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Lean more common than thought within health care

Monica Kaltenbrunner Nykvist

Monica Kaltenbrunner Nykvist, researcher at the University of Gävle, has studied how much of Lean has been adopted in primary care and how this has, for instance, affected care quality.

Monica Kaltenbrunner Nykvist was surprised of how much of Lean had been adopted by health care centres in Gävleborg and that the staff were so positive.

“Primary care is a rather complex part of health care. Usually, there is more of Lean in the accident and emergency departments, in laboratories or radiology departments, into which the Lean method can more easily be adapted,” Monica says.

The patient first

In general, the staff believe that they are good at establishing what each patient finds important, what contributes to the quality of the care in a positive way for the patient. Moreover, the staff feel that they are good at developing and following up routines.

“To work in a more standardised manner means to do tasks in the same way every time, as this makes it easier to spot mistakes. It could concern wound management, to perform the task according to established guidelines. “

Here there was a positive connection: the more Lean, the higher the perceived quality in the health care units.

Spider in the net missing

But the spider in the net, the important driving force in introducing Lean in every unit is generally missing. Swedish county councils have chosen to hire a Lean coordinator who is to use managers to introduce the Lean method to staff.

“But research shows that neither managers nor members of staff know what Lean really is about and how to practice Lean.”

Reporting a nonconformity

The staff also lacked opportunities to solve problems in a structured way, that is to measure and follow up activities. This is a cornerstone in Lean; the teams solve their own problems and evaluate their own work. The team should also have the mandate to change their way of working.

“In the health care sector, one is not very good at this sort of thing. In general, one just reports a nonconformity and then nothing much happens.”

In studies, one has with great success placed nurses and doctors in the same room, so that they can sit together and discuss the patient and plan the care.

Health care staff appreciate Lean, some studies show.

Effects of Lean in health care

Monica now intends to continue her research by studying how Lean affects the psychosocial working environment and staff health.

“In the industrial sector, there is a tendency to be sceptical towards Lean because it is believed that it means more stress and more demands. In the health care sector, more people tend to be positive, but not enough studies have been carried out to say anything with certainty as yet.”

“It is very easy to measure the number of appointments, but is also important to make sure that the staff enjoy being at their workplace. It mustn’t be forgotten.”

“So far, research gives few answers as to how Lean works in the health care sector,” Monica Kaltenbrunner Nykvist says.


After the second world war, Japan had to reorient its military industry to a civil industry. Toyota was inspired by western mass production principles and adopted them to their economic situation. The concept “Lean production” has since then been used also outside the manufacturing industry, for example within the health care sector.
  • In Lean, the customer is in focus.
  • The main principle of Lean is to eliminate waste.
  • The core of Lean within the health care sector consists of a number of principles that concern improving processes from the patient’s point of view and to allow staff to continuously improve their ways of working

Previous studies of lean in health care show that the effects of Lean are:

  • Waiting times are shortened
  • Patient safety increased
  • Faster recovery
  • Mortality decreases
  • There are also studies that show that staff appreciate lean


For more information, please contact
Monica Kaltenbrunner Nykvist, PhD student at the University of Gävle
Phone: 026-64 85 14, 073-270 74 39
Email: Monica.Kaltenbrunner.Nykvist@hig.se

Text: Douglas Öhrbom
Photo: Ove Wall

Published by: Douglas Öhrbom Page responsible: Anders Munck Updated: 2017-10-07
Högskolan i Gävle
Box 801 76 GÄVLE
026-64 85 00 (växel)