LEAN SYSTEM IMPLEMENTATION IN HEALTHCARE SERVICES

1.0

RESEARCH BACKGROUND
Lean originally was a production system known as TPS (stands for Toyota Production

System) coined for the benefit of manufacturing sector. It was founded by Taichi no (1988) to
help Toyota Motor survive the environment with limited resources post World War II by
optimizing production system through elimination of waste. This system also prove its success in
sustaining Toyota Motors prosperity during global oil crisis in 1973 (Chen, 2006). Nowadays,
lean has become more than just a production system, it has expanded into a philosophy or some
express it as a thinking (Figure 1). As this system expand into thinking, it seems that lean not
only limited for manufacturing and production purpose but also applicable in service sectors
such as municipal (Jonsson, Andersson, Stentoft Arlbjrn, Vagn Freytag, & de Haas, 2011) and
now trending in healthcare services (Brandao de Souza, 2009).

2.0

RESEARCH MOTIVATION
As seen in Figure 1, studies on lean healthcare only started around year 2002, which

means there must be quite much research gaps left to be filled in as the contribution within this
research area. Several review papers were published by different researchers (Brandao de Souza,
2009; Curatolo, Lamouri, Huet, & Rieutord, 2014; Mazzocato, Savage, Brommels, Aronsson, &

Thor, 2010) related to lean healthcare but none local (Malaysia) work was cited in this paper.
Besides, from author personal search, there are only 6 local publications found using key phrases
lean hospital Malaysia and lean healthcare Malaysia through Google Scholar database (Table 2).
All these publications all dated not earlier than year 2011.
Table 2: Local publications related to lean healthcare
Authors
Ir M et al. (2011)

Survey
Average waiting time
Patient satisfaction level
Factors of waiting time

Kalong and Yusof (2012)

Non-survey

Healthcare Information
System
Waste Identification based on
7 Muda (Ono Model)

Shazali,

Habidin,

Khaidir,

and

Ali, SEM: Relationship of lean

Jamaludin healthcare practices and

(2013)
healthcare performance
Norazlan, Habidin, Roslan, SEM: Relationship of kaizen
and Zainudin (2014)
Habidin,
Khaidir,
(2014)

Shazali,
and

blitz and sustainable

performance
Ali, SEM: Relationship between

Jamaludin lean healthcare practices and

supply chain innovation
performance

This search results have strengthen the fact that studies in lean healthcare within local scope
started not before 5 years ago and prove the authors assumption; there are much gaps left within
this research area especially for local context.
Unlike lean manufacturing, lean healthcare can be regarded as something new in
Malaysia and publications related to this research interest are still few. Due to the lack of
research on it within local scope, author believe that healthcare service provider might not yet
aware of lean system application for healthcare service. As far as author concern and notice,
none local hospital or healthcare service provider have declared they are practicing lean system
inside their facilities like in UK and US. Then, how can researchers find the relationship between

lean and performance (as in Table 2) if the healthcare service providers do not even aware of and
implement this system? Therefore it is appropriate to identify and confirm whether healthcare
service providers already aware of lean healthcare or not. If they are well aware about it, do they
have implemented lean system inside their facilities or not? If they not yet implement it, do they
ready to begin the implementation?
3.0

RESEARCH PURPOSE
The purpose of this research is to investigate whether healthcare service providers aware

of lean healthcare or not. From their awareness, it is interesting to find that if they already have
implement the system (unintentionally or on purpose) as well as discover to what extent their
implementation is (none, partial or extensive). From the implementation status and level,
researcher can extract readiness factors towards the implementation.

On the same time,

researcher intended to propose lean practices which might be appropriate and relevant to be
implemented in healthcare service facilities. The following are specific research questions, RQs
and research objectives, ROs for this study.
RQ1: Do local (Malaysian) healthcare service providers aware of lean healthcare system?
RO1: To investigate the awareness of lean healthcare system among local (Malaysian)
healthcare service providers.
RQ2: What are the status of lean healthcare system implementation by local (Malaysian)
healthcare service providers?
RO2: To determine the status of lean healthcare system implementation by local (Malaysian)
healthcare service providers.
RQ3: What are the readiness factors which influent lean healthcare system implementation?
RO3: To identify readiness factors which influent lean healthcare system implementation.
RQ4: What are the relevant lean practices to be implemented in healthcare service facilities?
RO4: To propose appropriate lean practices to be implemented in healthcare service facilities.

