At a hospital in Pittsburgh, the emerging vision for the “hospital of the future” is described as giving the right patient, the right care, at the right time, in the right way, all the time.

Creating the Course and Tools for a Lean Accounting System

A lean accounting implementation fills the frustrating disconnect between shop-floor improvements and the financial statement.

Knife Company Hones Competitiveness by Bucking the Status Quo

An iconic family-owned company turns to lean manufacturing to reduce costs by at least 30% to keep its U.S. operations open.

Office and Service Processes

The “inventory” of mail already is paid for, so moving it faster doesn’t improve cash flow as in lean manufacturing. But Canada Post discovered that traditional batch-and-queue postal operations could benefit from lean principles.

Lean Landscapers

At an Atlanta landscaping company, lean practices are making inroads into a service industry in unusual yet fundamental ways.

LSG Sky Chefs Caters to New Market Realities

Business at airline caterer LSG Sky Chefs dropped 30% when airlines cut flights after the terrorist attacks on September 11, 2001. Sky Chefs responded with a rapid launch of a lean initiative.

leveraging Lean to Get the Oil Out

Aera Energy LLC, a California oil and gas company,  relies on lean principles to improve key processes, including drilling new wells, repairing existing ones, and maximizing the number of barrels of crude pumped each day.

Columbus Public Schools Use Process Thinking to Improve Academic Achievement.

Columbus, OH, public schools, experiment with lean tools and process thinking to remove wasteful activities that don’t help them help students learn.

Lean Inroads into Alabama Academia

How the University of Alabama in Huntsville integrated lean concepts throughout its industrial engineering curriculum.

Linking Lean Thinking to the Classroom

Value-stream mapping is one of many activities included in the Ford Partnership for Advanced Studies (Ford PAS), an academic program designed to link high-school classroom learning to the skills needed in college and business.

Build Your “House” of Production on a Stable Foundation

Rigorous problem solving creates basic stability in a machining intensive facility.

For Athletic Shoe Company, the Soul of Lean Management Is Problem Solving

After talking a lean tools approach to change, management re-organized the transformation around problem solving and process improvement to create a culture that engaged people while boosting performance.

Toothbrush Plant Reverses Decay in Competitiveness

The rapid introduction of a lean system, beginning with just-in-time production and pull, helps a highly automated Midwest plant fight off overseas competition by reducing lead times and inventory while augmenting the plant’s advantage in service.

A Journey to Value Streams: Reorganizing Into Five Groups Drives Lean Improvements and Customer Responsiveness

An approach to creating a value-stream culture centered on autonomy, entrepreneurialism, and lean principles.

Making Lean Leaders — Ariens internship program develops lean and leadership skills

Besides making snow-blowers, mowers, and string trimmers, Ariens Co., of Brillion, WI, makes lean leaders.

Starting with daily management walkabouts and standard work, this 84-year-old, family-owned distributor laid the groundwork for steady gains for years to come, just two years after its first kaizen workshop.

Sustain Your Lean Business System with a “Golden Triangle”

After a medical device maker took a hit to margins to fight off global competition, it rebuilt them by lifting its lean operating system to a higher level and keeping it there with a “golden triangle” of sustainability. You’ll recognize two elements of the triangle right away: visual control and standardized work . The third, accountability management or a kamishibai system, is probably less well known but just as critical.

Cultivating a Lean Problem-Solving Culture at O.C. Tanner

If you are in the “appreciation business”, you have to live it in your own workplace. For O.C. Tanner that meant a lean transformation had to show the company appreciated and wanted people’s problem-solving ideas. Here’s a report on that effort, including what worked and what didn’t.

Lean Thinking in Aircraft Repair and Maintenance Takes Wing at FedEx Express

A major check that used to take 32,715 man-hours was cut to 21,535 hours in six months. That translated into a $2 million savings, which dovetailed with the company’s emphasis on reducing costs during the recession.

Construction

Input from nurses, doctors, therapists, technicians, and patient parents heavily influenced design decisions—from incorporating emergency room hallways that protect the privacy of abused children to the number of electrical outlets in each neonatal intensive care room.

Virtual Lean Learning Experience (VLX)

A continuing education service offering the latest in lean leadership and management.

Written by:

lean management case study with solution

About Chet Marchwinski

Chet has been a humble, unwashed scribe of the lean continuous improvement movement since books by Taiichi Ohno and Shigeo Shingo first hit North America in the 1980s. At LEI, he contributes to content creation, marketing, public relations, and social media. Previously, he also wrote case studies on lean management implementations in…

Leave a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Be the first to learn of new learning opportunities and the latest practical, actionable information. Subscribe to an LEI newsletter.

Join us on social, privacy overview.

Southern States Toyotalift

  • Bendi Drexel
  • Switch to Electric
  • Batteries & Chargers
  • Racking & Shelving
  • Online Catalog
  • Fleet Management
  • Toyota Lean Management
  • Agriculture Industry
  • Beverage Industry
  • Distribution Industry
  • Manufacturing Industry
  • Concrete Industry
  • Problems We Solve
  • MyToyota Parts Store
  • Forklift Certification Training Course
  • Safety Checklists
  • Safety Products
  • Safety Videos
  • Why Work with Us
  • Hiring Forklift Technicians
  • Leadership Library

Specials

Toyota’s Lean Management Program Explained (with Real Life Examples)

by Frank Stuart , on Nov 1, 2023 3:45:00 AM

Toyota’s Lean Management Program Explained

If you’ve ever searched for information online about the Toyota Production System, you've probably seen a variety of house-shaped graphics. But even though we all know what a house is, understanding what the TPS house graphic means can be a challenge — especially when some of the words are Japanese.

In this article, I’ll explain the house graphic and Toyota’s lean management principles. Because I worked for Toyota and have spent many years as a Toyota lean practitioner, I’ll share insights you won’t find anywhere else including:

  • How the Toyota management system boosts employee retention
  • Three common misinterpretations of Toyota’s lean methodology
  • Several real-world examples and a customer case study

The Toyota Production System is What Makes Toyota #1

Toyota has made the best-selling forklift in North America since 2002. That’s a long time to be number one. How do they do it? By following the Toyota Production System (TPS). 

What is Toyota Lean Management vs. The Toyota Production System? Toyota Lean Management (TLM) is a system that takes the principles of the Toyota Production System and applies them to other industries such as construction, supply chain, healthcare and of course manufacturing. I’ve yet to find a business that doesn’t benefit from the Toyota production management system.

Toyota Principles Improve Retention and Your Bottom Line

Improving efficiency and customer satisfaction are the best-known reasons for following Toyota’s lean management practices. Most people don't know it can also improve employee retention.

Hiring and retaining qualified workers was the number one challenge reported in MHI’s 2023 Top Supply Chain Challenges survey . The responses come from more than 2000 manufacturing and supply chain industry leaders from a wide range of industries. 

This isn’t the first year hiring and retention created major heartburn for supply chain operations, and it likely won’t be the last. If finding and keeping good people is something your organization struggles with, TLM can help with that too .

Toyota Lean Management House

Here’s my version of the TPS house.

Why is it a House?

Most people use a house-shaped graphic to explain TPS because the function of a house is to preserve what’s inside . All the parts of the house interact with each other to protect what’s the business and its people — from the groundwork to the pillars to the roof.

The Groundwork

Respect for People, Long-Term Thinking and Continually Improve

Respect for People, Long-Term Thinking and Continually Improve are fundamental management philosophies that drive all policy and decision-making under the Toyota way.

Respect for People is not about being nice (although that is important). This principle is about creating a home-like atmosphere where everyone is encouraged and supported to reach their full potential. 

EXAMPLE: A supervisor has monthly one-on-one meetings with each associate to:

  • Review personal performance
  • Discuss issues with work processes
  • Uncover opportunities for improvement

This mentor-mentee program develops people from within. Associates move into higher and higher positions so eventually, the people leading the company not only know the product but understand the work.

Respect for people also includes being mindful of how decisions in one department affect another. Uncoordinated decisions can negatively impact the customer.

EXAMPLE: If sales and marketing decide to have a big sale the weekend before Thanksgiving, the extra orders could overwhelm an already understaffed shipping department — creating delays for the customer and/or increased overtime expenses.

Last but not least, respect for people means providing stable employment. This leads us to the next fundamental principle… 

Long-Term Thinking — During COVID and the supply chain challenges that followed, many companies made the hard decision to lay off workers. I was in the training department at Raymond during this time.

Instead of letting workers go, we chose to strengthen the company by training associates and improving processes. We developed online training programs on various topics for hundreds of associates in various roles. These actions and this type of thinking goes back to the 1950s when Toyota decided to focus on building a strong, stable company for the long term. The economy will cycle up and down, but because our people are our most important asset, we must take care of them and protect them, even during economic downturns.

Short-term decisions, like letting experienced and tenured employees go, can improve the bottom line in the short term, but long term it hurts the business. All too often, corporate culture lives and dies on a quarterly report. This is short-sighted. When times are good, you have to squirrel money away in your war chest to protect the company and its people when times are bad .

Continually Improve – It is said in business, as in life, we are either growing or dying. A structured focus on continual improvement ( kaizen ) and challenging the status quo ensures a company stays competitive and growing.

EXAMPLE: We challenged the team who reconditioned our forklifts this year. At the beginning of the year, our lead time was 12 weeks. By mapping the process, improving flow and using a kaizen philosophy, we are now at 6 weeks. We are not satisfied with this improvement and have further challenged the team to cut the lead time in half again by the end of this year.  

TLM cleaning station

The Foundation

Organize, Standardize, Optimize

The next level of the TPS house is all about creating an efficient work environment. It starts with a clean, orderly workspace where the next tool (or whatever the worker needs) is right there and not hidden in a pile of clutter.

If we don’t give people an organized workspace and standards to follow, we’re not helping them be successful. Even worse, we’re wasting their time. It goes back to respect for people.

EXAMPLE: The litmus test I used in the factory was to have a workstation set up with all the necessary tools. If I could take a tool away from the workstation and the operator couldn’t tell me within five seconds what was missing, that meant we had more work to do to. 

To be clear, it isn’t about telling people: you must do it this way or to make changes for the sake of making changes. The goal is to:

  • Find the best way of doing things for the people who are doing the work
  • Develop standards and best practices
  • If a better way is found, everyone starts using that new way instead

That last bullet point is the principle of kaizen showing up again. Toyota Lean Management is an ongoing process where small, incremental changes result in measurable improvements to quality or reduced cost, cycle or delivery times.

FYI, we haven’t gotten to the actual Toyota Production System yet. The groundwork and the foundation are the basis for TPS. The system doesn’t work without establishing the groundwork and creating a solid foundation. 

Creating optimized workspaces and processes are deceptively simple assignments. It’s really easy to make work hard and it’s hard to make work easy. When you’re stuck in chaos it can be hard to see the way out. 

The foundation of TPS helps make work easy. Once an orderly, efficient system has been established, we work on the two pillars.

TPS Pillars: The Toyota Production System

Just in Time & Continuous Flow

The first pillar is all about having what you need, when you need it. Waste, in the form of wasted time or excess inventory, should be avoided. 

Back in 2021, Bloomberg and other news organizations excitedly reported how Toyota had abandoned its “just in time” philosophy because it started stockpiling computer chips. This is just one example of how Toyota principles are misunderstood by the Western world.

Misunderstanding #1 Here’s what most news outlets got wrong: After the earthquake and tsunami in 2011, Toyota reevaluated the lead time required for semiconductors and other parts. Their assessment revealed they were unprepared for a major shock to the supply chain, such a natural disaster. 

To ensure a continuous flow of chips to their factories, Toyota required suppliers to carry a 2-6 month supply of semiconductors. When COVID hit, the news reported Toyota was “stockpiling” chips when, in fact, the company was simply following a plan it had created ten years earlier. 

auto plant assembly line

Our business training in the Western world is all about the balance sheet. Reducing inventory becomes a goal unto itself and that’s when things start to go badly. “Just in time” doesn’t mean “last minute.” It means keeping enough supply to ensure a continuous flow.

For Toyota, "just in time" meant a supply that could weather supply chain ups and downs. In 2021, when the chip shortage forced other automakers to stop their production lines, Toyota kept churning out vehicles and raised its earnings forecast by 54% . 

Visual Management & Zero Defects

EXAMPLE: Zero defects is pretty self-explanatory, but here’s an example of zero defects through visual management. The first thing Mr. Toyoda built was an automated loom for the textile industry. Occasionally, a thread would break and the operator wouldn’t see it. When this happened, the final product had to be thrown away. 

To fix the problem, Mr. Toyoda put a washer in the thread. If the thread broke, the washer fell off into the machine and it stopped. The operator could fix the problem without any waste (defective product). This also allowed one operator to oversee multiple machines.

Misunderstanding #2 Some people say Toyota Lean Management is basically the same as Six Sigma. I disagree. There are major differences between the two systems , but here’s a big one related to TPS Pillar Two: Six Sigma says you can have 3.4 defects per million operations. An “operation” is defined as a single action, such as attaching a wire or screwing a bolt. Building a jumbo jet requires millions of operations. Knowing 3.4 defects are permitted per million operations, would you rather fly on an airplane built by a company that follows Six Sigma principles or Toyota?

Another comparison you may have heard is one about a GM versus a Toyota factory. At GM, workers can get in trouble for stopping the line. At Toyota, it’s the opposite. If workers aren’t periodically stopping the line, managers get concerned. It goes back to the fundamental principles we talked about in the very beginning: respect for people and a culture of continuous improvement.

Toyota Lean Management Case Study

I worked with a hard cider manufacturer in upstate NY. The company was approaching its busy season and trying to build up its inventory to supply its distributor. Their “we gotta get this done” mentality caused them to overrun their facility.

A Foundational Problem The company thought they were following the “just in time” lean methodology. What they had was a mess. 

  • Product and supplies were all over the place
  • Equipment was haphazardly maintained
  • They didn't have good standards on how to clean the kegs

A bottleneck in their system meant a new batch would get stuck behind the previous batch and unfinished inventory would pile up. Disorganization and stress led to unnecessary handling, damage and waste (wasted time and wasted product). 

After speaking to everyone who helped produce the cider, we created a list of best practices. Next, we helped the company organize, standardize and optimize the workspaces and procedures throughout their facility. With groundwork laid and a firm foundation in place, we were ready to move on to Pillars One and Two.

cider conveyor belt

Guess what? The company had more than enough capacity. They didn’t need to build up inventory for their distributor. All they had to do was tame their operational chaos.

  • Standardized practices saved time and improved product quality
  • Clear processes and optimized workspaces helped everyone work more efficiently
  • The company reclaimed space previously used to store inventory

Cider Batches Now Flow Continuously Once the bottleneck was subdued and equipment was kept in good working order, the cider company could run continuously with minimal downtime between batches. By staggering five batches to start over six weeks the company could meet customer demands.

The Core of the House: Its People

Grow People: Skills, Competence, Leaders

I added this circle in the center of the house (you won’t find it in other TPS house graphics) because I was fortunate to learn about Toyota’s lean management system directly from Toyota executives. 

The addition was inspired by a story I heard that really stuck in my mind. Mr. Onishi, Toyota’s president, visited a plant in Canada. He asked one of the plant managers to explain TPS. The manager described the house and the elements of zero defects, continuous improvement, etc. Mr. Onishi politely said, “It’s actually a people development process. We want to improve people’s skills and competence and grow them into leaders. Our goal is to promote people from within because they know the products, the customers and understand the work.”

The TPS Circle

Everything starts and ends with respect. 

Teamwork is about supporting the person who does the thing the customer is paying for. 

EXAMPLE: At SST, that means the technician working on a customer’s forklift.

Go and See — when a problem arises, the best way to find a solution is to observe the problem. 

EXAMPLE #1: At the forklift factory, units occasionally came off the line with the wrong counterweight. We observed the employee do everything right until one time he read the build sheet but chose the wrong counterweight. He was always on the go which created an opportunity for this mistake. By adding a simple step, stopping to highlight the weight info, the problem disappeared.

warehouse with boxes

EXAMPLE #2: A warehouse thought they needed to buy more pallet rack and even had a rack consultant on-site while I was there. Turns out the company had plenty of rack space. They just needed to throw out three years of inventory they couldn't sell. The executive team almost wasted thousands of dollars on rack they didn’t need rather than take a hit on their balance sheet.

Challenge does not mean I had a challenging day because two associates didn’t show up for work. It means aiming for the stars and making it to the moon.

To generate significant improvements, you need an aggressive challenge and a team that’s committed to reaching a common goal. It changes your approach. To keep the space analogy going, consider all the technological innovations we enjoy that came from putting a man on the moon .

