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The improvements described are all about supplies and the handling of patients by nurses and administrative staff.

There is not a word about any changes to the work of doctors themselves or involvement by doctors in the improvement process. What form might that take? I don’t know, but, the last industrial engineers to work on health care before Lean were Frank and Lillian Gilbreth 100 years ago, and their focus was the work of surgeons inside operating rooms, not patient handling before and after they see a doctor.

The result of their work was the now standard mode of operation in which the surgeon calls for tools that are handed to him by nurses. It seems hard to believe today but, earlier, surgeons would actually leave patients to fetch tools.

Following in the Gilbreths’ footsteps today would mean for Lean Health Care to get involved with the core of the activity: what doctors do with patients.

In manufacturing, successful Lean implementations start with the work of production on the shop floor, not with the logistics upstream and downstream from production. First you worry about line layout, work station design, and the jobs of production operators. Then you move on to keeping them supplied and shipping their output.