**1. The change of paradigm**

An innovative way of hospital management appeared in the 1990s. Methods originating from the industry and known as lean management and Theory of Constraints (TOC) have proven surprisingly adequate in health care environment. These helped to overcome the problems of many hospitals facing severe issues and as a result requiring turnaround.

Effective management of the organization has to be holistic in nature and focus exclusively on the point of view of client/patient instead of unit managers. The effectiveness and process synchronization have to be also looked upon from the same perspective. Management approach aiming at local optimizations traps the managers ultimately leading to underperformance of the organization as a whole, witch hunt and frustration from the very bottom to the top of the organizational ladder. Moreover, most of the employees including top managers are not fully aware of the structure of processes in their company. These processes do not fit the most commonly applied management practices. In their nature, these are horizontal and not vertical like the structures of most of the organizations [1].

The term "lean management" has been first formulated by the American researcher John Krafcik who has been investigating the reasons behind competitive advantage of Japanese automobile industry over its American counterpart. Krafcik has been particularly impressed by the Toyota Production System (TPS), which has been developing in Japan from mid-1940s.

Essentially, lean system could be defined as an elimination of waste and respect to all of the employees organization-wide. The goal of the organization is to deliver added value to the patient/client/payer. Added value is generated when any activity that delivers tangible results in the process is performed correctly the first time and for which the patient/client/payer is ready to pay. All the rest is regarded as waste. There are seven types of waste defined by the TPS originator—Taiichi Ohno. Detailed description is outside the scope of this book, but an interested reader will easily find it outlined in many available resources [2].

The set of tools and techniques applied in lean is usually presented as the socalled Toyota House or Lean House. The fundaments of the house comprise 5S—the system of creating and maintaining a neat and clean work environment, continuous improvement, standard work, balanced distribution of the job, and visual controls. All of these elements are crucial; nevertheless, 5S and standardized work require closer explanation.

The majority of organizations do not realize how much waste is hidden in their current processes. There is an abundance of unnecessary tools, equipment, excess inventory, documentation, etc., in any hospital. All these obscure the real problems. Any attempt to optimize the processes without launching 5S at the very beginning is doomed to fail as the main issues will stay hidden behind the visible surface.

Standard work in lean is different from what is usually meant by the notion. Standardization is the best presently known way of performing a certain task. If the employees develop a better, safer way, the standard work can be changed almost immediately. This is different from the traditional approach relying on rigid rules, which are almost impossible to change. Actually, lean is a scientific method based on continuous experiments, which make it extremely flexible, and ensures involvement of the employees on all the levels.

Two walls of the Toyota House can be distinguished. The first one is continuous flow, which concentrates on elimination of delays as well as right care in the right time in the right place. The second one is a quality approach, focusing on error detection, preventing errors at the very source, and involving the employees in problem-solving. The most important rule is to ensure that no witch hunt takes place. Instead, employees providing information about the existing and possible issues and implementations of related solutions should be rewarded.

Finally, the roof comprises the ultimate goals: health, safety, staff morale, and patient satisfaction.

Unfortunately, the term "lean" has been misinterpreted, mainly in the USA, and used in the form of practices involving layoffs and increased work burden. As a result, it has lead to pathologies that are in no way connected to the Japanese ideas. The authors would like to stress that the aforementioned mismanagement has nothing in common with genuine lean, which is based directly on TPS.

Theory of Constraints emerged at the beginning of the 1980s, when the Israeli physicist, Dr. Eliyahu Goldratt who became interested in the production planning processes, published his first book on the subject in the form of a bestselling business novel *The Goal* [3]. Goldratt claimed that every organization has its own main constraint, either internal or external, and proposed a set of five steps called the Process of Ongoing Improvement (POOGI) to handle these issues accordingly. The aforementioned steps are:

**137**

cal personnel alike.