Misunderstanding #3 Toyota’s Production System strives for 100% customer satisfaction by eliminating wasteful activities. Many business leaders incorrectly believe running lean means using cheaper materials or reducing staff. By now you know this isn't the Toyota way. Building a strong house requires leaders who respect their people and think long-term. 

Companies that refuse to think beyond the bottom line will always struggle to stay competitive. Their short-term savings on cheap materials create long-term losses as customers become dissatisfied. They will also waste money hiring and training people who leave when they aren’t treated with respect. 

Sometimes I have to have a conversation with new clients about helping team members overcome challenges. When something goes wrong, some companies look for someone to blame (reprimand or fire) but that’s not the Toyota way.

Toyota’s approach focuses on fixing broken systems, not pointing fingers. We encourage leaders to challenge their team members to improve processes, but if the team member fails and gets fired after one try, how is that person’s replacement going to feel about taking on the same challenge?

The Roof of the TPS House

The roof protects the house and the people inside. A safe workplace that produces quality products at the lowest cost with the shortest delivery time in a good environment generates high morale and protects the business. By protecting the business, you protect the people inside and help them to grow into successful leaders. 

Request a Free Toyota Lean Management Consultation

If you’d like to reduce costs and turnover while increasing customer satisfaction, why not schedule a free consultation ? Toyota Lean Management has a low cost of implementation and is designed to help you get more out of your existing resources. 

During the initial consultation, we’ll talk about where your company is now versus where you’d like to be. The next steps depend on the individual client, but typically we’ll Go and See your space and look for:

  • Inventory build-ups
  • Excessive transportation
  • Cluttered workspaces
  • Unnecessary motion
  • Producing more than what’s needed for the near-term
  • Piles of defects

To learn more, contact us online or by phone (800) 226-2345.

FLORIDA : Jacksonville South, Jacksonville North, Ocala, Orlando, Lakeland, Tampa, Winter Haven GEORGIA : Albany, Macon, Midland, Valdosta

Optimize your business with TLM

The SST Blog

Want to increase your productivity, increase your safety, and increase your profits? Our blog can help. Fill out our form below to subscribe.

Subscribe to Updates

Forklift Fleet Consultation

  • Aerial Equipment (3)
  • Electric (11)
  • Finance and Leasing (4)
  • Fleet Management (7)
  • Forklift Batteries (4)
  • Forklift Maintenance (24)
  • Forklift Parts (6)
  • Forklift Repair (15)
  • Forklifts (46)
  • Industrial Cleaning (5)
  • Insider (2)
  • New Equipment (9)
  • Pallet Jack (2)
  • Pallet Rack (10)
  • Problems We Solve (7)
  • Recruitment (3)
  • Safety (31)
  • Scissor Lift (3)
  • Special Offers (3)
  • Stacker (2)
  • Toyota Lean Management (3)
  • Training (10)
  • Used Equipment (3)
  • Utility Vehicles (2)
  • Warehouse Automation (2)
  • Warehouse Solutions (24)
  • May 2023 (4)
  • May 2019 (3)
  • December 2019 (3)
  • February 2020 (3)
  • May 2020 (3)
  • October 2020 (3)
  • May 2021 (3)
  • September 2021 (3)
  • March 2022 (3)
  • July 2022 (3)
  • September 2022 (3)
  • April 2023 (3)
  • July 2023 (3)
  • August 2023 (3)
  • October 2023 (3)
  • August 2018 (2)
  • June 2019 (2)
  • July 2019 (2)
  • September 2019 (2)
  • July 2020 (2)
  • August 2020 (2)
  • November 2020 (2)
  • December 2020 (2)
  • January 2021 (2)
  • March 2021 (2)
  • April 2021 (2)
  • June 2021 (2)
  • July 2021 (2)
  • August 2021 (2)
  • October 2021 (2)
  • November 2021 (2)
  • December 2021 (2)
  • January 2022 (2)
  • February 2022 (2)
  • April 2022 (2)
  • June 2022 (2)
  • November 2022 (2)
  • February 2023 (2)
  • June 2023 (2)
  • September 2023 (2)
  • November 2023 (2)
  • December 2023 (2)
  • January 2024 (2)
  • February 2019 (1)
  • April 2019 (1)
  • August 2019 (1)
  • October 2019 (1)
  • January 2020 (1)
  • April 2020 (1)
  • June 2020 (1)
  • February 2021 (1)
  • May 2022 (1)
  • August 2022 (1)
  • October 2022 (1)
  • December 2022 (1)
  • January 2023 (1)
  • February 2024 (1)

New call-to-action

Southern States Toyotalift

Corporate office 115 s. 78th st,  tampa, fl 33619  call:  800.226.2345  •  813.734.7940 accounts receivable: (813) 549-3545 / [email protected], florida locations.

Winter Haven, FL 863.967.8551

Orlando, FL 407.859.3000

Ocala, FL 352.840.0030

Jacksonville, FL 904.764.7662

Lakeland, FL 863.577.5438

Georgia Locations

Valdosta, GA 229.247.8377

Macon, GA 478.788.0520  

Midland, GA 706.660.0067

Albany, GA 229.338.7277

  • Spotter Trucks
  • Personnel Carriers
  • JLG Aerial Platforms
  • Industrial Floor Cleaners

TMH_Logo_White_KO

Henry Harvin Blog

Home > Learn More About Six Sigma Green Belt > Amazon Lean Management: The Six Sigma Case Study in 2024 [Updated]

Amazon Lean Management: The Six Sigma Case Study in 2024 [Updated]

lean management case study with solution

Free Counselling :

Table of Contents

Amazon, whose signature smile logo we are all familiar with, has begun embracing Six Sigma for its numerous business benefits. Since its founding as an online bookstore, Amazon has expanded its product line, entering the technology market with its Kindle e-reader and tablet offerings. Even more so, they have incorporated innovative methods such as same-day delivery, which is likely to reach new heights of efficiency with drone-based delivery. Their rapidly expanding portfolio of Amazon Originals is comparable to that of online titans such as Netflix. However, have you ever wondered how Amazon became one of the world’s most excellent online retailers? Today we shall discover – Amazon Lean Management: The Six Sigma Case Study in 2023.

“Hi gals!! This is my first Diwali and my mother-in-law has given me a real tough task. In this cyber city where do I search for cow dung cakes for Diwali puja??”

Lean Six Sigma Green Belt Certification Training

45-min online masterclass with skill certification on completion

Kounal Gupta (CEO, Henry Harvin)

Access Expires in 24Hrs

Register Now for Free

Images

Find our Upcoming Batches of Six Sigma Green Belt Certificate :-

“Just relax!! Apni Dukan hai na . ”

You mean Amazon

“Wow!! But I knew they sell only books, electronics, clothing artifacts and other fascinating things.”

Post Graduate Program in Content Writing

Ranks Amongst Top #5 Upskilling Courses of all time in 2021 by India Today

lean management case study with solution

According to an analyst, “When you think of wed shopping, you think of Amazon first”

Amazon has made a strong shift in purchasing habit of the world  from ‘think to buy’ to ‘ click to buy’.

Amazon – Jeff Bezos’s Brain Child

lean management case study with solution

Jeff Bezos, a computer engineer from Princeton University, quitted his flourishing career of Wall Street as the Senior Vice President of D.E.Shaw &Co. to set up his own e-commerce business. In 1994, Jeff started his business of selling online books from a small garage at Seattle, Washington.

Proving wrong to all the critics in his life, Jeff moved ahead with a big dream of owning the largest share of e-com world. And that’s how he finally landed with the name of the company as AMAZON – on the name on the biggest river in the world.

Ambitious, adventurous and consistency is the secret of success of Jeff as well as Amazon. Amazon, from day one, was a customer-centric company.

Amazon was started as an online book store. In 2000, the logo of the company featured an arrow leading from A to Z, like a smile. Just as the logo suggested the mission and vision was lined accordingly – Customer Delight and humongous expansion of business.

Amazon.com has expanded its business from books to music, toys, movies, electronics, housewares, clothing brands, artifacts, whole foods, artificial intelligence and many more.

They have their own cloud computing service as Amazon Web Service for various data management and storage.

The first e-book platform Kindle was innovation of Amazon.

Although the annual report or any publish material of Amazon dose not feature any implementation of Six Sigma in the organization however, the operational excellence at Amazon has the credit to concepts of Six Sigma and Lean Manufacturing Principle.

What makes it so easy for Amazon to be Competitor’s envy since last 25 years??

Customer Obsession – Leadership Vision

lean management case study with solution

When world’s service industry was struggling for customer satisfaction , this one leader envisioned of mastering customer obsession in a start up of niche industry. The spirit of lean management and customer centric approach was imbibed at Amazon from day one.

Amazon has proven that customer obsession is a holistic approach to become successful in a customer service industry. Compulsive focus on customer is a huge advantage for any company. Focusing on customer, leads to innovation and ensures business growth in right direction by creating great products and services.

No customer will like or pay for waste – this was very clear in Jeffs mind. The information technology unit was used at Amazon to collate customer data, what customer wanted and they downloaded the right information to fulfillment center and customer service center

With the central focus on operational excellence Amazon streamlined its operation by deploying more workforces in fulfillment and customer center department…

Jeff was stubborn on vision and flexible on details.

The Lean Management

lean management case study with solution

Lean is set of tools that assist an organization, specially manufacturing units, to identify and eliminate waste which in turn helps in reducing the cost, improve quality, reduce lead time, increase efficiency and consistency.

The common lean tools used in any organization are 5S , Autonomation, JIT (Just In Time), Kaizen (Continuous Improvement), Poka Yoke (Mistake Proving, Kanban (Pull System), Gemba , Root cause Analysis.

Sounds very technical, but Lean methodology works on simple ideas like –

  • Deliver value as per customer’s perspective
  • Eliminate waste
  • Improve continuously on daily basis

Some of the benefits of Lean Managements are –

  • Increased and improved productivity and efficiency of work force
  • Optimized utilization of resources.
  • A more stable work force and stable production system
  • Encourages continues improvement

It appears to be a classic process of – measure, analyze, improve, control. As a part of Lean, to implement strong and continuous improvement in front liner staff they were engaged with gemba workers

Amazon’s system and processes are based on Lean principles to achieve an unparalleled customer experience.

Micro-management using Kaizen

lean management case study with solution

Kaizen is combination of two Japanese symbols for “change” and “good”, most commonly translated as “change for the better”. The process speaks about – take it apart and put it back together in a better way.

Amazon faced one of the major challenge in enforcement of “standard work” while deploying the lean concept as it involved human. A well defined standard process was set for the assigned work and a small kaizen team was appointed to track down all abnormalities and eliminate them. It helped employees achieve regular and incremental improvement.

A single kaizen or change is a simple thing but a reservoir of kaizen makes a remarkable difference. The whole process of continuous improvement is the most important tool of Amazon’s increasing progress and success.

The fulfillment center was the center of attraction when it came to implementation of kaizen. Jeff Bezos ensured that all senior management staff of customer service department spends at least one day a year in the fulfillment center as a part of their kaizen training. This is to ensure that they become capable of efficiently attend and resolve any problem faced and reported by a front line staff.

If you have Data, you are the king

lean management case study with solution

Six Sigma is a mathematical and statistical calculation of data to find out the defects or the percentage deviation for the standard of error set. In any organization, data should be treated as an asset and not as a department’s property, especially in an era where the world runs on data round the clock.

At Amazon, digging into data ushered new business avenues. In respect to both customer and products.

At a very nascent stage of his business, Jeff had ensured to inculcate a data-driven culture from frontline staff to the managers. From the very beginning, Amazon had hired engineer for the purpose of various kinds of data mining. He believes that data is empowering and helps in decision making. Probably this is the reason for the organization to successfully sustain its larger market share in e-commerce industry since more than 25 years.

It was Bezos’s farsightedness which helped him place data as the center of his corporate culture. He structured the organization in a way that the data was open and available at every level. It empowered the front liners to take a lot of small and daily decision to improve customer satisfaction.

Amazon utilized its data technology system to research consumer behavior which analyze and expand upon offering low price product with great convenience and personalized product recommendation, type of purchase, demand cycle of products on shelf.

They were able to innovate and introduce new products on the basis of customer’s search data.

With data churning it became easy to search for vendors at convenient delivery location at the lowest price with high quality of products. In this digital era, with data in hand, testing and analyzation of information became faster and easier. This promoted frequent learning and improvement to expand profitability.

Weed out the waste – The Andon Cord

lean management case study with solution

A trainer of Six Sigma at Amazon once questioned Jeff Bezos – Why do I sweep?  Why do I not instead eliminate the source of dirt?

In Lean Six Sigma, Andon is considered as the visual management system which enables smooth operation by eliminating all or any bottleneck.

Andon cord is a Japanese word for traditional paper lantern. An Andon system is one of the principle elements of ‘Jidoka’ – ‘empowering the employees’. Andon system –

  • Improves transparency at work
  • Increases productivity within the given time
  • Strengthen flexibility by empowering employee
  • Reduce downtime to resolve issue
  • Save cost by improving quality.

The Andon cord eliminates tens of thousands of defects per year.

Amazon implemented this concept that if a repetitive error or defect is detected, the customer service agent had the authority to ‘stop the line’ and take off the product from the website until the defect is fixed.

With the implementation of Andon cord, frontline workers felt empowered and motivated to enhance their service standards. The agenda was to eliminate waste or deformities and put back the products on shelf and gain back customer’s trust.

There are different kinds of Andon card – physical or virtual. Amazon used virtual Andon Cord, the Lean concept, where an employees can address to defects immediately and effectively to his supervisor and helps the over all organization to reduce future customer complaints.

Inventory management

lean management case study with solution

Amazon started as a ‘virtual retailer’ with no inventory, no warehouse, and no overhead. Today, Amazon owed it popularity to excellent customer service, which was possible with a great inventory management system.

Initial days of inventory management was hectic with handling all kinds in inventory like

  • Raw material
  • Work in progress
  • Finished goods
  • Transit inventory
  • Buffer inventory

Organization, being customer centric, started to hording huge inventories anticipating customer’s order, preventing stock-outs, purchase benefits of low cost in bulk, unpredictability of supply and demand. All these management started to take lots of time and money, and various inventory costs.

Another big problem that started to arise was arranging and expanding huge physical space to build up warehouses at different locations to ease out timely and quick delivery of products to customers.

By 1999, Amazon had acquired a significant market share of e-com customers depending mainly upon the IT service, intact warehouses, inventory management and efficient transportation services.

The only concern was warehousing and space. With an Inventory goal of – right product in the right quality at the right place at right time; so their final decision was OUTSOURCE.

In 2001, Amazon adopted the “Drop Shipment Model” basing inventory outsourcing. In this process the orders placed by the buyer are forwarded to retailer, by Amazon, who then dispatches the goods to the buyer. It increased the overall efficiency and streamlined the logistic issues.

This ensured cost of operating warehousing is reduced to around 20 % and the capacity increased 3 times. This was the first time Amazon earned its profit margin.

Now Amazon is tagged as – the Warehousing Giants

Advanced Supply Chain Management Practices

lean management case study with solution

Supply Chain management in a typical manufacturing company encompasses the following processes – manufacturing, warehousing and transportation. In a service industry it is restricted to warehousing and transportation. Amazon has always been researching, innovating and implementing bold supply chain strategies.

In 2004, 10 years after Amazon was founded, its annual revenue was just under $7 billion. According to Statista, by 2018, revenue reached almost $233 billion. In fact, Amazon is the fastest company to reach $100 billion in sales revenue, taking only 20 years.

From its inception, Amazon has been growing approximately 20% per year. It grew by 30% from 2018 to 2019. Currently, it enjoys more than 13% of gross global e-commerce sales.

The major contributor for the quick and efficient supply chain management is the advanced utilization of information technology, extensive network of warehouses, multitier inventory management and excellent transportation management and facilities.

Also, Check Our Other Courses

Six Sigma Green Belt Certification

Six Sigma Black Belt Certification

Six Sigma Master Black Belt Certification

1. Outsourcing Inventory Management

lean management case study with solution

Amazon has a huge network of warehousing and fulfillment center all across the world. However, their supply chain is largely dependent on outsourcing of inventory. Also almost 82 % of Amazon’s sales are supplied by third- party sellers.

Outsourcing of ordered inventory at different locations from different sellers eased out amazon from the necessary warehousing establishment, which was not possible at all locations.

2. Delivery Options for Customer

lean management case study with solution

Amazon offers to its users a wide range of delivery options. One hour delivery, Prime delivery, one-day delivery, first class delivery and free super delivery. Amazon’s one hour delivery or same day delivery is successful because of its in-house logistics usage. Amazon relies more on the own transportation arrangements rather than being dependent on any third party logistics to deliver their orders on time.

