LEAN MANAGEMENT IN HOSPITAL

Fadli Amarullah¹, Dwi Anugerah Surya², Herisman Tisnakomara³

Widyatama University

Lean Management is an operational approach to organizational management. Lean

Management is driven by the philosophy of respect to people and continuous
improvement. This effort is carried out systematically with existing resources, focusing on
customer value and eliminating waste. The ultimate goal is to get process speed, quality
improvement and efficiency.

Lean has a methodology that is able to improve processes so that it can provide better
products & services, faster and at lower costs. Lean can be applied to all organizations,
including health service organizations such as hospitals. Lean provides an opportunity for
even the lowest position staff to speak up, share their ideas & take necessary actions for
improvement.

To implement Lean not mean replicate exactly ( copy and paste ) what was done by Toyota
(as the origin of the concept of Lean ) or from other hospitals were deemed successful in
implementing Lean . Hospital managers can develop Lean according to the conditions of
their respective hospitals or work units. Currently, Lean Management is used by various
hospitals (RS) as an effort to carry out cost control quality control in the era of National
Health Insurance (JKN).

There are several key factors for the successful implementation of Lean , including 1)
Organizational culture, 2) Leadership and management commitment, 3) Availability of
resources, 4) Communication strategy and 5) Organizational support. According to Sobek
II (2011), the success factors for implementing Lean in hospitals include: 1) broad
involvement, 2) strong leadership, 3) communication, 4) training, 5) problem solving , and
6) standardization. The factors that support lean implementation at the Hasna Medika
Kuningan Heart Hospital include: 1) Lean implementation according to the hospital's
goals/strategy, 2) Management support and commitment, 3 ) It is carried out in stages, 4)
There is support from human resources, 5) There is recognition and appreciation for the
efforts made, 6) Hospital infrastructure.   

The need to adapt to changes in the organization is happening so fast every day. If it does
not adapt, then the organization is at risk of decreased productivity, low quality, and high
costs (inefficient). Culture in an organization can be directed so that it has a positive
impact. With a strong organizational culture can help organizations remain competitive in
the competition with the environment. Without culture, everyone in the organization will
have their own culture or different from one another. This can affect the overall
performance of the organization and even make organizational management chaotic.

A positive organizational culture such as a culture of continuous improvement or

improvement will allow the implementation of Lean to be more leverage (successful).
Carrying out continuous improvement efforts will distinguish whether the activity is a
culture or just a momentary “contribution work”. The hallmark of this continuous
improvement is the difference in activities carried out from the previous day. As long as
everyone is doing today like what was done yesterday, then the implementation of Lean
has not been effective continuously from time to time. Familiarizing the application of the
Lean Management philosophy to all staff will allow the implementation of Lean to be easy
to implement.

Respect (respect) others means respecting people as whole people. Respect also means
treating others the same, regardless of race, religion, gender, posture, age, or origin. It also
means that policies and procedures within the organization are implemented consistently
so that people feel that they are treated fairly and equitably.

A culture of respect for others associated with the organization can start with simple things
such as wanting to be a good listener and paying attention to non-verbal communication
from work relationships. Respect in the organization is also characterized by the habit of
accepting or asking for advice from others, including subordinates. Furthermore, there is
also a culture of delegation of authority or employee empowerment.

Together with communication, empowerment and teamwork, leadership is one of the

important cultures for a successful Lean implementation . True, it is very easy to say the
need for cultural change. But it's much more difficult to actually make it happen. Education
and training will help the process of cultural change occur, but it is not enough.

This is where leadership is needed. Leaders are the locomotive of a change including
organizational culture or an improvement in the organization. For successful
implementation of Lean in healthcare, leadership, inter alia: lead by example, involving
staff, understand the tools (tools) lean , march to the value stream , commitment of
resources to be successful, trust and give others responsibility.

The success of lean implementation is not only determined by leadership, but leadership
behavior also has a big impact on the success of lean implementation . Leaders can be
involved in encouraging shared awareness, responsibility, vision and mission of the
organization and support for resources in the change process. It is also important for
leadership to create an environment where people feel safe and free to report mistakes or
problems that occur without fear or become victims of reprisals for reporting (Sobek II,
2011). The leadership also has the authority and can appoint a leader or team member for a
change in lean implementation (in some hospitals in Indonesia it is called Quality Control
Team-Cost Control).

The success of Lean implementation is determined, among others, by changes in

organizational culture and leadership. Every change process requires leadership,
determination, “resilience”, commitment and engagement from staff because staff is a
fundamental part of lean . Developing staff, giving them autonomy and empowerment in
solving problems in their daily life are important in lean practice . For continuous
improvement efforts, it is necessary to teach and expect proper problem solving by all
staff. All staff must accept and embrace a lean culture . This is the key to the success of
lean implementation . Small but progressive improvements made every day are another
key to success in Lean implementation. Staff engagement requires trust, inspiration from
leaders and management, openness, training and rewards including incentives.