Jenei István

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István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration the system which, in turn, becomes more capable of responding also to this special challenge (Ghosh and Sobek, 2006). • At the same time, when the target to be changed is selected, one must separate the processes characterised by significant variability and the recurrent activities. Research has demonstrated the existence of many recurrent processes in health care, to which it is logical to apply the lean principles (Ghosh and Sobek, 2006). • Since assignments related to the transformation process may imply significant extra workload in addition to the daily routine, provisions must be made to relieve the workers of some of the burdens (Fillingham, 2007). • Since the targets of the “transformation” in health are typically humans, it is essential to interpret and communicate the lean principles and tools adequately. Naturally the personnel will anyway point out that the subjects of these processes are sensitive human beings and not motorcars. (Fillingham, 2007; Radnor et al., 2006). • Quality is interpreted differently in the services area than in industry: in addition to the outcome, the process itself is evaluated as well (Parasuraman et al., 1985). After this review of the special planning requirements due to the service specifics, let us discuss another typical feature of health care: the division of the person being served and the one that finances the service. 2.3.2. The difficulties defining the “customer” The point of departure of the five steps of lean thinking is the definition of customer value. In Toyota, the user of the product can be defined unambiguously, and so the company is in a good position to define customer needs. In health care, on the other hand, it is not quite clear who the “customer” of value created by the organisation is. For instance, health care must provide also for - 41 -
István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration incapacitated individuals (who cannot make decisions). Consequently, the financier (who pays for the service), the customer and the person deciding on the fate of the customer are distinct entities and hence “customer" as understood in the terminology of micro-economics is divided into three parts (Kornai, 1998). The picture is even more complex if we add the role of the municipalities which maintain the institutions, the administration (ministry), which mediates/represents the will of the tax-payer citizens and also the direct regulatory authorities. His financial concernedness notwithstanding, the beneficiary of the service (the patient), who can evaluate the performance of the organisation (at a certain level), will only provide a certain part of the counter-value of the service if he pays for it at all. Hence the performance of the service provider and the counter-value of the service are separated from each other, which makes feedback more difficult. It is therefore difficult to grasp the essence of “customer value”. This problem is one of the crucial issues of this research. Another major difference relative to the market conditions is the limited decisionmaking power of the individual: the patient cannot choose any of the services on offer at his discretion (without limits in space and time). The services do not compete; the goal is not the comprehensive survey and satisfaction of the patient’s needs. Let us add that the institutions concerned have no comprehensive decision-making competence either: both the hospitals, for example, and the financier organisations operate within certain limits. Consequently, health care service providers operate in a particularly complex environment (Figure 6.). - 42 -
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Jenei István

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