3. Push  – Pull Strategy for Supply Chain Success

lean management case study with solution

Amazon being a global brand receives orders from every corner of the world. Location, size and number of warehouses became important sustenance strategy. With increasingly fast delivery promise, company had to position its ware houses as closest possible to the supply area as well local urban market.

They use the ‘push strategy’ to stock in the warehouses with products forecasting demand in the nearby location. They use the ‘pull strategy’ by selling the product directly from third-party sellers.

4. Automation

lean management case study with solution

In 2012, Amazon acquired “Kiva System”. It facilitates automated and robotic warehouse solutions. This got re-branded as Amazon Robotics in 2015. This robot has replaced manual intervention for pick and pack of products reducing the time spends in arranging the warehouse. Till 2017, Amazon had acquired 45,000 robots. They help bring products to staffs for picking up orders.

Futuristic dream is to bring in the next generation robot which will pick orders as well.

5. Supply Chain Cost

lean management case study with solution

Supply chain is the tools of manufacturing industry. Due to economies of scale, Amazon has used this tool and reduced it’s per unit supply cost to minimum range.

Hire best and Develop best

lean management case study with solution

The leadership believes to work in the future, and they do not believe in leaning away from the future so hire the best of work force that are quick, innovative and high speed and has a progressive approach.

Amazon acknowledges the transformation happening in the industry and therefore they focus on hiring efforts and take the responsibility to up skill and train employee with living skills needed to move up the ladder.

They groom employees with living skills to stay on toes with changing environment and prospect for a long term career.

As a part of on the job training, leaders at Amazon keep raising the performance bar to bring out exceptional talents and more leaders to invent mechanism for development.

Deliver Results

lean management case study with solution

With designers, developers, vendors, packaging, shipping, re-ordering legal and finance, new innovation and many more challenges keep cropping up as daily routine.

All the leadership positions are trained to proceed with perseverance, keep striving, take responsibility, recover fast, focus right, drive solution because only thing that matter @ Amazon is – “ RESULTS”

Not  just the attitude of the employee alone contribute to a greater company, the outcome at Amazon is also credited upon six sigma parameters of great inventory management, increased efficiency, streamline control and a strong value and culture.

Despite all setbacks, leaders here aspire to deliver results with right quality and ‘ On Time Delivery’

Game-Changing Delivery Strategy

lean management case study with solution

“Amazon Prime “was a game changing business strategy for customer acquisition by Amazon.

“Amazon Prime Day” sounded better than a ‘Black Friday’. Amazon started selling yearly membership under the tag Amazon Prime which will guarantee – “ two-day shipping/delivery ” for more than thousands of products with no shipping charge.

The two-day shipping strategy encouraged customers to change their purchasing behavior. The other service offered to customer in the Amazon Prime scheme was subscription to music, movies and books. The economies of scale helped expand the customer and lowered overall shipment costs.

Their business strategy team not only outshined the brand image and also made competitor’s life difficult by this innovative strategy.

Drones: The Supply Chain of the Future

Once again in 2013, Amazon’s CEO Jeff Bezos proved that he is too stubborn to conquer the world.The Giant Online Retailer announced that the company is developing a drone-based delivery system which would be named as ‘Amazon Prime Air’.

These drones will deliver products weighing less than 5 pounds in locations within 10 miles of any Amazon fulfillment center in just 30 minutes or less.

The idea and the thought process of developing a drone delivery system indicate that Amazon is not going to leave its 25 years old place as market leaders in e-commerce business.

Recommended Reads

  • Top 25 Best Six Sigma Certification in India
  • Top 14 Best Six Sigma Certification in Bangalore
  • Top 25 Six Sigma Certification Costs
  • Top 30 Six Sigma Interview Questions & Answers
  • 10 Facts About Certified Six Sigma Black & Green Belt Salary

Q1.Dose Amazon use Lean Six Sigma?

Ans. There is no specific mentioning of Six Sigma implementation in the annual report of the company. However, various principles and methodology of Six Sigma and Lean is being implemented in the process of the organization.

Q2. How dose Amazon uses Six Sigma?

Ans. Amazon is giant data-driven organization. They use the standard deviation and error management practices of Six Sigma to all sphere of their work.

Q3. What are the five principles of Lean?

Ans. The five Lean manufacturing principles are – value, value streams, flow, pull and perfection. Lean practitioner strives for nothing but perfection.

Q4. How does Amazon manage quality?

Ans. They check for quality of product, packing, and presentation at each any every stage from indent to storage to packing to supply. If products are supplied from third party, a pre-shipment inspection for total quality management checking is called for so that the product can be thoroughly checked before dispatch.

Recommended Programs

Ranked No.1 Six Sigma Certification in India | Aligned to IASSC Book of Knowledge | Combining Lean and DMAIC Methodology to Impart Key Skills | Gain Experience of 12+ Projects | Both Classroom and Live Online Options Available

Lean Six Sigma Black Belt Certification Training

Ranked No.1 Six Sigma Black Belt Certification in India | 9361+ Participants Trained | Aligned to IASSC Book of Knowledge (BOK) | Gain Advanced Expertise Over Lean and Six Sigma Methodology| Gain Experience of 12+ Projects | Both Classroom and Live Online Options Available

Lean Six Sigma Master Black Belt Certification

Step-in to a new designation of being Explicit Quality Professional | Get acknowledged as a Lean Six Sigma Evangelist | Connect to the rarest community of worldwide Black Belt specialists | Validate your professional skills in leading intricate projects | Execute Lean methodologies with perfection.

Recommended videos for you

Six Sigma Green Belt Training

Six Sigma Green Belt Training Tutorial

Certified Six Sigma Black Belt Course

Best Six Sigma Black Belt Training

Punam

Punam Sharma is a seasoned banker with specialization in retail banking. She is an MBA with Finance as specialization. She is a certified bank trainer from National Institute of Bank Management, Pune. Punam is a budding blogger and a pen enthusiast.

lean management case study with solution

Top 13+ Creative Writing Courses in Bangalore

lean management case study with solution

What is KANBAN: Does It Guarantee Efficiency in 2024? [Updated]

Related posts.

Quality Circle Image

Quality Circle- Definition, Benefits, and Process

lean management case study with solution

7 Basic QC Tools For Six Sigma Projects in 2024 [Updated]

lean management case study with solution

10 Best Six Sigma Certification Courses in Nigeria

lean management case study with solution

Walmart Case Study: Lean Six Sigma Implementation in 2024 [Updated]

lean management case study with solution

Lean Six Sigma For Everyone: A 2024 Guideline

lean management case study with solution

5S Lean Management & Six Sigma in 2024 [Updated]

23 comments.

' src=

I appreciate you sharing this important information on amazon six sigma, brother. This is quite helpful to me as a beginner. I want to take six sigma training from a reputed institute.

I read your full blog on amazon six sigma. Your content is really genuine, and your all blogs are quite helpful. Thanks to Henry Harvin for sharing such an informative blogs

Thanks for the blog this is my first time seeing it, and I really like your clarity. I wish you could talk a little more slowly. Despite this, your blog is excellent and the information contained in it related to amazon six sigma is also helpful

I appreciate you sharing your wise insight with us, sir. No one shares the such type of informative blogs. I honestly believe in positive things and whenever I read your blog I received some positive things. This is also genuine information on amazon six sigma

Your blog always shared something informative with us and I want to say thanks to you for sharing this blog. I have read this full article and found it quite informative and knowledgeable. Thank you so much for sharing this blog amazon six sigma

What’s an amazing blog on amazon six sigma and I was looking for such type of blog from a long time and thank you so much for sharing this blog

Thanks, I really found this blog very interesting. Your article is also very useful. Your article on Amazon Lean Management: The Six Sigma Case Study very awesome and it contains amazing tips this is helpful in my business.

Thank you so much for such a Amazon Lean Management: The Six Sigma Case Study. I am glad that i found your site and visit on it. I really want to appreciate you an all the best for future post.

Thanks for sharing a valuable topic about Amazon Lean Management: The Six Sigma Case Study in India. In this Blog Really it is very helpful and interesting.

Everyone has heard of Amazon, and the Amazon lean management case study is a well-defined example. It’s inspiring to see how Amazon got to where they are with Six Sigma. As a result, I strongly suggest this course.

Excellent Work It Helped Me A lot I Was Looking For the Amazon Lean Management: The Six Sigma Case Study From a Long Time Thank you Soo Much Sir.

Thanks for sharing such valuable information. It is very helpful for my career. I am getting very good quality of course content related to my skills.

A well defined and descriptive case study on amazon lean management. Six sigma course also helps to improve the business skill.

Amazon name about heard all people, the amazon lean management case study is well defined expiation. How amazon reached where they are with Six Sigma is such an inspiration. So I highly recommend this course.

I feel Amazon lean Management course is a business management course and various module available this course its help to grown the business. so really this course is good course. After complete this course, if you started own business and apply business strategy. Thanks

Various institute start Amazon lean management course. this course is highly demanded course. Also Henry Harvin provide this course. Thanks this blog

Amazon the name all have heard or might have brought something from there, the Amazon Lean Management Case Study is explained pretty well. How amazon reached where they are with Six Sigma is such an inspiration. Keep up the good work!

I just want to say that all the information you have given here is awesome…great and nice blog thanks sharing this amazon lean management six sigma blog..

The peer reviews were mostly constructive and the instructor was clear and brought her learnings across. Highly recommended!

Its very informative blog of amazon lean management. Highly recommanded.

A very deep and descriptive case study on amazon lean management.

Six sigma helps soo much in amazon to improve the quality of their products.

After reading this article I get to know how this big brand implements six sigma and increases its market sales.

Join the Discussion Cancel Reply

Save my name, email, and website in this browser for the next time I comment.

lean management case study with solution

Our Career Advisor will give you a call shortly

lean management case study with solution

Just purchased a course

Type above and press Enter to search. Press Esc to cancel.

Book cover

European Lean Educator Conference

ELEC 2022: Lean, Green and Sustainability pp 72–81 Cite as

A Lean Approach for Reducing Downtimes in Healthcare: A Case Study

  • Stefano Frecassetti   ORCID: orcid.org/0000-0002-9649-314X 19 ,
  • Matteo Ferrazzi   ORCID: orcid.org/0000-0001-9035-0773 19 &
  • Alberto Portioli-Staudacher   ORCID: orcid.org/0000-0002-9807-1215 19  
  • Conference paper
  • First Online: 12 February 2023

377 Accesses

Part of the IFIP Advances in Information and Communication Technology book series (IFIPAICT,volume 668)

Lean Management is considered one of the most successful management paradigms for enhancing operational performance in the manufacturing environment. However, it has been applied throughout the years to several sectors and organisational areas, such as service, healthcare, and office departments. After the Covid-19 outbreak, increasing attention has been given to potential performance improvements in healthcare organisations by leveraging Lean. This paper intends to add further knowledge to this field by presenting a case study in a hospital. In this paper, a pilot project is presented carried out in a healthcare organisation. Lean methods were used to improve the operating room performance, particularly by reducing the operating room changeover time. The A3 template was used to drive the project and implement a new procedure using the Single Minute Exchange of Die (SMED) method. With the implementation of the new procedure, the changeover time between two different surgeries in the operating room was significantly reduced, together with a more stable and reliable process.

  • Lean thinking

This is a preview of subscription content, log in via an institution .

Buying options

  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
  • Available as EPUB and PDF
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
  • Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Amati, M., et al.: Reducing changeover time between surgeries through lean thinking: an action research project. Front. Med. 9 (2022). https://doi.org/10.3389/fmed.2022.822964

Bharsakade, R.S., Acharya, P., Ganapathy, L., Tiwari, M.K.: A lean approach to healthcare management using multi criteria decision making. Opsearch 58 (3), 610–635 (2021). https://doi.org/10.1007/s12597-020-00490-5

Article   Google Scholar  

Costa, F., Kassem, B., Staudacher, A.P.: Lean office in a manufacturing company. In: Powell, D.J., Alfnes, E., Holmemo, M.D.Q., Reke, E. (eds.) Learning in the Digital Era. IFIP Advances in Information and Communication Technology, pp. 351–356. Springer, Cham (2021). https://doi.org/10.1007/978-3-030-92934-3_36

Chapter   Google Scholar  

Costa, F., Kassem, B., Portioli-Staudacher, A.: Lean thinking application in the healthcare sector. In: Powell, D.J., Alfnes, E., Holmemo, M.D.Q., Reke, E. (eds.) Learning in the Digital Era. IFIP Advances in Information and Communication Technology, pp. 357–364. Springer, Cham (2021). https://doi.org/10.1007/978-3-030-92934-3_37

Curatolo, N., Lamouri, S., Huet, J.C., Rieutord, A.: A critical analysis of Lean approach structuring in hospitals. Bus. Process Manag. J. 20 (3), 433–454 (2014)

D’Andreamatteo, A., Iannia, L., Lega, F., Sargiacomo, M.: Lean in healthcare: a comprehensive review. Health Policy 119 (9), 1197–1209 (2015)

Guercini, J., et al.: Application of SMED methodology for the improvement of operations in operating theatres. The case of the Azienda Ospedaliera Universitaria Senese. Mecosan 24 (98), 83–203 (2016). https://doi.org/10.3280/mesa2016-098005

Henrique, D.B., Godinho Filho, M.: A systematic literature review of empirical research in Lean and Six Sigma in healthcare. Total Qual. Manag. Bus. Excell. 31 (3–4), 429–449 (2020)

Henrique, D.B., Filho, M.G., Marodin, G., Jabbour, A.B.L.D.S., Chiappetta Jabbour, C.J.: A framework to assess sustaining continuous improvement in lean healthcare. Int. J. Prod. Res. 59 (10), 2885–2904 (2020)

Holweg, M.: The genealogy of lean production. J. Oper. Manag. 25 (2), 420–437 (2007). https://doi.org/10.1016/j.jom.2006.04.001

Sales-Coll, M., de Castro, R., Hueto-Madrid, J.A.: Improving operating room efficiency using lean management tools. Prod. Plan. Control 1–14 (2021). https://doi.org/10.1080/09537287.2021.1998932

Matos, I.A., Alves, A.C., Tereso, A.P.: Lean principles in an operating room environment: an action research study. J. Health Manag. 18 (2), 239–2577 (2016)

Portioli-Staudacher, A.: Lean healthcare. An experience in Italy. In: Koch, T. (ed.) APMS 2006. ITIFIP, vol. 257, pp. 485–492. Springer, Boston, MA (2008). https://doi.org/10.1007/978-0-387-77249-3_50

Rosa, A., Marolla, G., Lega, F., et al.: Lean adoption in hospitals: the role of contextual factors and introduction strategy. BMC Health Serv. Res. 21 , 889 (2021). https://doi.org/10.1186/s12913-021-06885-4

Rosa, C., Silva, F.J.G., Ferreira, L.P., Campilho, R.D.S.G.: SMED methodology: the reduction of setup times for Steel Wire-Rope assembly lines in the automotive industry. Procedia Manuf. 13 , 1034–1042 (2017)

Shah, R., Ward, P.T.: Lean manufacturing: context, practice bundles, and performance. J. Oper. Manag. 21 (2), 129–149 (2003)

Sunder, M.V., Mahalingam, S., Krishna, M.S.N.: Improving patients’ satisfaction in a mobile hospital using Lean Six Sigma – a design-thinking intervention. Prod. Plan. Control 31 (6), 512–526 (2020)

Torri, M., Kundu, K., Frecassetti, S., Rossini, M.: Implementation of Lean in IT SME company: an Italian case. Int. J. Lean Six Sigma (2021)

Google Scholar  

Welsh, I., Lyons, C.M.: Evidence-based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice: an empirical contribution to the debate. J. Psychiatr. Ment. Health Nurs. 8 (4), 299–305 (2001)

Yin, R.K.: Case Study Research and Applications: Design and Methods, 6th edn. Sage, Los Angeles (2018)

Download references

Author information

Authors and affiliations.

Politecnico di Milano, Department of Management, Economics and Industrial Engineering, Milano, Italy

Stefano Frecassetti, Matteo Ferrazzi & Alberto Portioli-Staudacher

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Stefano Frecassetti .

Editor information

Editors and affiliations.

University of Galway, Galway, Ireland

Olivia McDermott

LUM University "Giuseppe Degennaro", Casamassima, Italy

Angelo Rosa

Instituto Superior de Engenharia do Porto, Porto, Portugal

José Carlos Sá

Aidan Toner

Rights and permissions

Reprints and permissions

Copyright information

© 2023 IFIP International Federation for Information Processing

About this paper

Cite this paper.

