Improving healthcare delivery with lean thinking: Action research in an emergency department.

R.W. Rosmulder

Research output: ThesisPhD Thesis - Research UT, graduation UT

522 Downloads (Pure)


The healthcare sector faces a challenge to deliver more and better patient care with less manpower and less financial resources. This action research (AR) thesis deals with the question if industrial engineers can contribute to this by applying process improvement concepts that were successful in industry. In the research, the principles of lean thinking were used to address problematic patient flow in the emergency department (ED) of an academic hospital in the Netherlands. Using a soft systems approach, we collaborated with the ED managers and healthcare professionals from all disciplines contributing to the care delivery. We invited them to critically look at the care delivery from a lean thinking perspective. Together we defined feasible actions to make the healthcare delivery run more smoothly. Experiments were set up to test these new ways of working and measure the effects on the patient flow. Five AR projects were carried out. In all five projects, the industrial engineers were able to have the other participants in the AR look at the healthcare delivery from the perspective of lean thinking. It proved to be a substantially different perspective than what the ED managers and other healthcare professionals were used to. Together, we developed a closer understanding of the patient flow and the inherent activities that did not add to the patient care. On the whole, the direct participants in the AR were able to experiment successfully with making the healthcare delivery run more smoothly. Other healthcare professionals, who had not directly participated, were, by contrast, not always willing to support the new ways of working. This complicated the experimentation in the projects. This probably explains why a clear improvement of patient flow was found in only one of the five projects. Fortunately, the other projects produced promising clues of improvement. This thesis concludes that industrial engineers, through careful application of lean thinking principles, can contribute to the improvement of healthcare delivery in hospitals. The soft systems approach deserves further application for this purpose. This approach was, to our knowledge, not used before by industrial engineers to apply lean thinking in healthcare.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Twente
  • Krabbendam, Johannes Jacobus, Supervisor
  • Kerkhoff, Antoon, Supervisor
Award date13 Oct 2011
Place of PublicationEnschede
Print ISBNs978-90-365-3258-7
Publication statusPublished - 13 Oct 2011


  • METIS-279563
  • IR-78230


Dive into the research topics of 'Improving healthcare delivery with lean thinking: Action research in an emergency department.'. Together they form a unique fingerprint.

Cite this