*Resource-Based View of Laboratory Management: Tissue Bank ATMP Production as a Model*

• Exploit the constraint—ensure that the constraint is operational all the avail-

• Subordinate all the resources within the organization to the requirements of

• If the constraint has been broken, identify the new one and start the process all

Over the following years, Goldratt developed the applications of the TOC in various areas like project management, sales, marketing, and people management. In the 1990s, he introduced the TOC thinking processes—a set of tools aimed at enhancing the analysis of the problems and building solid, logical, time-proven solutions. Today, TOC has found its applications in many different areas both in manufacturing and in services like logistics, strategy, health care, education, and

It has to be stressed that both lean and TOC—if they are to be implemented the proper way—have to be a company-wide effort closely supervised and led by the top management. Both clinical and nonclinical departments must be taken into account. Obviously, the positive cultural change of the organization will follow as an ultimate result of the implementation. The task is by no means easy, but the payoffs are well worth it. Potential benefits include 20–80% of productivity improvement, reduction of unnecessary length of stay, and significant

Neither lean nor TOC is meant to replace the golden medical standards or the standards of pharmaceutical production like GMP. They are rather complementary tools and techniques, paving the way for the existing standards to rise to new

Dr. Stanislaw Sakiel Burn Treatment Centre (CLO) based in Siemianowice Śląskie, Poland, is a top hospital specializing primarily in the treatment of burns and chronic wounds. CLO has been a pioneer in application of TOC and lean in hospital management since early 2016. According to the knowledge of the authors, it is the only hospital in Poland where the system not only is still functioning but also delivers constantly better results. The Bank of Tissues has been among the first units where the approach has been applied. The project was initiated in 2016. Despite the fact that GMP was already in place, it soon became apparent that there is still a huge room for improvement. The decision to implement 5S quickly delivered results. Process mapping followed, together with visible changes in the flow in local production site. Today, the flow is faster, job is better organized, and the breaks are sporadic instead of being a norm. Improved communication with the operating theater resulted in more on-time deliveries and less unnecessary additional transports. This in turn contributed to shorter surgical procedures and better overall conditions for patients and medi-

reduction in inventory and space, and savings counted in millions of local currency are not uncommon if the methods are applied properly and given sufficient time [5]. One has to remember that both methods advocate continuous and growing improvement and are therefore not a one-time

*DOI: http://dx.doi.org/10.5772/intechopen.86561*

• Elevate the constraint, i.e., widen it, and

over again, but be aware of the inertia.

• Identify the constraint,

able time,

resocialization [4].

initiative.

levels.

the constraint,

*Resource-Based View of Laboratory Management: Tissue Bank ATMP Production as a Model DOI: http://dx.doi.org/10.5772/intechopen.86561*

• Identify the constraint,

*Biochemical Testing - Clinical correlation and Diagnosis*

been developing in Japan from mid-1940s.

ment of the employees on all the levels.

closer explanation.

patient satisfaction.

aforementioned steps are:

easily find it outlined in many available resources [2].

The term "lean management" has been first formulated by the American researcher John Krafcik who has been investigating the reasons behind competitive advantage of Japanese automobile industry over its American counterpart. Krafcik has been particularly impressed by the Toyota Production System (TPS), which has

Essentially, lean system could be defined as an elimination of waste and respect to all of the employees organization-wide. The goal of the organization is to deliver added value to the patient/client/payer. Added value is generated when any activity that delivers tangible results in the process is performed correctly the first time and for which the patient/client/payer is ready to pay. All the rest is regarded as waste. There are seven types of waste defined by the TPS originator—Taiichi Ohno. Detailed description is outside the scope of this book, but an interested reader will

The set of tools and techniques applied in lean is usually presented as the socalled Toyota House or Lean House. The fundaments of the house comprise 5S—the system of creating and maintaining a neat and clean work environment, continuous improvement, standard work, balanced distribution of the job, and visual controls. All of these elements are crucial; nevertheless, 5S and standardized work require