Frecassetti, S., Ferrazzi, M., Portioli-Staudacher, A. (2023). A Lean Approach for Reducing Downtimes in Healthcare: A Case Study. In: McDermott, O., Rosa, A., Sá, J.C., Toner, A. (eds) Lean, Green and Sustainability. ELEC 2022. IFIP Advances in Information and Communication Technology, vol 668. Springer, Cham. https://doi.org/10.1007/978-3-031-25741-4_8

Download citation

DOI : https://doi.org/10.1007/978-3-031-25741-4_8

Published : 12 February 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-25740-7

Online ISBN : 978-3-031-25741-4

eBook Packages : Computer Science Computer Science (R0)

Share this paper

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Publish with us

Policies and ethics

The International Federation for Information Processing

Published in cooperation with

  • Find a journal
  • Track your research
  • Utility Menu

University Logo

5b833306552607c7751d83281934fae0

Data-smart city solutions, case study: performance management and lean process improvement - results washington, an operational excellence in government success story.

lean management case study with solution

  • May 31, 2017
  • Operational Excellence in Government

This resource is part of the Ash Center's Operational Excellence in Government Project.

Executive Summary

This case study is one of three highlighting successes identified as part of the Operational Excellence in Government Project. The purpose of the case studies is to elevate and document the successes, and in doing so to provide a greater amount of detail than is typically available about such efforts. The case studies explain the implementation steps, the key challenges, and the driving factors for success. With this work, we hope to reduce the cost of identifying opportunities for efficiency and cost savings across all layers of government, and to accelerate the transfer and deployment of successful cases.

This case study describes how the state of Washington implemented two key operational efficiency strategies for government — performance management and employee-driven process improvement. The effort, called Results Washington, sets priorities and then focuses on delivery to achieve results that make a difference in the lives of Washingtonians. Results Washington was launched in 2013 by Governor Jay Inslee. He established five top-priority statewide goals and challenged state government leaders to track their progress against these goals and to apply Lean thinking and tools to improve their processes. Highlights of the success of the initiative include:

Performance management. Every activity of state government aligns with one of five priority goals: World-Class Education; Prosperous Economy; Sustainable Energy and a Clean Environment; Healthy and Safe Communities; and Effective, Efficient, and Accountable Government. Indicators of progress toward these goals are tracked on a public dashboard ( www.results.wa.gov ), and the underlying data is publicly available too. Success to date includes:

  • 50 percent of the nearly 200 Results Washington goals are on track to meet or beat targets  
  • Many of the indicators tracked are complex challenges that require collaboration across departmental lines, such as homelessness, pollution, offender recidivism, and teen pregnancy. State employees work with private and nonprofit partners as well as customers to devise strategies to deliver results.    
  • Monthly progress meetings are public and are also live-streamed. All data, agendas, and meeting results are published to the Results Washington website.

Process improvement. Lean process improvement empowers employees to remove bottlenecks and unneeded processing steps. This puts problem solving where it is most powerful, in the hands of those who best understand processes- from the frontlines of service delivery to backend administration. This approach has proven successful- a study showed that $4.5 in value to taxpayers is returned for every $1 invested in the Lean process improvement program. A total of $33 million in savings and avoided costs have been achieved, as well as countless hours saved via streamlined processes, resulting in improved customer satisfaction.

Selected individual project results include:

  • One million hours [1] of time saved waiting in Department of Licensing lobbies using process improvements and partnering with private driver-training schools  
  • 15-percent [2] decrease in speed-related deaths  
  • 20-percent [3]  faster processing of DNA tests at the Crime Lab, reducing the backlog by 10 percent and cutting staff overtime 56 percent   
  • $6.2 million in recovered overpayments from Department of Labor and Industries, a 28-percent increase in one year  
  • $2.3 million in savings a year on long-distance phone calls

One key to the success of Results Washington is that it is both top-down and bottom-up. Top-level executive sponsorship has been consistent and high profile — the governor not only presides over monthly meetings, he walks around in state agencies asking employees for input and holds department heads accountable for delivering results that span the silos of government. Employees are empowered — a third of the workforce has been trained in how to improve processes, and 11 percent of all state employees have participated in a Lean process improvement project — it is becoming part of the organizational culture.

The state employees who have accomplished this did not do it alone — the public and the private sectors both contributed. The public contributes ideas via an interactive survey on the state website and through public results meetings. Private-sector Lean process improvement experts from 130 companies have contributed thousands of hours of expertise teaching, coaching, and mentoring state staff working on process improvement projects. 

Other state and local governments do not need to reinvent the wheel but can instead borrow from what Washington has done on both performance measurement and process improvement. As Rich Roesler, former acting director of Results Washington says, “We steal ideas from other states and welcome people to steal our ideas.”

The pages that follow describe how Results Washington was implemented and how it operates, and provide resources to help other jurisdictions achieve more efficient operations.

Download Full Case Study (PDF)

Learn more about performance and accountability.

  • Operational Excellence

Also from the Operational Excellence Project

Case study: new york city office space optimization, an operational excellence in government success story.

lean management case study with solution

... Read more about Case Study: New York City Office Space Optimization, An Operational Excellence in Government Success Story

... Read more about Case Study: Performance Management and Lean Process Improvement - Results Washington, An Operational Excellence in Government Success Story

Case study: atlanta's blue ribbon commission on waste & efficiency in government report, an operational excellence in government success story.

lean management case study with solution

... Read more about Case Study: Atlanta's Blue Ribbon Commission on Waste & Efficiency in Government Report, An Operational Excellence in Government Success Story

logo-TEC

SCM Case Studies With Examples

What is an scm case study.

  • Procurement

infographic: supply chain management case studies

  • Product lifecycle management (PLM)
  • Inventory management
  • Demand planning
  • Order management
  • Warehousing
  • Transportation
  • Customer service

What’s Included in SCM Case Studies?

  • Client profile —company type, industry, and a brief history and description of the company
  • The situation —the circumstances that initially caused the company to become interested in a new SCM solution
  • The challenges —the problems and issues the company was facing that an SCM solution could solve
  • The process —the heart of the case study, as it shows how the SCM vendor, reseller, or service provider—or TEC—performed its services in a way that met or exceeded the client’s goals and expectations
  • The results —the benefits to the client at the end of the day
  • Vendor/service provider profile —brief description of the vendor, reseller, or service provider—or TEC—including contact information

The Benefits of an SCM Case Study in the Selection Process

Because modern SCM software is generally quite complex, it can be difficult for companies to determine which SCM solution is the right one for their needs. Fortunately, there is a lot of documentation and research that companies can reference to assist them. As a category, SCM case studies can be of particular value because they describe how other companies overcame challenges inherent in the SCM software selection process. In the best case, organizations, such as manufacturing and distribution companies, can find SCM case studies that feature companies like theirs with similar needs and circumstances.

How TEC's SCM Case Studies Can Help You Find the Best-Fit SCM Software

TEC is a software service provider; we are not a vendor or reseller. As an industry-leading software advisory firm, we focus on three areas that are of critical importance to our clients:

  • evaluation and selection
  • implementation oversight
  • vendor/reseller contract negotiations

TEC case studies show how our advisory services helped companies of varying types, sizes, and industries succeed in all three areas.

TEC’s SCM Software Selection Process

Selecting enterprise software presents some significant issues. The complexity of today’s enterprise software can be a challenge for companies that lack the appropriate in-house expertise. Most companies are unused to cataloging their processes and goals and then matching them to software features and functions. And while vendors sell software every day, companies seldom make a software purchase, giving vendors a built-in advantage when it comes to contract negotiations. Finally, software implementation is a specialty of its own, requiring specific expertise and oversight in this process. As you can see right below, TEC’s software selection process provides assistance in all these areas with a proven methodology developed over hundreds of successful selection projects and implementations.  

  • Assess : Assess the client’s business processes and goals, gaps in key processes, and discover their functional requirements
  • Review : Review SCM solutions and vendor capabilities to meet the client’s business needs
  • Identify : Identify the shortlist of SCM vendors and their partner(s)
  • Demonstration : Assess SCM solution demonstrations scripted to the client’s business processes
  • Proposal : Create and distribute SCM request for proposal (RFP) to vendors to clarify deliverables and project total cost of ownership (TCO)
  • Reference : Evaluate SCM vendor and their partner(s) through reference checks from real-world clients on previous projects
  • Contract : Perform contract review and price negotiations on behalf of the client for cost savings
  • Implementation : Perform oversight and monitor the implementation of the SCM application(s) to enable successful transformation and business growth

TEC’s proven methodology is backed by our decision support software TECAdvisor , ensuring that every software selection decision is driven by data and is an impartial evaluation of the current enterprise software market.

Learn More with Our Free Library of SCM Case Studies

Refine results.

  • Enterprise Resource Planning (ERP) 536
  • Discrete Manufacturing ERP 127
  • Process Manufacturing ERP 122
  • Mixed-Mode ERP 112
  • ERP for Small Manufacturing Business 100
  • Distribution ERP 83
  • ERP for Service Industry 35
  • ERP for Small Business 33
  • Engineer-to-Order (ETO) 121
  • Supply Chain & Logistics 299
  • Supply Chain Management (SCM) 158
  • Inventory Management 87
  • Manufacturing Execution Systems (MES) 57
  • Merchandising Software 18
  • Supply Relationship Management (SRM) 29
  • Transportation Management Systems (TMS) 25
  • Demand Management Software 27
  • RFID Software 5
  • Warehouse Management Systems (WMS) 97
  • Business Intelligence & Data Analytics 247
  • Spreadsheet 1
  • Business Process Management (BPM) 100
  • Enterprise Performance Management 60
  • Business Intelligence (BI) and Data Management 181
  • Customer Relationship Management & Support 219
  • Call Center 6
  • Event Management 1
  • Proposal Management 10
  • Contract Management 2
  • Sales Force Automation Software 21
  • Customer Relationship Management (CRM) 185
  • Field Service Management (FSM) 80
  • Configure Price Quote (CPQ) 33
  • Benefits Administration 12
  • Compensation Management 6
  • Human Resources 24
  • Performance Management 14
  • Time & Attendance 11
  • Workforce Management 15
  • Learning Management Systems (LMS) 75
  • Talent Acquisition Software 14
  • Talent Management Systems 43
  • Human Capital Management (HCM) 83
  • Financial 130
  • Billing & Invoicing 17
  • Point of Sale (POS) 2
  • Accounting and Financial Software 85
  • Asset Management 122
  • Facility Management 6
  • Computerized Maintenance Management System 109
  • Asset Management (EAM) 97
  • Product Lifecycle Management (PLM) 115
  • Process PLM 15
  • Discrete PLM 16
  • Regulatory and Compliance PLM 26
  • Fashion PLM 22
  • Retail PLM 48
  • Information & Document Management 69
  • Document Management Systems (DMS) 58
  • Enterprise Content Management (ECM) 52
  • Content Management System (CMS) 17
  • IT & IT Security 57
  • Help Desk 6
  • Virtual Private Network (VPN) 1
  • Remote Access 3
  • Network Security 16
  • E-commerce 31
  • Web Content Management (WCM) 6
  • Communication & Collaboration 31
  • Collaboration 2
  • Project Management 8
  • Project and Process Management (PPM) 23
  • Marketing 23
  • Marketing Automation 23
  • Design/Creative 9
  • Computer-Aided Design (CAD) 9
  • Industry-Specific 3
  • Property Management 3
  • Manufacturing 41
  • Wholesale and Retail Trade 21
  • Food and Beverage Products 8
  • Chemical Products 5
  • Pharmaceutical and Botanical Products 4
  • Transportation 4
  • Construction 3
  • Motor Vehicles and Other Transport Equipment 3
  • Agriculture and Forestry 2
  • Health Care and Social Work 2
  • Hotels and Restaurants 2
  • Life and Natural Sciences 2
  • Mining & Quarrying 2
  • Public Administration and Defense 2
  • Publishing and Media 2
  • Telecommunications 2
  • Warehousing 2
  • Electronics and High-tech Components 1
  • Industry Independent 1
  • Insurance 1
  • Recreational, Cultural, and Sporting Activities 1

Publication Types

  • Blog Posts 1,213
  • White Papers 772
  • Case Studies 158
  • Industry Reports 65
  • Brochures 41
  • Software Reviews 40
  • Buyer's Guides 14
  • Datasheets 14
  • Accreditation Reports 6
  • Plex Systems 9
  • Pronto Software 7
  • Synergy Resources 6
  • Technology Evaluation Centers 6
  • Demand Management Inc. 5
  • Microsoft 5
  • Blue Yonder 4
  • AFS Technologies, Inc. 3
  • Bamboo Rose 3
  • MSM Solutions 3
  • AppFinity Software Corp. 2
  • Cadre Technologies, Inc 2
  • Cameleon Software 2
  • Chiron Technologies, Inc. 2
  • Dassault Systèmes 2
  • Habanero Consulting Group 2
  • LOGO Business Solutions 2
  • NGC (New Generation Computing) 2
  • Nucleus Research 2
  • Waer Systems Limited 2
  • Arena Solutions (a PTC Business) 1
  • Know the option you’re looking for? Type in the search field.

Increased Productivity through Automation

Top Publications

The Digital Manufacturing Operations Imperative (For All Size Businesses)

CASE STUDIES

lean management case study with solution

BUILDING RELIABLE TECHNOLOGICAL PARTNERSHIPS

Priority Technology Holdings (PRTH), a scalable platform integrating payments and banking solutions, grew exponentially. It required a staff augmentation alternative to scale quickly and find suitable candidates for their technology and software development teams.

Lean Solutions Group Success Story: Project 44 trusts Lean Tech to find top development talent for their fast-growing business

In a fast-changing and challenging market, Project44, a tech-enabled company that provides the most advanced visibility platform that helps shippers and 3PLs connect to carriers in real time and efficiently manage supply chains, was growing amazingly fast, and they needed to fill highly technical roles with the right talent quickly to keep pace with business growth.

Our Tech Division Scales Logistics Company's Development Team

Since its foundation in 2019, Lean Tech has become a true technology partner with customers in the logistics sector. Our expertise enables us to understand our customer’s specific needs and provide unique talent to grow their software development teams.

No results found

  • Research article
  • Open access
  • Published: 28 August 2021

Lean adoption in hospitals: the role of contextual factors and introduction strategy

  • Angelo Rosa 1 ,
  • Giuliano Marolla   ORCID: orcid.org/0000-0002-2095-8641 1 ,
  • Federico Lega 2 &
  • Francesco Manfredi 1  

BMC Health Services Research volume  21 , Article number:  889 ( 2021 ) Cite this article

4307 Accesses

12 Citations

2 Altmetric

Metrics details

In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting.

Methodology

The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy.

The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level.

The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system.

Peer Review reports

Over the last decade, healthcare has been called upon to respond to the increasing pressures arising from changes in demand – due to epidemiological changes and the demand for quality and safety – and increased costs due to the introduction of new technologies [ 1 , 2 ]. These major challenges are exacerbated by the shrinking resources available in health systems and, for most countries, by the principle of universal access to patient care. In order to meet the patients’ needs, a hospital must utilize a number of scarce resources at the right time: beds, technological equipment, staff with appropriate clinical skills, medical devices, diagnostic reports, etc. [ 1 , 2 ].

One of the most relevant issues for the management of a healthcare provider is the management of patient flows in order to purchase, make available, and use these scarce resources at the right time and in the right way, and to ensure the best possible care [ 3 , 4 , 5 ]. In this scenario, hospitals need to focus on the patient pathways in order to ensure fast, safe, and high-quality service [ 3 , 6 , 7 , 8 ]. The search for solutions to these challenges has extended beyond the boundaries of healthcare practices to study organizational methods and paradigms that have been successfully implemented in other sectors [ 3 , 5 ]. Among these, lean thinking has proven to be one of the most effective solutions for improving operational performance and process efficiency and for reducing waste [ 5 , 9 ]. Lean is a process-based methodology focused on improving processes to achieve a customer ideal state and the elimination of waste [ 10 ]. Waste is defined as the results of unnecessary or wrong tasks, actions or process steps that do not directly benefit the patient. The taxonomy of waste is: overproduction, defects, waiting, transportation, inventory, motion, extra-processing and unused talent [ 3 , 4 , 5 ]. In addition, lean addresses other key service issues such as continuous improvement and employee empowerment, whether healthcare professionals or managers [ 1 , 11 , 12 ]. Lean healthcare is defined as a strategic approach to increasing the reliability and stability of healthcare processes [ 7 , 13 , 14 ].