4.0

LITERATURE REVIEW

4.1

Lean Healthcare in Malaysia

Brandao de Souza (2009) made a review on trends and approaches in lean healthcare research.
They had reported 90 publications in this review but none were focusing on Malaysian scope.
A study from de Souza (2009) evidenced that most of the Lean initiatives in healthcare
have occurred in the US (57 percent) or in the UK (29 percent).
211 articles (Curatolo et al., 2014)
Lean Awareness
From Table 2, it seems most of local studies focused on the use of structure equation model
(SEM) to determine the relationship between factors and effect; in particular lean healthcare and
performance. As far as author concern and notice, none hospital or healthcare service provider
have declared they are practicing lean system inside their facilities. Then, how can researchers
find the relationship between lean and performance if lean system is not yet be practiced in the
healthcare facilities? That is why it is wise and appropriate to identify and confirm whether a
healthcare service provider already have implemented lean or not. In more positive assumptions,
they do implement lean system, but it might be indirectly (unintentional).
Readiness for lean in healthcare - views from the executive
Assessing Lean Deployment in HealthcareA Critical Review and Framework
Lean Implementation in Healthcare - the Challenged Transformation

(Burgess & Radnor, 2013) evaluated lean in English healthcare industry using annual reports and
websites.

Compare implementation of lean between two period 2007/2008 and 2009/2010

(Abdelhadi, 2015) takt time, 2 emergency room; male and female. Imbalance
(Abdelhadi & Shakoor, 2014) takt time, 2 pharmacies; outpatient and inpatient
Abdelhadi, A. (2015). Investigating emergency room service quality using lean manufacturing.
International journal of health care quality assurance, 28(5), 510-519.
Abdelhadi, A., & Shakoor, M. (2014). Studying the efficiency of inpatient and outpatient
pharmacies using lean manufacturing. Leadership in Health Services, 27(3), 255-267.
Brandao de Souza, L. (2009). Trends and approaches in lean healthcare. Leadership in Health
Services, 22(2), 121-139.
Burgess, N., & Radnor, Z. (2013). Evaluating Lean in healthcare. International journal of health
care quality assurance, 26(3), 220-235.
Chen, F. F. (2006). Measuring leanness of manufacturing systems and identifying leanness target
by considering agility. Virginia Polytechnic Institute and State University.
Curatolo, N., Lamouri, S., Huet, J.-C., & Rieutord, A. (2014). A critical analysis of Lean
approach structuring in hospitals. Business Process Management Journal, 20(3), 433454.
Habidin, N. F., Shazali, N. A., Ali, N., Khaidir, N. A., & Jamaludin, N. H. (2014). Exploring lean
healthcare practice and supply chain innovation for Malaysian healthcare industry.
International Journal of Business Excellence, 7(3), 394-410.
Ir M, D., Johari Dato Mohd Ghazali, R., Hazilah Abd Manaf, N., Hassan Asaari Abdullah, A.,
Abu Bakar, A., Salikin, F., . . . Ismefariana Wan Ismail, W. (2011). Hospital waiting time:
the forgotten premise of healthcare service delivery? International journal of health care
quality assurance, 24(7), 506-522.

Jonsson, P., Andersson, D., Stentoft Arlbjrn, J., Vagn Freytag, P., & de Haas, H. (2011). Service
supply chain management: A survey of lean application in the municipal sector.
International Journal of Physical Distribution & Logistics Management, 41(3), 277-295.
Kalong, N. A., & Yusof, M. M. (2012). Understanding waste for lean health information systems:
a preliminary review. Studies in health technology and informatics, 192, 749-753.
Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in
healthcare: a realist review of the literature. Quality and Safety in Health Care, 19(5),
376-382.
Norazlan, A. N. I., Habidin, N. F., Roslan, M. H., & Zainudin, M. Z. (2014). Investigation of
kaizen blitz and sustainable performance for Malaysian healthcare industry. International
Journal of Quality and Innovation, 2(3-4), 272-284.
no, T. (1988). Toyota production system: beyond large-scale production: Productivity press.
Shazali, N. A., Habidin, N. F., Ali, N., Khaidir, N. A., & Jamaludin, N. H. (2013). Lean
healthcare practice and healthcare performance in Malaysian healthcare industry.
International Journal of Scientific and Research Publications, 3(1), 1-5.