Jenei István

István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences,
PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration
2.3. Effects of the special features of health care on lean
transformation
It is imperative to take stock of branch-specific differences in connection with the
examination of the new application of Lean in health care. This chapter will tackle that
issue.
Before embarking on a more detailed examination of the health care system, let’s
take a look at it from an economics perspective:
Certain inputs are needed for the “production” processes of health care, including,
in addition to the typical industrial production items (workforce, machinery, equipment,
materials, structures) the patients. Since the patient himself exerts a major influence on
the care process and its outcome, it is rather difficult to assess the real performance of
the system. A further problem is the ambiguity of the notion of “performance”:
depending on the approach ever, it may refer to state-of-health as an assessment
criterion, but also to many other criteria or a combination thereof. This large array of
possible performance evaluation options is a significant problem as far the unambiguous
performance measurement and direct employee feedback objectives of the lean system
are concerned.
Another major problem in health care is the definition of the “customer” and the
consequent identification of “customer value”, the point of departure of lean
management. The relevant causes (due mainly to the specific health care financing
system) will be described in detail later on.
Let us investigate now the three essential feature clusters of health care services
which have significant influence on the adaptability of lean management:
1. Health care is a service, not a production activity.
2. The overwhelming majority of (Hungarian) hospitals operates as central
budget institutions.
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