The first documented cases of lean applications in a hospital setting (HS) date back to the late 1990s. These aimed at improving patient care processes, interdepartmental interaction, and employee satisfaction [ 1 , 2 ]. The Virginia Mason Medical Center is one of the first and most emblematic examples of a successful migration of lean methodology from the manufacturing sector to healthcare. The hospital, based on the principles of the Toyota Production System, created the Virginia Mason Production System, a holistic management model in continuous evolution that not only had a strong impact on the quality of the services provided and on the reduction of lead time, but it also led to a decrease in operating costs [ 14 , 15 ]. Over time, many hospitals have followed in the footsteps of the Virginia Mason Medical Center [ 8 , 16 , 17 ]. The lean paradigm crossed the US border and spread to other countries such as Canada and England [ 5 , 12 ]. It was not until the early 2000 that the model was introduced in European hospitals [ 12 , 16 ].

The implementation of the lean paradigm in HS environments has increasingly attracted the attention of researchers and professionals. The interest in lean in HSs was fostered by the idea that the paradigm was particularly suitable for hospitals because its concepts are intuitive, compelling, and, therefore, easy for medical staff to use [ 18 , 19 ]. However, over time, alongside the evidence of successful implementation of lean in HSs, much of the research has shown failures in adopting the paradigm [ 5 , 20 , 21 ]. Moreover, a literature review showed that most of the cases were characterized by a partial implementation of lean methodologies and concerned single processes in the value chain or restricted technical applications [ 20 , 22 ]. Even today, few hospitals apply lean principles at a systemic level [ 23 , 24 ].

The failure of lean implementation is a hot topic. Many authors who have focused their studies on social and managerial issues have highlighted the existence of factors that either enable or hinder the implementation of lean. These factors are mostly related to the context and the implementation strategies [ 5 , 16 , 25 , 26 , 27 ]. Lean implementation is not self-evident, and the process of transforming an organization into a lean organization requires a long-term strategic vision, a commitment by management, and a culture of change in the entire organization [ 5 , 16 , 26 ]. Contextual factors influence successful implementation and introduction strategy; lean adoption, in turn, changes contextual factors. A lean transformation must be planned and managed; it is not a quick solution, but a strategic plan in constant evolution [ 5 , 28 , 29 ]. From this point of view, the introduction phase plays a fundamental role in implementation because it facilitates the dissemination of the lean principle in hospitals and enables the contextual elements that support change. Although most researchers have recognized the role of the introduction step, the impact of this phase on contextual factors has been poorly reported on in the literature [ 5 , 12 , 20 ]. Most of the articles have focused more on the benefits of this phase than on how to manage it.

In light of this, it is necessary to examine how hospitals introduce lean into their clinical pathways in order to explain the success of the lean implementation. Starting with an in-depth analysis of the contextual factors discussed in the literature, the document helps to clarify what drives success in lean implementation within the hospital. The research has therefore undertaken a critical study of the introduction of lean in the case study of the haematology ward at a university hospital in the south of Italy. The objective is to highlight: (a) the role of contextual factors for successful lean introduction and implementation in a hospital ward; (b) how the pilot project has improved the pathway of a cancer patient undergoing chemotherapy infusion; and, (c) how the success of the pilot project modified the contextual factors, facilitating the spread of lean within the organization.

The study has the merit of detailing all the lean introduction phases. The analysis period is about 2 years. The lean introduction started in May 2018 and lasted 7 months. The pilot project results refer to the follow-up period of December 2018 to May 2020, while the dissemination results refer to the period from December 2019 to May 2020.

The paper is structured as follows: In the following section, the theoretical background is provided. Section 3 describes the research methods, while Section 4 presents the results of the pilot project. Finally, Section 5 presents the conclusion, highlights some limitations of this study, and proposes some directions for further research.

Theoretical background

Most authors point out that the introduction phase is a crucial moment in lean implementation [ 10 , 12 , 16 ]. This phase reduces distrust of the method and organizational resistance to change. It shows the benefits of lean and assesses the organization’s ability to undertake continuous improvement. Many case studies report the success of lean in HSs by describing the use of lean instruments [ 8 , 30 , 31 ]. They offer the practitioners some methodological support, but not in a structured way since they do not provide a clear implementation roadmap [ 5 , 32 , 33 ]. Some authors have tried to fill this gap in the literature by offering guidelines for implementation. Augusto and Tortorella [ 33 ] suggests carrying out a feasibility study focused on the desired performance before implementing continuous improvement activities. The author suggests defining the techniques, roles, and results related to the improvement path. Curatolo et al. [ 5 ] argue that the improvement procedure has to take into account six core operational activities of business process improvement and five support activities. The six core operational activities are: selecting projects, understanding process flows, measuring process performance, process analysis, process improvement, and implementing of lean solutions. The five support activities are: monitoring, managing change, organizing a project team, establishing top management support, and understanding the environment. These studies, while offering further guidance on the process of introducing lean into a hospital, do not describe either the organizational context in which the method is being implemented or the strategies for its implementation [ 5 , 12 , 25 ]. The introduction of lean into a HS is not an easy task; there are many organizational issues to be addressed. Among these, the analysis of the context and the definition of the implementation strategy are the ones with the greatest impact on the success of the introduction [ 16 , 26 , 34 ].

The contextual elements are the special organizational characteristics that must be considered to understand how a set of interventions may play out [ 35 , 36 ]. They interact and influence the intervention and its effectiveness [ 34 , 36 ]. Two of the most cited contextual element are the drive to improve processes and the level of maturity [ 5 , 10 ]. The drive for improvement is represented by the exogenous and endogenous needs that act as triggers for the introduction of improvement methodologies [ 25 , 26 , 35 , 37 ]. The level of maturity refers to knowledge and experience in process improvement initiatives. It includes knowledge of methodologies and tools, experience gained, confidence, trust, and dissemination within the organization. Where the maturity is low, there is a risk of lean introduction failure in both the processes and the organization as a whole [ 5 , 16 , 38 ]. As long as the organization does not reach a fair level of maturity, the rate of change tends to be slow and sometimes frustrating. However, as the degree of maturity increases, lean implementation becomes a “day-to-day job” rather than a series of projects that take place at discreet moments [ 10 , 21 , 39 ]. Hasle et al. [ 39 ] highlighted that a high level of maturity allows for the implementation of principle-driven lean. Contextual elements include organizational and technological barriers such as resistance to change, lack of motivation, skepticism, and a lack of time and resources that inhibits the introduction and the implementation process [ 4 , 8 , 21 , 40 ]. The lean introduction process in HS is also complicated by the organizational context and the double line of clinical and management authority in hospitals [ 41 , 42 ].

With regard to internal contextual factors, many authors explored the readiness and sustainability factors influencing the adoption of lean. Readiness factors are those elements that improve the chances of lean implementation success; they provide the necessary skills and knowledge to enable organizational change [ 23 , 43 , 44 , 45 ]. The readiness and sustainability factors include any practices or characteristics that allow organizational transformation by reducing or nullifying potential inhibitors of success. High commitment and strong leadership of managers and physicians, continuous training, value flow orientation, and the hospital’s involvement in continuous improvement are just some of the most discussed topics [ 5 , 10 , 16 , 43 ]. Other examples include understanding employees needs, identifying the organization’s strategic objectives, project management, and teamwork [ 5 , 12 , 16 , 46 ].

From the study of the contextual elements described so far, some authors have developed models to assess the impact of context on the implementation of organizational improvement activities. Kaplan et al. [ 36 ] put forth the Model for Understanding Success in Quality (MUSIQ). The authors identified 25 key contextual factors at different organizational levels that influence the success of quality improvement efforts. They defined five domains: the microsystem, the quality improvement team, quality improvement support and capacity, organization, and the external environment. Kaplan et al. [ 36 ] suggest that an organization that disregards contextual factors is doomed to fail in implementing an improvement program; an organization that adopts a context-appropriate implementation strategy can change the outcome by triggering implementation enablers. Previous studies of lean adoption in HSs suggest that the fit between the approach taken and the circumstances will influence the chances of success [ 3 , 12 , 34 ].

There are two strategies for introducing lean in a HS, and they are characterized by the implementation level. The level of implementation refers to either micro or meso implementation. Brandao de Souza [ 16 ] defined meso-level implementation as the condition under which lean is spread throughout the organization and is implemented at the strategic level, while micro-level implementation is where lean is implemented at a single process level in discrete moments. Meso-level implementation is crucial for long-term success because a lack of integration in a lean system can lead to the achievement of local rather than global objectives and can also affect the sustainability of the paradigm [ 23 , 26 , 47 ]. However, organizations that want to implement lean at the strategic level often do not recognize the need for a long-term implementation program and introduce lean as a “big-bang initiative”. This leads in many cases to a failure to introduce the method [ 16 , 47 ]. Many researchers suggest introducing the lean approach through a pilot project run by a specially formed lean team [ 12 , 16 , 48 , 49 ]. The pilot project should be challenging, involve a process relevant to the organization, and require the use of a systemic approach. In particular, it should not be limited to the application of “pockets of good practice” or lean tools, but should include the systemic adoption of improvement programs such as the Plan-Do-Check-Act (PDCA) cycle [ 21 , 48 ]. Brandao de Souza [ 16 ] asserts that the first initiative should be tested on a relevant patient pathway. The lean team should be composed of clinical and non-clinical staff actively involved in the patient pathway. A pilot project that meets these conditions is a useful tool for increasing the maturity of the method within the organization [ 21 , 39 ]. It can increase the confidence of the team and staff in the lean approach and can promote the learning of lean methodologies and techniques [ 21 , 39 ]. Moreover, the pilot project activates the contextual elements, enabling the introduction of the model [ 10 , 12 ]. The successes of the pilot initiative must be celebrated and communicated within the organization [ 10 ]. When the first initiative leads to visible and easily quantifiable results, the method has a greater chance of spreading throughout the organization [ 10 , 12 , 16 ]. In light of these considerations, the lean implementation requires that the contextual elements and the introduction strategy be assessed at the same time. In addition, it would seem fair to assume that as contextual factors influence the introduction strategy, the results of the implementation strategy will influence the contextual factors.

In Fig.  1 , we propose an adaptation of the MUSIQ model [ 36 ] that shows the impact that the lean implementation strategy has on the contextual elements.

figure 1

Our adaptation of the MUSIQ model

Study setting and design

This is an explanatory single-case study of the introduction of lean at a university hospital in Southern Italy. In particular, the introduction of lean in the pathway of a cancer patient undergoing infusion chemotherapy in a haematology ward will be discussed. This study was designed to evaluate how the contextual elements discussed so far have influenced the introduction of the method and how the successful pilot project has enhanced the internal context. We used the adaptation of the MUSIQ model [ 36 ] proposed in Fig. 1 to systematically trace the antecedents of the lean introduction and to explain how the success of the implementation strategy changes the contextual elements.

The work covers four periods over 2 years (Fig.  2 ). The first period concerns lean introduction and implementation strategy. The second is related to the pilot project implementation in the haematology ward. The third shows the pilot project results. The last assesses the impact of the pilot project on the dissemination of lean within the organization.

figure 2

Stages of data analysis

Data collection

Different data sources and data collection methods are used with the aim of improving data validity through triangulation. The data sources are lean training documents, direct observations and nonparticipant observations, process performance reports, process data recorded by patients, and two questionnaires submitted to the hospital staff (the questionnaires assess the “pre” and “post” lean dissemination phases and the difference regards three open questions) (Fig. 2 ). The second author is the consultant who trained the lean team and coordinated the pilot project, and the first author conducted approximately 50 h of nonparticipant observations. The questionnaire was delivered to 25 medical department staff members in September 2018 and in May 2020. The first questionnaire focused on contextual factors that existed before the introduction of lean, and the second investigated changes in the contextual elements - in particular trust, maturity and lean dissemination. The semi-annual performance reports from 2017 to 2020 for the clinical pathway under examination include daily averages of the number of chemotherapies per chemo chair (MT), the patients’ length of stay (LOS), and the daily average of the percentage of patients undergoing chemotherapeutic infusion within 3 hours of hospital admission (P3). Each day, from September 2018, a document containing all the steps of the clinical pathway was given to each patient. For each activity, the patient recorded the start and end time, and a signature of the doctor or nurse was required. In the period of September 2018 – May 2020, the medical staff collected more than 1.250 reports from patients. The study also draws on 10 semi-structured interviews. The hospital CEO, the chief of the medical department, the nurse supervisor, the chief of the antiblastic chemotherapy handling units, and the chief of the clinical laboratory were interviewed in September 2018 and May 2020. The interviews focused on the contextual elements either enabling or inhibiting lean introduction or its dissemination, and ranged from 30 min to 1 hour in duration.

Data analysis

The factors described in Fig. 1 were used to systematically analyse the antecedents of the results and to understand their causal influence on the lean introduction. This data collection allows for the description of the case study. In addition, it simplifies the interpretation of the evidence that emerged through the study of the factors listed. The authors carried out a content analysis to classify the data by theme. The content analysis followed an inductive approach based on the identification of meaning units at the semantic level and the encoding of results [ 49 , 50 ]. Whenever researchers did not agree on semantic meaning, a new unit of analysis was proposed. The principle of consensus among all panel members was used to determine the interpretation, addition or deletion of elements of analysis. The discussion of the case study focuses on four themes: (a) contextual elements enabling or hindering lean introduction, (b) implementation strategy, (c) pilot project results, and (d) lean dissemination and adoption in hospital. These themes were submitted for review by the interviewees; their feedback was used to improve the accuracy of the case study description.

Case study presentation

The university hospital is a model of excellence in Italy for pre-clinical, translational, and clinical research and care activities. It is equipped with 110 beds to treat all types of oncological pathologies in adults. There are 115 researchers working there. The hospital is structured into six departments, of which three are clinical (Medical Area, Diagnosis and Imaging Therapy, Surgical Area), two are services, and one is an administrative/management department. The medical area includes four wards: medical oncology for thoracic pathology, medical oncology, haematology, medical oncology for oncology patient care. In 2015, the institute was accredited as a clinical cancer centre according to the Organization of European Cancer Institutes (OECI). Since 2015, evidence-based medicine and patient-centred care methodologies have been successfully implemented in the hospital, but no process improvement methodology has been used. In 2017, the hospital became a hub for oncological diseases, which led to an increased demand for care and services. The hospital has received national funds dedicated to hubs and has made investments in infrastructure improvements and the purchase of new innovative medical equipment.

Contextual factors enabling or hindering lean introduction

The description of the external and internal contextual factors, as revealed in the first questionnaire and the interviews, is given in Table  1 . Below is a brief description of each item.

External context and organizational elements driving lean introduction in the haematology ward

The analysis of the context revealed external and internal elements influencing the introduction of lean. Starting with the external elements, the most frequently discussed motivators that led to the search for methodologies for process improvement include the continuous increase in patient volume and the benchmark of process performance with other providers. Although the clinical results were above the national average, the increase in demand - especially in the medical area - highlighted the inability to manage the increasing flow of patients. The inability to manage the increasing number of patients also affected the performance of the process in the diagnostic area.

Internal elements driving the lean introduction were related to dissatisfaction with inefficient work practices within the medical area and the dissatisfaction of many patients who complained about long wait times and lengths of stay.

The choice of lean methodology derives from the desire to follow the example of certain Tuscan hospitals that have been using lean at a strategic level since 2015. These hospitals are considered the benchmark for continuous process improvement. One of these hospitals was already included in the 2013 OASI Report, edited by CERGAS - Bocconi, among the six Italian companies that were the first and best to successfully implement Lean Thinking in healthcare. In addition, the methodology was strongly sponsored by the clinical director and the general director of the hospital. They had participated in a 60-h regional training course on lean healthcare in the second half of 2017. During the training course, they studied case studies of excellence in lean implementation.

When, in May 2018, the hospital directorate proposed the introduction of lean methodology in the medical area, the head physicians showed strong resistance because of the resources that would need to be allocated to the implementation process. In addition, some doctors did not trust the method. This brought up some conflicts with the medical area managers. The haematology staff, represented by their head physician, were the only ones who explicitly agreed to implement the lean introduction. The department, as in most Italian hospitals, is structured as a clinical area where the physicians - in contrast to other professionals - were members of the ward organizationally. Haematology staff were strongly motivated to do research and achieve excellent process performance. They were interested in taking the opportunity to define excellent clinical pathways, as the ward was undergoing managerial and layout restructuring. In addition, the haematology staff believed that lean could further improve clinical performance and improve the patient-centred and evidence-based approach. Until mid-2017 the ward was part of oncology; afterward, it was made independent and new areas of the hospital were assigned to it. Since the ward became independent, one head physician, three doctors and four nurses have been hired. The department is equipped with the most modern medical equipment. The layout of the ward was not yet fully defined, and some rooms that could have potentially been assigned to medical, diagnostic and therapeutic activities had not been assigned to process activities. The ward shares the Antiblastic Chemotherapy Handling Unit (UMACA) and the analysis laboratory with the other four medical department wards in the hospital, so the staff needed to coordinate clinical processes so as not to create bottlenecks.