The majority of organizations do not realize how much waste is hidden in their current processes. There is an abundance of unnecessary tools, equipment, excess inventory, documentation, etc., in any hospital. All these obscure the real problems. Any attempt to optimize the processes without launching 5S at the very beginning is

Two walls of the Toyota House can be distinguished. The first one is continuous flow, which concentrates on elimination of delays as well as right care in the right time in the right place. The second one is a quality approach, focusing on error detection, preventing errors at the very source, and involving the employees in problem-solving. The most important rule is to ensure that no witch hunt takes place. Instead, employees providing information about the existing and possible

Finally, the roof comprises the ultimate goals: health, safety, staff morale, and

Unfortunately, the term "lean" has been misinterpreted, mainly in the USA, and

Theory of Constraints emerged at the beginning of the 1980s, when the Israeli physicist, Dr. Eliyahu Goldratt who became interested in the production planning processes, published his first book on the subject in the form of a bestselling business novel *The Goal* [3]. Goldratt claimed that every organization has its own main constraint, either internal or external, and proposed a set of five steps called the Process of Ongoing Improvement (POOGI) to handle these issues accordingly. The

used in the form of practices involving layoffs and increased work burden. As a result, it has lead to pathologies that are in no way connected to the Japanese ideas. The authors would like to stress that the aforementioned mismanagement has noth-

issues and implementations of related solutions should be rewarded.

ing in common with genuine lean, which is based directly on TPS.

doomed to fail as the main issues will stay hidden behind the visible surface. Standard work in lean is different from what is usually meant by the notion. Standardization is the best presently known way of performing a certain task. If the employees develop a better, safer way, the standard work can be changed almost immediately. This is different from the traditional approach relying on rigid rules, which are almost impossible to change. Actually, lean is a scientific method based on continuous experiments, which make it extremely flexible, and ensures involve-

**136**


Over the following years, Goldratt developed the applications of the TOC in various areas like project management, sales, marketing, and people management. In the 1990s, he introduced the TOC thinking processes—a set of tools aimed at enhancing the analysis of the problems and building solid, logical, time-proven solutions. Today, TOC has found its applications in many different areas both in manufacturing and in services like logistics, strategy, health care, education, and resocialization [4].

It has to be stressed that both lean and TOC—if they are to be implemented the proper way—have to be a company-wide effort closely supervised and led by the top management. Both clinical and nonclinical departments must be taken into account. Obviously, the positive cultural change of the organization will follow as an ultimate result of the implementation. The task is by no means easy, but the payoffs are well worth it. Potential benefits include 20–80% of productivity improvement, reduction of unnecessary length of stay, and significant reduction in inventory and space, and savings counted in millions of local currency are not uncommon if the methods are applied properly and given sufficient time [5]. One has to remember that both methods advocate continuous and growing improvement and are therefore not a one-time initiative.

Neither lean nor TOC is meant to replace the golden medical standards or the standards of pharmaceutical production like GMP. They are rather complementary tools and techniques, paving the way for the existing standards to rise to new levels.

Dr. Stanislaw Sakiel Burn Treatment Centre (CLO) based in Siemianowice Śląskie, Poland, is a top hospital specializing primarily in the treatment of burns and chronic wounds. CLO has been a pioneer in application of TOC and lean in hospital management since early 2016. According to the knowledge of the authors, it is the only hospital in Poland where the system not only is still functioning but also delivers constantly better results. The Bank of Tissues has been among the first units where the approach has been applied. The project was initiated in 2016. Despite the fact that GMP was already in place, it soon became apparent that there is still a huge room for improvement. The decision to implement 5S quickly delivered results. Process mapping followed, together with visible changes in the flow in local production site. Today, the flow is faster, job is better organized, and the breaks are sporadic instead of being a norm. Improved communication with the operating theater resulted in more on-time deliveries and less unnecessary additional transports. This in turn contributed to shorter surgical procedures and better overall conditions for patients and medical personnel alike.
