Who are your lean health customers? Identifying influential lean customers in health services : current practice and insights from stakeholder analysis

Objective: Lean process thinking has successfully increased customer value through the elimination of wastes in manufacturing processes and increasingly is applied to health settings. The core of Lean manufacturing philosophy is to make value (as perceived by the customer) the key concern of all employees. While the paying customer is easily located in product manufacturing processes, in public health services a variety of funding groups exist and co-payments are common. Furthermore, the health consumer, in the role of patient, is relatively passive and often excluded from process and purchase decisions. This paper compares the Lean manufacturing literature's focus upon customers with that of Lean health literature. It then proposes and demonstrates the use of stakeholder analysis to identify and manage the fluctuating salience of multiple health customers. Design: Systematic reviews of Lean manufacturing and Lean health literature in Business Source Complete, Cinahl Plus, Academic Search Complete, Health Business Fulltext Elite and Medline databases measured the frequency of customer reference. Articles containing specified search terms in their abstract were selected. Chi2 tests were used to test the significance of the findings. Setting: English language articles from newspapers, health industry and scholarly journals were analysed. Results: The results show the Lean health literature displays a reduced focus on process customers compared to the Lean manufacturing literature, and routinely names patients as the only customer type. Conclusions: The range of customers revealed through stakeholder analysis exposes a requirement to assess the needs and influences of many health customers, including but not limited to patients. The multiplicity of health customers has practical and theoretical implications; the outcomes of Lean health initiatives may be jeopardised if inappropriate customers are selected as the focus of Lean health projects. Directions for future research are also considered.