Since haematology is a strategic ward for the hospital, and in the last 2 years the demand for treatment has increased more than in other wards, the managers of the medical area have deemed it appropriate to introduce lean there. Haematology ward is considered strategic due to its high attractiveness and high immigration rates of patients from outside the region. These phenomena derive from the excellent reputation of the department in relation to the quality of care. Although the clinical pathways were characterized by excellent clinical outcomes, qualitative benchmarking activities (based on testimonials from physicians and patients) showed that the organization of the haematology patient pathway was very different compared to the benchmark (a Tuscan hospital) and that the patients’ perception of non-clinical service quality was lower. Although no investigation was carried out with respect to the ratio of equipment and personnel available per number of patients and amount of activities regarding the hospitals taken as benchmarks, the testimonials prompted management to come up with new specific, measurable, attainable, relevant and time - bound (SMART) goals (Table  2 ). The goals will be described in the next section.

Internal contextual elements enabling and hindering lean introduction in the haematology ward

At the organizational level, hospital management has strongly supported the introduction of the method. Since the haematology staff had no experience in process improvement activities, management provided the budget for an external consultant. In addition, three non-clinical personnel were allocated part-time to support the implementation of visual management systems and communication. The organizational structure of the ward has been modified to a matrix form. A team of three haematology ward physicians and two nurses was established and the ward’s head physician was elected project manager. The project manager had formal authority over the team and the personnel employed in the process to be improved; this reduced conflicts due to the double line of hierarchical authority. In this phase, the top-down decision-making approach was crucial to the successful restructuring of the organizational structure and the definition of the new organizational roles. The lean advisor supported the group for 8 months through training and project supervision. He coordinated two meetings per week and carried out Kata coaching activities. The theoretical training activity, lasting 5 week ends (in June 2018), was differentiated to accommodate technical and managerial competency needs. The team project manager and the medical area manager were trained on topics such as project management, team management, leadership, and the dissemination of lean. The members of the lean group were trained in lean techniques and tools. The key principles of lean thinking, the PDCA cycle methodology and lean assessment were taught to all participants. The most difficult barrier to overcome was the time available. The team agreed to spend 8 hours per week on training and pilot project implementation. The management of the team was facilitated by the experience gained with the implementation of the patient-centred care and evidence-based medicine. The motivation of the medical staff–microsystem element–and the focus on team management were key success factors for the involvement of team members. The culture of change introduced by patient-centred and evidence-based medicine was another enabling factor.

Implementation strategies

Pilot project definition.

Hospital managers and lean team members, who had experience in implementing patient-centred care methodologies, suggested starting a pilot project for the lean introduction. The consultant agreed. The team, with the support of the expert, analysed the clinical pathways in haematology. Six pathways emerged: a) diagnostic visits, b) biopsies, c) check-up visits, d) transfusions, e) infusion chemotherapies, and f) oral chemotherapies. Hospital managers argued that the pathway of the patient undergoing infusion chemotherapy was the most critical for patient and organization value. This process is the only one that involves several departments and requires a large amount of materials and time-consuming resources. In the first and second half of 2017 and 2018, there was a significant increase in the number of chemotherapeutic preparations. LOS, P3, and MT performance decreased during the same periods (Table  2 ). In addition, outpatient visits and the number of biopsies also increased. The medical staff stated that the increase in demand in the medical area had particularly affected the infusion therapy activities because they involved technical and instrumental resources that are shared with other departments (Table  2 ). The length of stay was analysed for patients undergoing short (LOS s ) and long-term infusion (LOS l ) chemotherapy. The first has a minimum duration of 90 min and a maximum of 180 min, and the second has a minimum duration of 181 min and a maximum of 360 min. Each patient was assigned to one of the infusion treatment classes. Process data were collected and analysed by the Department Management Control Office. The process performance data collection and reports were established in 2015 for the implementation of evidence-based medicine.

Pilot project implementation

The pilot project started in June 2018. The first month was dedicated to Gemba Walk, Methods-Time Measurement (MTM) and implementation of the 5S. In addition, the consultant trained the project manager, department managers and lean team members. There were many difficulties during the training period, especially with regard to process mapping and the concept of value, the latter being interpreted by doctors as clinical output. The non-medical staff dedicated to the project assisted the team in the drawing of the visual management material. A room in the medical department was dedicated for team meetings, and some notice boards were installed to post the materials developed during the project. The project activities were organized according to the Report A3 scheme. It followed the phases of the consolidated Deming cycle: Plan-Do-Check-Act (PDCA). Implementing the approach proposed by Deming allowed for the trial-and-error empirical method to be abandoned in favour of the “scientific” one. The PDCA allowed accurate planning of objectives and activities and their monitoring. The departmental managers and the consultant through the study of the national publications and explicit requests to colleagues in other hospitals - considered virtuous - identified the benchmark (Table  2 ). They took into account the hospital’s specific characteristics, such as the policy of not accepting haematochemical reports from outside for fragile patients. This choice is dictated by the risk management plan and affects P3 and MT performance. Time for blood sampling and haematochemical analysis is added to the cycle time; however, it eliminates many risks associated with clinical treatment.

The existing care process was mapped through Value Stream Mapping (VSM) based on the patient reports, Gemba walks, interviews, and direct observation. For instance, Fig.  3 shows the pathway of a patient undergoing short-term infusion chemotherapy. The cycle time in Fig. 3 was calculated over an observation period of 1 week and included 51 patients. In addition, the application of the Demand Map and the Spaghetti Chart were used to evaluate the ward nodes activated by the patients and the ward’s layout. These tools were useful in defining the possible sources of waste in the process. The application of these tools lasted more than 2 months and required several revisions. Once completed, the results were posted in the meeting room and were used for discussions with colleagues in the medical department. The lean team requested support from the consultant for the drafting of the VSM and for the layout analysis. In addition, the consultant was asked to simplify negotiations with staff from other departments who were reluctant to be subjected to time and method measurements. The negotiation activity required a degree of organizational effort. The facilitating elements were manifold: they enabled the involvement of staff opposed to the introduction of measuring instruments. In particular, the most effective were: the intervention of the directorate general, the delegation of hierarchical authority to the project manager and finally the endorsement of trade union committees. Moreover, during the planning phase, many difficulties emerged, including the selection of a unique and standardised measurement system, the coordination of work and meeting schedules, and the deadlines set by the project Gantt. Although the project manager was able to manage the team, he did not have enough experience in lean tools. The external consultant played a key role in managing these activities.

figure 3

As-is process represented by VSM

At the end of the as-is analysis process, an Ishikawa diagram was used for the definition of root causes. Four root causes emerged from the meetings and interviews. They were patient flow management, coordination activities with other departments, layout, and Information Technology equipment (IT).

Patient flow management concerned the absence of priority in the management of patients based on the clinical path and the arrival of patients in the early hours of the morning. The lack of coordination with other departments led to delays in the preparation of infusion chemotherapy and blood test reports. The layout was such that the flow of doctors and nurses crossed the flow of patients, and this caused great inconvenience to the doctors and nurses. Also, the computer software was not compatible, which meant that the same data had to be recorded several times.

After some meetings and rigorous brainstorming, the lean team suggested changes to be made in the existing pathway. This was done by considering how patients could be divided into clusters so that the infusion activity could start as soon as possible without affecting other occurrences. Moreover, it is made possible to simplify the coordination between diagnostic units. The patient flow has been managed in such a way that long-term patients are given priority (first to be accepted and blood sampled), followed by patients needing biopsies, first visit, follow-up visit. Finally, short-term patients are treated in a way that limits waiting time and does not affect the activities of other departments. Theories of queues and operational research methodologies were implemented to address chemo chair saturation. A chemo chair activities plan was implemented through pull logic. In addition, the hospital engineer was involved in making sure the information systems were compatible. Whenever integrating the software was not possible, a data entry person was assigned to prevent medical staff from wasting their time on low-value activities. The ward layout has been modified to prevent patient flows from intersecting with the flows of doctors and nurses. In addition, the use of one room has been changed from a small warehouse to a blood collection room to increase the value of the activities carried out within it. The waiting rooms were moved outside the ward and, during the first 2 hours of the working day, the biopsy room was reassigned to blood collection activities to speed up the requests for therapies in UMACA. Patient intake, blood collection, and tube labelling activities have been paralleled to be performed simultaneously in the same room. The routes and modalities for the delivery of blood samples to the laboratories were revised in order to reduce the time and distance travelled by non-clinical staff. Tablet reporting systems were installed. Finally, a patient chemo chair allocation system was developed.

The resources needed for these changes were determined. The team tested and modified the changes during December 2018 and January 2019. The tests were evaluated based on the performance data, patient reports and the team’s expertise.

Pilot project results

In January 2019, it was decided to implement the new standard procedures that were tested in order to improve performance. The team met once a week for 6 months. On a monthly basis, performance was reviewed and new changes were tested. Clinical and nonclinical personnel from other wards and departments were invited to each weekly meeting to share with them the results of the pilot project, and to involve them in the lean methodology.

Every morning, the team leader investigated the impact of organizational changes in order to avoid conflicts. Organizational problems that emerged were discussed and resolved by consensus. In the follow-up phase, the consultant performed supervisory activities. Each week, the team leader performed the Kata coaching. During the first 6 months, the monitoring of activity was very frequent to prevent a return to old operating modes. Subsequently, when the staff had learned the new procedures, monitoring was reduced to once a month.

Table  2 and Fig.  4 shows the results achieved through the implementation of the pilot project. The objectives were not reached for all indicators; however, the results improved over time.

figure 4

Figure  5 shows the to-be state of the same process analysed in Fig. 3 . From the cycle time analysis of each process step, the areas of waste eliminated are clear.

figure 5

To-be process represented by VSM

The incremental improvements in process performance over time are explained by the need for staff to learn new procedures in the early period. In addition, the patients’ resistance to changing their habits also slowed down the improvement in performance. Patients have been educated over time, through an intense communication activity based on visual management systems and telephone reminders.

In addition to the results showed in Table  2 , the pilot project had a positive impact on the performance of other patient pathways in the medical department. The cycle time variability reduction and the levelling of the service demand allowed the UMACA and the analysis laboratory to better plan their activities. The new layout reduced waste due to unnecessary movement. Nurses walk 2 km less per day and doctors 1.5 km less per day. Software integration has reduced data logging time by 35 min per day for each doctor. Patients have evaluated the change positively. In particular, they have experienced a drastic reduction in wait times, and greater attention from the medical staff. Increased privacy and a precise time of service are other improvements reported by patients.

Finally, the clinical staff was satisfied with the new procedures because they reduce overloads and allowed for better planning of activities. They say that dividing patients into time slots based on clinical priority reduces stress and simplifies the coordination of activities with other departments. The success of the project was communicated internally and externally to the organization. In June 2019 the results were celebrated with a formal team award ceremony. The resulting Report A3 was posted on the bulletin boards in the hospital wards and in the reception area. By means of an internal circular sent to all medical directors, the directorate officially thanked the members of the lean team and highlighted the excellent results achieved in terms of waiting lists and process time reduction. In addition, the directorate funded the lean team’s participation to national conferences in order for the team to discuss the project. The improvement activities and results were described and summarized in an official report sent to the regional health authority and cancer patient associations (the latter were also given an evaluation form and an invitation to observe the optimised process in the field). Reporting was carried out by the hospital directorate and the project manager.

Lean dissemination and adoption in the hospital

Following several meetings between the directors and the primary doctors of the medical area, it became clear that there was a willingness to implement further improvement projects in other medical wards. The feedback from the pilot project team was a strong convincing factor. Moreover, the results of the external communication of the pilot project played a critical role in increasing the desire for emulation. The regional authorities requested for the project team to co-design the diagnostic and therapeutic care pathways (PDTA) of the haematology patient pathway inside the regional network. The patient association lobbied for similar projects to be implemented in other clinical oncology pathways. The change of internal context and enabling factors were of great importance at this stage. The drive to disseminate lean was characterized by both the need to improve process performance and to the desire to emulate the success of the project pilot. In addition, increased trust in the lean method has prompted the directors to provide a peer internal training program in the medical area. In June 2019, members of the pilot project lean team were promoted to the position of lean champions. Their role was to disseminate the lean methodology in the medical area and to train colleagues. The hospital directorate set up the Lean Support Office and assigned to it the three non-clinical resources that had already supported the pilot project. The first methodology to spread throughout the medical department was 5S. According to the lean sponsors, this methodology was a prerequisite for implementing lean methodologies in all wards and for facilitating inter-process lean implementation. Visual management systems have been implemented to facilitate changes and standardization of activities and to guide the patient through the hospital. The 5S methodology and visual management, which was initially underestimated by the medical staff, has solved many problems in the working environment. Increasing the availability of tools, simplifying the transmission of documentation, reducing errors in medical records and nursing diaries, reducing the duplication of requests and medical documentation, creating flexible workplaces, less movement and transportation in the hospital, and increasing patient autonomy are just some of the improvements achieved. However, the most important result to be achieved was an improvement in workplace wellbeing. Among the most used tools for 5S implementation and visual management are: checklists, one point lessons, kaizen forms, horizontal and vertical marking, red tags, Kanban, spaghetti charts. Finally, the demand map was implemented to trace the patient flow across the departments of the medical area and the vertical swim lanes and the resources/process matrix were utilized to identify staff involved in several processes and the potential bottlenecks (in addition to the UMACA and the blood chemistry laboratory). As of August 2019 many other lean projects have launched sometimes spontaneously and sometimes at the demand of department heads or project managers (Fig.  6 ). In August 2019, three projects were undertaken in the medical oncology for thoracic pathology and the medical oncology wards. Two of them concerned the same clinical pathway addressed in the pilot project, and the last one was the harmonization of protocols for caring for an oncological patient between departments. Each project has been implemented following the PDCA cycle (using the A3 report framework) with the support of one of the lean champions, who was assigned the role of project manager. Teams of three doctors and one nurse were dedicated to each project. In the planning phase, the tools adopted in each project were: spaghetti charts, VSM, Gemba Walk, standardized data collection sheets (both for patients and physicians), control charts, 5 Why or alternatively the Fishbone Diagram, definition of SMART objectives. In the “Do” phase, the solutions adopted for the resolution of problems are derived from Just in Time and agile approaches (especially for software’s’ integrations management). The pilot project A3 report was used as a knowledge management tool and resulted to be of great value to guide the implementation of the three projects. The members of the pilot project team supported their colleagues during the implementation of the three projects. This resulted in a positive impact on the quality and timing of the data collection activities, the drafting of the VSM, the definition of the KPIs and especially the root cause analysis. Even though the negotiation was simplified by peer training, support from more experienced colleagues and project management by a doctor, organizational and structural barriers emerged. The difficulty in getting the new procedures accepted, the impossibility of optimizing the layouts and the “not always respecting” the authority of the project manager limited the performance improvement. Although not all potential solutions have been implemented, the results obtained are evidence of the success of the projects.

figure 6

Lean projects and dissemination activities

In September 2019 the diagnostic department started 5S and visual management implementation initiatives. In October 2019 the same initiatives were undertaken in the surgical department. These initiatives were spontaneously implemented. The managers of these departments have asked the hospital director to introduce lean in their departments. Given the maturity of the method and the number of doctors trained, hospital managers did not consider it possible to undertake systemic improvement pathways in all departments. However, they have changed the organizational structures of the departments into matrix structures. Two doctors with lean experience, per department, have been assigned the role of project manager. The project managers have sponsored peer training and Kaizen blitz activities throughout the hospital departments. In the period October to December 2019 more than 60 doctors and nurses were trained in 40-h courses by their colleagues (Fig. 6 ). Three Kaizen blitz projects in the diagnostic department and two Kaizen blitz projects in the surgical area were carried out (Fig. 6 ). In addition, a PDCA cycle project was implemented in the medical area for the stocking and tracking of drugs and instruments. Moreover, the two bin Kanban systems, drug tracking tools, optimisation of the position in the storage layout and systems for the analysis of consumption time series were implemented.

