Intended for healthcare professionals

Education And Debate

Using industrial processes to improve patient care

BMJ 2004; 328 doi: (Published 15 January 2004) Cite this as: BMJ 2004;328:162
  1. Terry Young (, professor1,
  2. Sally Brailsford, senior lecturer2,
  3. Con Connell, senior lecturer2,
  4. Ruth Davies, professor3,
  5. Paul Harper, lecturer4,
  6. Jonathan H Klein, senior lecturer2
  1. 1Department of Information Systems and Computing, Brunel University, Uxbridge, Middlesex UB8 3PH
  2. 2School of Management, University of Southampton, Southampton SO17 1BJ
  3. 3Warwick Business School, University of Warwick, Coventry CV4 7AL
  4. 4School of Mathematics, University of Southampton
  1. Correspondence to: T P Young
  • Accepted 8 December 2003

Might industrial processes improve quality, reduce waiting times, and enhance the working environment?

Radical thinking about the design of industrial processes over the last century has greatly improved the quality and efficiency of manufacturing and services. Similar methods to deliver higher quality health care at lower cost would be extremely valuable. In health care, however, we must also consider how patients feel about the processes and the extent to which they are able to exercise meaningful, informed choice.

Although the potential of using industrial methods in health care has been discussed,1 2 their value is hotly debated. Some doubt that there is a valid analogue between industry and health care, while others see it as an excuse to force an overworked community to work even harder.3 4 We describe three established industrial approaches—lean thinking,5 6 theory of constraints,7 and six sigma,8 9—and explore how the concepts underlying each might relate to health care.

Lean health care

Lean thinking started with Toyota in the 1950s and was developed by Womack and Jones.6 It seeks to provide what the customer wants, quickly, efficiently, and with little waste (box 1). An obvious application to health care lies in minimising or eliminating (within a framework of clinical excellence) delay, repeated encounters, errors, and inappropriate procedures. Some conceptual issues that arise in relating lean thinking to health care include the extent to which patients, service providers, or even taxpayers equate to customers in the commercial setting and the way in which health outcomes, patient satisfaction, or even cost can be legitimately used to define value. Furthermore, although the routes followed by items in a manufacturing process are clearly defined, those followed by individual patients depend on clinical judgments at various stages, which may complicate a rigorous analysis.

The NHS could learn …

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