In December 2019, in all the departments discussed so far, doctors were involved in continuous improvement activities, with projects structured through the use of both PDCA cycle and Kaizen blitz. The activities were undertaken spontaneously without the supervision of a manager and without any impact on daily clinical activity. The maturity of the methodology, the support of colleagues, and trust were enabling elements. However, some barriers such as infrastructural constraints and coordination of doctors and nurses and information systems have frequently affected the implementation of the method and two projects failed.

Due to the success of implementations at the micro level, managers have attempted to implement the lean methodology at the meso level. Hospital managers discussed, formalized and communicate in organization the Lean Strategic Plan. In January 2020, the Lean Support Office was transformed into a lean projects control room and renamed as the Operations Management Office. The role of this office is to define lean development policies and to supervise continuous improvement activities. The office has been placed in line with the strategic direction. Two lean project managers, two hospital managers, and three administrative officers have been assigned to it. Lean assessment, to evaluate the degree of lean maturity in organization, and Honshi Kanri, to strategically govern change activities, were implemented to the organizational level. While the lean assessment revealed an increase in both advance in the use of lean tools and the principles behind them, the governance of strategic implementation through Honshi Kanri did not seem to provide the foreseen results. Operations management office project managers did not always agree with hospital directorate on project prioritization. In addition, there often were disagreements between the Operations Management Office staff and departmental project managers about when to launch a project and how to manage it and communicate project results. Although there were many process improvement projects underway, these have not always been decided harmoniously between the Operation Management Office and the hospital departments. Moreover, many projects undertaken spontaneously by lean teams were not communicated to the Operations Management Office, which was therefore unable to govern the dissemination of the method. Medical leadership in departments seemed to dominate over managerial leadership; thus, there is great difficulty in strategically governing continuous improvement.

The marked differences in the responses to the closed questions of the questionnaires submitted provide significant evidence of how lean has spread throughout the organization (Fig.  7 ).

figure 7

Responses to the closed questions of the questionnaire

The marked differences in the responses to the closed questions of the questionnaires presented provide significant evidence of how lean has spread throughout the organization. In particular, the results show how standardisation, self-assessment, time for improvement and peer-to-peer training have become part of everyday working practice. Furthermore, problem solving and collaborative decision-making show significant improvements. These improvements were witnessed not only by management but also by doctors, nurses and technical staff in the medical area.

After the pilot project and the initial push for implementation by management, internal contextual factors changed radically within the organization. While initially sponsorship and management involvement were necessary for lean implementation, today the methodology is independently disseminated. In particular, small improvement groups have emerged that are able to address various challenges. Process vision and patient focus have become part of the hospital culture. Doctors claim that continuous improvements simplify daily work, save time, and increase the level of service and the number of services provided. However, although these changes occurred at the micro level, the organization failed to direct change at the strategic level. Thus, harmonization of lean projects according to the strategic direction of the facility has yet to be achieved.

In accordance with the findings of many researchers [ 10 , 16 ], this case study showed how a careful, context-driven lean introduction strategy facilitated the dissemination of lean - at micro level - within the hospital. The decision to implement lean was precipitated by external factors, including the need to improve the performance of processes in the medical area and to follow the example of other successful hospitals. The in-depth training by an external specialist and the pilot project, characterized by interdepartmental activities, the need for a systemic approach based on the Deming Cycle and the constant support of the external consultant, allowed the participants to acquire the necessary skills to support - sufficiently - the lean implementation in the clinical pathways of the medical department and to train their colleagues. The results of this project have been manifold. At the process level, there was a significant reduction in the patients’ length of stay, the wait times for haematological patients, the process time variability, and an increase in the number of daily chemotherapy therapies performed. At the medical area level, a spontaneous spread of the culture of improvement has emerged. Directorate commitment, motivation of the medical department staff and management, and the presence of a consultant were the main enabling factors for the success of the pilot project. In turn, the results of the pilot project were the trigger for the spread of lean in the hospital. The pilot project itself, and the changes made to standard procedures that were inspired by the intervention, altered the contextual elements, mirroring the MUSIQ model [ 18 , 26 , 36 ]. Moreover, as trust and maturity raised, the speed of lean dissemination increased. This confirms that knowledge of the lean method tends to reduce organizational barriers and resistance [ 5 , 21 , 51 , 52 ]. Kata training and coaching were other key elements for the dissemination of the methodology. Initially, the consultant carried out the training activity, and after the pilot project, the team members became trainers and project managers; in this way, lean spread in the organization spontaneously. Moreover, as stated by many researchers [ 12 , 21 , 46 ], the matrix structure and project managers helped the staff to support and better coordinate process improvement. The many projects activated in the period July 2019–March 2020 are the measure of the diffusion itself.

However, some issues have arisen. For the new working procedures, the willingness of and the acceptance by the staff is crucial to achieving and sustaining the results of lean initiatives; where this did not occur, conflicts arose and the speed of change slowed. In addition, although in the early stages of implementation the bottom-up approach must prevail over a top-down approach to facilitate consensus and trust among physicians, nurses, and all workers, during the dissemination phase a greater equilibrium between the two decision-making approaches must be achieved. In accordance with [ 2 , 5 , 10 ], this case study demonstrates the importance of the right balance between bottom-up and top-down approaches. Medical leadership tends to dominate managerial leadership such that continuous improvement, even though it takes place in clinical processes, does not follow the strategic organizational guidelines. This leads to conflicts between managers and medical staff. Organizational, technical and infrastructural obstacles have hindered the adoption of the methodology. It is clear from what has been found that the introduction strategy was correct, but that the implementation at the strategic level has not yet taken place. The context has changed considerably from an organizational point of view, but some barriers have not been overcome. The management, which strongly sponsored and supported the introduction and implementation of lean, was subsequently unable to guide the implementation at the strategic level.

Our adaptation to the MUSIQ model is useful for interpreting the relationship between lean introduction strategies and changing contextual elements. Looking backward through this model allows us to understand the links between contextual elements, lean implementation and outcomes.

Conclusions

This study revealed that the strategy of introducing lean has improved readiness, sustainability and confidence in the method within the organization. The growing maturity of the organization has encouraged lean dissemination. However, the choice of strategy depends heavily on contextual factors. The two factors, therefore, influence each other. Although the introduction strategy may facilitate the introduction of lean, it may be less important when certain organizational, technical and infrastructural barriers remain. This is particularly relevant for systemic implementation. Contextual elements, which changed over time, influenced the success of the implementation at micro-level. At the meso-level, however, the organization has not reached the maturity for a systemic implementation of the method.

As has already been shown in the literature, the determining factors for introducing the methodology refer to external and internal pressures. The level of commitment of both the leadership and management are decisive for the success of the implementation only if the staff is motivated. Furthermore, the analysis shows that managing lean implementation at the micro and meso-levels requires different types of efforts. While the level of maturity speeds up the adoption of lean at the clinical level, it is not true that the dissemination of lean at the operational level inevitably translates into its application at the strategic level. Medical leadership, reinforced by the success of lean project implementations, could instead undermine proper implementation at the meso-level. This experience strengthens the MUSIQ model and complements it by showing the importance of the lean introduction strategy and its impact on contextual factors.

Limitations and future research

The main limitations concern the complexity of detecting and analysing all the relevant social and organizational aspects that have characterized the introduction and dissemination phases and the observation period of the dissemination phase. Moreover, the expert content analysis could introduce opportunities for misinterpretation of the data. The relationship between the contextual elements and the pilot project results were mainly assessed through participant and patient reports, document studies, and observations. The authors used data triangulation and a review of hospital staff to overcome the limits of the content analysis. Given the specificity of the hospital’s contextual factors and strategic choices, it is also clear that the case study cannot be generalized.

The sustainability aspect of lean was not considered because the observational study was conducted over a period of only 2 years. To understand this issue, the authors will investigate the socio-technical aspects of lean and how the context supports continuous improvement over time.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

Hospital Setting

Information Technology

Length of stay

Number of chemotherapies per chemo chair

Methods-Time Measurement

Model for Understanding Success in Quality

Organization of European Cancer Institutes

Patients undergoing chemotherapeutic infusion within three hours of hospital admission

Plan-Do-Check-Act

Antiblastic Chemotherapy Handling Unit

Value Stream Mapping

Godman B, Novakovic T, Tesic D, Oortwijn W, Martin AP, Parker M, et al. Addressing challenges for sustainable healthcare in central and Eastern Europe. Exp Rev Pharmacoecon Outcomes Res. 2016;16(6):685–7. https://doi.org/10.1586/14737167.2016.1165610 Epub 2016 Mar 30. PMID: 26966924 .

Article   Google Scholar  

Teisberg E, Wallace S, O’Hara S. Defining and implementing value-based health care: A strategic framework. Acad Med. 2020;95(5):682–5. https://doi.org/10.1097/ACM.0000000000003122 PMID: 31833857; PMCID: PMC7185050.

Article   PubMed   Google Scholar  

Lum B, Png HM, Yap HL, Tan C, Sun B, Law YH. Streamlining workflows and redesigning job roles in the theatre sterile surgical unit. MJ Open Qual. 2019;8(3):e000583. https://doi.org/10.1136/bmjoq-2018-000583 .

Radnor Z, Holweg M, Waring J. Lean in healthcare: the unfilled promise? Soc Sci Med. 2012;74(3):364–71. https://doi.org/10.1016/j.socscimed.2011.02.011 .

Curatolo N, Lamouri S, Huet J, Rieutord A. A critical analysis of lean approach structuring in hospitals. Bus Process Manag J. 2014;20(3):433–54. https://doi.org/10.1108/BPMJ-04-2013-0051 .

Roemeling O, Land M, Ahaus K. Does lean cure variability in health care? Int J Oper Prod. 2017;37(9):1229–45. https://doi.org/10.1108/IJOPM-07-2015-0452 .

Chiarini A, Bracci E. Implementing lean six sigma in healthcare: issues from Italy. Public Money Manag. 2013;33(5):361–8. https://doi.org/10.1080/09540962.2013.817126 .

Parkhi SS. Lean management practices in healthcare sector: a literature review. Benchmarking. 2019;26(4):1275–89. https://doi.org/10.1108/BIJ-06-2018-0166 .

Joosten T, Bongers I, Janssen R. Application of lean thinking to health care: issues and observations. Int J Qual Health Care. 2009;21(5):341–7. https://doi.org/10.1093/intqhc/mzp036 .

Article   PubMed   PubMed Central   Google Scholar  

Womack JP, Jones DT. Lean consumption. Harv Bus Rev. 2005;83(3):58–68 148. PMID: 15768676 .

PubMed   Google Scholar  

Spear SJ. Fixing health care from the inside, today. Harv Bus Rev. 2005;83(9):78–91 158. PMID: 16171213 .

D’Andreamatteo A, Iannia L, Lega F, Sargiacomo M. Lean in healthcare: a comprehensive review. Health Policy. 2015;119(9):1197–209. https://doi.org/10.1016/j.healthpol.2015.02.002 .

Mazzocato P, Holden RJ, Brommels M, Aronsson H, Bäckman U, Elg M, et al. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren children’s hospital, Stockholm, Sweden. BMC Health Serv Res. 2012;12(28). https://doi.org/10.1186/1472-6963-12-28 .

Andersen H, Røvik KA. Lost in translation: a case-study of the travel of lean thinking in a hospital. BMC Health Serv Res. 2015;15(401). https://doi.org/10.1186/s12913-015-1081-z .

Goodridge D, Westhorp G, Rotter T, Dobson R, Bath B. Lean and leadership practices: development of an initial realist program theory. BMC Health Serv Res. 2015;15(1):362. https://doi.org/10.1186/s12913-015-1030-x .

Brandao de Souza L. Trends and approaches in lean healthcare. Leadersh Health Serv. 2009;22(2):121–39. https://doi.org/10.1108/17511870910953788 .

Ulhassan W, von Thiele SU, Thor J, Westerlund H. Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study. BMC Health Serv Res. 2014;14(1):480. https://doi.org/10.1186/1472-6963-14-480 .

Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q. 2010;88(4):500–59. https://doi.org/10.1111/j.1468-0009.2010.00611.x .

Nelson-Peterson DL, Leppa CJ. Creating an environment for caring using lean principles of the Virginia Mason production system. J Nurs Adm. 2007;37(6):287–94. https://doi.org/10.1097/01.NNA.0000277717.34134.a9 .

Mazzocato P, Savage C, Brommels M, Aronsson H, Thor J. Lean thinking in healthcare: a realist review of the literature. Qual Saf Health Care. 2010;19(5):376–82. https://doi.org/10.1136/qshc.2009.037986 Epub 2010 Aug 19. PMID: 20724397 .

Brandao De Souza L, Pidd M. Exploring the barriers to lean health care implementation. Public Money Manag. 2011;31(1):59–66. https://doi.org/10.1080/09540962.2011.545548 .

Kaplan GS, Patterson SH, Ching JM, Blackmore CC. Why lean doesn’t work for everyone. BMJ Qual Saf. 2014;23(12):970–3. https://doi.org/10.1136/bmjqs-2014-003248 Epub 2014 Jul 23.

Al-Balushi S, Sohal AS, Singh PJ, Al Hajri A, Al Farsi YM, Al AR. Readiness factors for lean implementation in healthcare settings--a literature review. J Health Organ Manag. 2014;28(2):135–53. https://doi.org/10.1108/JHOM-04-2013-0083 .

Article   CAS   PubMed   Google Scholar  

Henrique DB, Filho MG. A systematic literature review of empirical research in lean and six sigma in healthcare. Total Qual Manag Bus Excell. 2020;31(3–4):429–49. https://doi.org/10.1080/14783363.2018.1429259 .

Coles E, Wells M, Maxwell M, Harris FM, Anderson J, Gray NM, et al. The influence of contextual factors on healthcare quality improvement initiatives: what works, for whom and in what setting? Syst Rev. 2017;6(1):168. https://doi.org/10.1186/s13643-017-0566-8 .

Kaplan HC, Froehle CM, Cassedy A, Provost LP, Margolis PA. An exploratory analysis of the model for understanding success in quality. Health Care Manag Rev. 2013;38(4):325–38. https://doi.org/10.1097/HMR.0b013e3182689772 .

Tay HL, Singh PJ, Bhakoo V, Al-Balushi S. Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects. Oper Manag Res. 2017;10(3–4):118–36. https://doi.org/10.1007/s12063-017-0126-3 .

Hussain M, Malik M. Prioritizing lean management practices in public and private hospitals. J Health Organ Manag. 2016;30(3):457–74. https://doi.org/10.1108/JHOM-08-2014-0135 PMID: 27119397 .

Fournier PL, Jobin MH. Understanding before implementing: the context of lean in public healthcare organizations. Public Money Manag. 2017;38(1):37–44. https://doi.org/10.1080/09540962.2018.1389505 .

Chiarini A. Risk management and cost reduction of cancer drugs using lean six sigma tools. Leadersh Health Serv. 2012;25(4):318–30. https://doi.org/10.1108/17511871211268982 .

Gonzalez ME. Improving customer satisfaction of a healthcare facility: reading the customers’ needs. Benchmarking. 2019;26(3):854–70. https://doi.org/10.1108/BIJ-01-2017-0007 .

Terra JDR, Berssaneti FT. Application of lean healthcare in hospital services: a review of the literature (2007 to 2017). Prod. 2018;28(0):e20180009. https://doi.org/10.1590/0103-6513.20180009 .

Augusto BP, Tortorella GL. Literature review on lean healthcare implementation: assessment methods and practices. Int J Serv Oper Manag. 2019;32(3):285–306. https://doi.org/10.1504/IJSOM.2019.10019746 .

Fournier PL, Jobin MH. Medical commitment to lean: an inductive model development. Leadersh Health Serv. 2018;31(3):326–42. https://doi.org/10.1108/LHS-02-2018-0015 Epub 2018 Jul 3. PMID: 30016920 .

Improta G, Romano M, Di Cicco MV, Ferrero A, Borrelli A, Verdolina C, et al. Lean thinking to improve emergency department throughput at AORN Cardarelli hospital. BMC Health Serv Res. 2018;18(1):265–78. https://doi.org/10.1186/s12913-018-3654-0 .

Kaplan HC, Provost LP, Froehle CM, Margolis PA. The model for understanding success in quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf. 2012;21(1):13–20. https://doi.org/10.1136/bmjqs-2011-000010 .

Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, et al. The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews. BMC Health Serv Res. 2015;15:277. https://doi.org/10.1186/s12913-015-0906-0 PMID: 26199147; PMCID: PMC4508989.

Hasle P, Bojesen A, Jensen PL, Bramming P. Lean and the working environment: a review of the literature. Int J Oper Prod. 2012;32(7):829–49. https://doi.org/10.1108/01443571211250103 .

Hasle P, Nielsen PA, Edwards K. Application of lean manufacturing in hospitals- the need to consider maturity, complexity, and the value concept. Hum Factors Ergon Manuf. 2016;26(4):430–42. https://doi.org/10.1002/hfm.20668 .

Narayanamurthy G, Gurumurthy A, Subramanian N, Moser R. Assessing the readiness to implement lean in healthcare institutions – a case study. Int J Prod Econ. 2018;197:123–42. https://doi.org/10.1016/j.ijpe.2017.12.028 .

Bijl A, Ahaus K, Ruël G, Gemmel P, Meijboom B. Role of lean leadership in the lean maturity - second-order problem-solving relationship: a mixed methods study. BMJ Open. 2019;9(6):e026737. https://doi.org/10.1136/bmjopen-2018-026737 .

Waring JJ, Bishop S. Lean healthcare: rhetoric, ritual and resistance. Soc Sci Med. 2010;71(7):1332–40. https://doi.org/10.1016/j.socscimed.2010.06.028 .

Arumugam V, Antony J, Kumar M. Linking learning and knowledge creation to project success in six sigma projects: an empirical investigation. Int J Prod Econ. 2013;141(1):388–402. https://doi.org/10.1016/j.ijpe.2012.09.003 .

Wilson WJ, Jayamaha N, Frater G. The effect of contextual factors on quality improvement success in a lean-driven New Zealand healthcare environment. Int J Lean Six Sigma. 2018;9(2):199–220. https://doi.org/10.1108/IJLSS-03-2017-0022 .

Gonzalez-Aleu F, Van Aken EM, Cross J, Glover WJ. Continuous improvement project within kaizen: critical success factors in hospitals. TQM J. 2018;30(8):335–55. https://doi.org/10.1108/TQM-12-2017-0175 .

Stanton P, Gough R, Ballardie R, Bertram T, Bamber GJ, Sohal A. Implementing lean management/six sigma in hospitals: beyond empowerment or work intensification? Int J Hum Res Manag. 2014;25(21):2926–40. https://doi.org/10.1080/09585192.2014.963138 .

McIntosh B, Sheppy B, Cohen I. Illusion or delusion--lean management in the health sector. Int J Health Care Qual Assur. 2014;27(6):482–92. https://doi.org/10.1108/IJHCQA-03-2013-0028 .

Jimmerson C, Weber D, Sobek DK 2nd. Reducing waste and errors: piloting lean principles at Intermountain Healthcare. Jt Comm J Qual Patient Saf. 2005;31(5):249–57. https://doi.org/10.1016/s1553-7250(05)31032-4 .

Drotz E, Poksinska B. Lean in healthcare from employees' perspectives. J Health Organ Manag. 2014;28(2):177–95. https://doi.org/10.1108/JHOM-03-2013-0066 .

Morgan SJ, Pullon SRH, Macdonald LM, McKinlay EM, Gray BV. Case study observational research: a framework for conducting case study research where observation data are the focus. Qual Health Res. 2017;27(7):1060–8. https://doi.org/10.1177/1049732316649160 Epub 2016 May 22. PMID: 27217290 .

van Rossum L, Aij KH, Simons FE, van der Eng N, Ten Have WD. Lean healthcare from a change management perspective. J Health Organ Manag. 2016;30(3):475–93. https://doi.org/10.1108/JHOM-06-2014-0090 .

Savage C, Parke L, von Knorring M, Mazzocato P. Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement. BMC Health Serv Res. 2016;16(588). https://doi.org/10.1186/s12913-016-1838-z .

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy

Angelo Rosa, Giuliano Marolla & Francesco Manfredi

Center in Health Administration, and Center for Applied Health Economics and Management of IRCCS Galeazzi, University of Milan, Via Giacomo Venezian, 1, 20133, Milan, Italy

Federico Lega

You can also search for this author in PubMed   Google Scholar

Contributions

All authors discussed the results and contributed to the final manuscript. GM conceived and designed the analysis, AR contributed data and analysis tools, FL and FM suggested the background reference model. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Giuliano Marolla .

Ethics declarations

Ethics approval and consent to participate.

Research project sheet describing the study purpose and procedures was provided and approved by Hospital Directorate. Hospital management informed potential participants and hospital staff about the study at its launch and before the interviews and questionnaires administration. It was disclosed that participation was voluntary and that voluntary participation in the study involved consent for publication. Fully informed verbal consent to participate was obtained from all participants prior to inclusion in the study. Anonymity was guaranteed as requested by the participants. The study was submitted to and approved by the LUM University Ethics Committee.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Rosa, A., Marolla, G., Lega, F. et al. Lean adoption in hospitals: the role of contextual factors and introduction strategy. BMC Health Serv Res 21 , 889 (2021). https://doi.org/10.1186/s12913-021-06885-4

Download citation

Received : 30 October 2020

Accepted : 09 August 2021

Published : 28 August 2021

DOI : https://doi.org/10.1186/s12913-021-06885-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Lean implementation
  • Contextual factors
  • Introduction strategy

BMC Health Services Research

ISSN: 1472-6963

lean management case study with solution

You are using an outdated browser. Please upgrade your browser .

  • Stay up to date with TXM

TXM Lean Solutions

  • TXM Attending Australasian Processing & Packaging Expo 2024
  • Manufacturing
  • Supply Chain and Distribution
  • Small + Medium Enterprise
  • Food and Agribusiness
  • Private Equity and Fund Managers
  • Lean Manufacturing
  • Facility Layout
  • Continuous Improvement
  • Operational Excellence
  • Industry 4.0
  • Lean Leadership
  • Supply Chain Management
  • Problem Solving
  • Practical 5S
  • Accelerated Productivity Programme
  • Lean Methodology
  • Lean Articles
  • Case Studies
  • TXM Consulting FAQs
  • TXM Training FAQs
  • TXM Training
  • TXM Television
  • New Zealand
  • Lean Supply Chain Case Studies
  • Automotive & Recreational Vehicles
  • Chemicals & Coatings
  • Modular Buildings
  • Defence & Aerospace
  • Food & Beverage
  • Health Care
  • High Tech Manufacturing
  • Industrial Products
  • Manufacturing Packaging Case Studies
  • Metal Processing
  • Pharmaceuticals
  • Private Equity
  • Service Industry Case Studies
  • Supply Chain Distribution Case Studies
  • Textiles Garments & Homewares
  • Tools & Hardware
  • 5S Case Studies
  • Lean Facility Layout Case Studies
  • Lean Leadership Case Studies
  • Lean Maintenance
  • Lean Management
  • Lean Manufacturing Case Studies
  • Lean Office
  • Lean Problem Solving Case Studies
  • Visual Management Case Studies
  • Australian Case Studies In Lean Solutions
  • Canada Lean Manufacturing Case Studies
  • China Lean Manufacturing Case Studies
  • European Lean Manufacturing Case Studies
  • UK Case Studies
  • Case Study Videos

TXM Lean Case Study – Houston’s Farms the Lean Agribusiness

TXM pioneered the application of Lean manufacturing concepts to the end-to-end process of fresh vegetable production from...

TXM Lean Case Study – Ivyline

Established in 1976 Ivyline have become the trusted partner for retailers. Ivyline are based in Coventry, UK and import and...

TXM Lean Case Study – Hazchem Safety

Hazchem Safety in Brackley are the UK's leading supplier of safety clothing and equipment for the transport and handling...

TXM Lean Case Study – Improving Supply Chain Performance in Paint Manufacturing

TXM was tasked with reducing inventory and increase on-time in full delivery by improving supply chain management and implementing...

TXM Lean Case Study – Production Outsourcing Project Management

The Challenge Our client was a major global high technology manufacturer. Their operation was highly vertically integrated...

TXM Lean Case Study – Regional Lean Supply Chain Development

The Challenge Our client’s plant in China produces a limited range of products in high volumes for the Chinese market....

TXM Lean Case Study – Lean Supplier Development

The Challenge Our client is a leading supplier of everyday brands in Oceania, with products ranging from footwear, home wear,...

Henry Technologies: the Lean Warehouse

How do you implement Lean in a Warehouse? This case study video explains how Lean warehouse processes were implemented at...

All manufacturing businesses are experiencing ferocious global competition as activities continue to go online. Most companies now turn to lean supply chain management to cut costs and have a competitive advantage. The process is seamless, and with a reliable partner, you can achieve all your business goals.

Lean Manufacturing Supply Chain Examples

At  TXM’s lean consulting firms , we let our results speak for us. Over the years, we have been at the forefront of helping businesses achieve top-rated lean manufacturing services they need to succeed with the stiff online completion. The various  TXM case studies  show our clients’ success rates over the period we worked together to boost operations and leverage competition.

For example, the TXM lean case study for the client  Holleys Fine Foods helped reduce the disruption caused by the COPVID-19 pandemic that forced the company to make rapid changes to stay in business. Our UK Lean Consultant Lee Candy  helped find the right ways to boost productivity and match the increase in demand within a short period.

Importance of Lean Supply Chain Management

Lean supply chain management helps promote operational efficiency by eliminating unwanted components of a process. Most of these processes apply to manufacturing, where customers order supplies then pay directly to the company without holding a lot of inventory.

The top characteristics evident in most lean supply chain case studies are:

  • Inventory optimization
  • Rapid fulfillment
  • Sustainability
  • Customization
  • Compliance and visibility

Every business must scrutinize its operations within the supply chain and isolate areas that could lead to waste of resources. The waste is measured in time, raw materials, and money. As a result, the business will boost its competitiveness and increase profits.

TXMs lean supply chain case studies offer a glimpse of results and  lean supply chain solutions  you will get by working with a reliable consulting firm. Did you know that TXM is also present in the United Kingdom? Visit  https://txm.com/uk/  for more information.

IMAGES

  1. lean methodology case study

    lean management case study with solution

  2. lean management case study with solution

    lean management case study with solution

  3. (PDF) Case Study: The Methodology of Lean Manufacturing Implementation

    lean management case study with solution

  4. Lean Case Studies

    lean management case study with solution

  5. Case Study, Lean Initiative Drives Increased Manufacturing Capacity

    lean management case study with solution

  6. Lean Project Management

    lean management case study with solution

VIDEO

  1. Lean Management

  2. Principles Of Management

  3. Lean Management Project Case Studies

  4. Strategic Management Case Study

  5. Lean management / Lean production

  6. Lean Start-Up Methodology

COMMENTS

  1. Lean Management Case Studies Library

    The following case studies of lean management principles in action show you how a variety of real businesses solved real business problems under diverse conditions. We've arranged the stories in 16 categories to help you find the examples you need. There is some overlap. For instance, a "Lean Manufacturing" case study may also appear with ...

  2. Lean Management Lean Manufacturing Case Studies

    Lean Management Case Studies. A business without the proper management strategies is doomed to fail. You need solutions that will help you handle and manage employees, raw materials, time, customer demands, and waste in a way that maximises productivity, efficiency, and your bottom line.

  3. Lean Manufacturing Case Studies

    Lean Manufacturing Case Studies - How TXM has Helped Companies Improve Efficiency. If you want ways to lower your production costs without compromising quality, the TXM Lean manufacturing consulting services offer a path to success. The TXM team understands the details of industrial engineering and how they relate to lean manufacturing.

  4. Lean Problem Solving Case Studies

    This article will discuss the TXM learning case study that we helped solve their processes. Our preliminary plan is to apply problem-solving approaches that reduces lead-time and waste. Moreover, our work ensures that our clients produce products according to customers' demand. We also help our clients to generate a fast flow of products that ...

  5. Improvement of Manufacturing Operations through a Lean Management

    In the case study, a Lean Management approach was pursued through the re-engineering of the production flow and the implementation of a pull-based system. Results from the case study show that it was a successful choice: efficiency KPIs, Works in Process, Cycle Time, etc. were dramatically improved.

  6. PDF Case Study: Performance Management and Lean Process Improvement

    Case Study: Performance Management and Lean Process Improvement — Results Washington An Operational Excellence in Government Success Story Case Study: Performance Management and Lean Process Improvement — Results Washington ... Jessica Engelman, and Project Manager of Data-Smart City Solutions Katherine Hillen-brand . This report is an ...

  7. Toyota's Lean Management Program Explained (with Real Life Examples)

    Toyota Lean Management Case Study. I worked with a hard cider manufacturer in upstate NY. The company was approaching its busy season and trying to build up its inventory to supply its distributor. ... Go and See — when a problem arises, the best way to find a solution is to observe the problem. EXAMPLE #1: At the forklift factory, units ...

  8. The Influence of Lean Management Practices on Process Effectiveness: A

    The Lean management philosophy and the ... argues that process management combined with lean management has provided companies with effective solutions and results ... Reilly S. J., Healy J., Murphy T., Ó'Dubhghaill R. (2019). Lean six sigma in higher education institutes: An Irish case study. International Journal of Lean Six Sigma, 10(4 ...

  9. Lean Manufacturing Case Studies per Lean Solution

    Read and Watch Lean Manufacturing Case Studies per Lean Solution provided by our experienced Lean Consultants and learn more with TXM Lean Solutions. P: +1 860 281 7332 ... TXM Lean Case Study - Daily Management in Mining. Daily Management in Mining Management in mining is a hard task to accomplish well. Being able to coordinate a mining ...

  10. Implementing Lean: A Case Study

    Solutions for: Business Higher ... Preview. Implementing Lean: A Case Study With Gemba Academy Liked by 380 users. Duration: 1h 11m Skill level ... Lean Inventory Management 1h 10m.

  11. Lean Management Implementation in Small and Medium Sized Companies ­- A

    Recommendations: For some of the solutions an impact study with their implementation was made. An analysis of the success factors proposed in the literature that were verified during the assessment stage of the case study was performed as well. Key words: Lean Management, SME, OEE, Lean Implementation Plan, Production Planning JEL codes: L11 ...

  12. Amazon Lean Management: The Six Sigma Case Study in 2024 [Updated]

    In Lean Six Sigma, Andon is considered as the visual management system which enables smooth operation by eliminating all or any bottleneck. Andon cord is a Japanese word for traditional paper lantern. An Andon system is one of the principle elements of 'Jidoka' - 'empowering the employees'. Andon system -.

  13. Lean Facility Management 4.0: A Case Study

    The purpose of this article is to present a case study on the application of the Lean Management as a quality improvement methodology with Industry 4.0 technology solutions for a company in the ...

  14. A Lean Approach for Reducing Downtimes in Healthcare: A Case Study

    Coherently with the aim of the research is to demonstrate a successful implementation of Lean tools in the healthcare sector for improving operational performance, a case study will be presented. The methodology used here is the single case study [ 20 ], considered the most appropriate one to address the starting research objective.

  15. Case Study: Performance Management and Lean Process Improvement

    This case study describes how the state of Washington implemented two key operational efficiency strategies for government — performance management and employee-driven process improvement. The effort, called Results Washington, sets priorities and then focuses on delivery to achieve results that make a difference in the lives of Washingtonians.

  16. SCM Case Studies With Examples & Solutions

    Source MSM Solutions June 7, 2021. Supply Chain Management (SCM) Computerized Maintenance Management System. Enterprise Resource Planning (ERP) RFID Software. Case Study: Aegis Laboratory. Aegis Sciences Corporation is a Nashville-based full-service forensic toxicology and healthcare sciences laboratory. Their customers range from major sports ...

  17. 5S Case Studies Lean Manufacturing

    With TXM Lean Solutions, you can streamline your business, minimise waste while maximising production, reduce lead time and inventory, standardise processes, and generally improve the work environment. For over 400 years, we've been successfully delivering problem and business-specific lean solutions to our customers across the United Kingdom ...

  18. Case Studies: Our Success Stories

    Since its foundation in 2019, Lean Tech has become a true technology partner with customers in the logistics sector. Our expertise enables us to understand our customer's specific needs and provide unique talent to grow their software development teams. Learn how Lean Solutions Group faced different challenges and provided the best solution ...

  19. Lean Leadership Case Studies

    Read and Watch Lean Leadership Case Studies provided by our experienced Lean Consultants and learn more with TXM Lean Solutions. P: +1 860 281 7332 ... to a new site. Housekeeping, employee engagement, waste and defects management were all poor. With TXM's 5S and Lean Daily Management, Ferguson Plarre Bakehouses was able to transform most of ...

  20. Lean adoption in hospitals: the role of contextual factors and

    Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and ...

  21. Lean Supply Chain Case Studies

    The various TXM case studies show our clients' success rates over the period we worked together to boost operations and leverage competition. For example, the TXM lean case study for the client Holleys Fine Foods helped reduce the disruption caused by the COPVID-19 pandemic that forced the company to make rapid changes to stay in business.