Implementation of the Lean Approach in the Context of the New Model of Medical Organization: Results and Prospects
Authors: Fedos'kina Aleksandra K. , Fedos'kina Lyudmila A. 
Published: April 2022

BACKGROUND: Given the aggressive spread of the novel coronavirus disease, more active implementation of the lean production principles is necessary for the construction of a new medical organization (MO) model that can be more effective for the generalization of existing experience and development of ways to overcome arising problems.
AIM: To identify key problems that arise during the formation of a new MO model based on a lean approach and to substantiate recommendations for overcoming them.
MATERIALS AND METHODS: The depth of the implementation of the principles of lean production was examined through a content analysis of the activities of MO positioning themselves as regional leaders. A systematic assessment of the results of their activities was developed based on the criteria of a new MO model providing primary medical and sanitary care. Seven medical institutions from different regions of the Russian Federation, i.e., the Volgograd, KhantyMansiysk, Vologda, Belgorod, Kirov, Sevastopol and Vsevolozhsk, and Leningrad regions, were selected as study objects. Their geographical separation allowed identifying systemic problems in the introduction of the lean-manufacturing methodology and to present their generalized assessment. Trends in changing consumer preferences of MO patients were evaluated, the depth of the implementation of the lean approach in Russian MO was analyzed, the problems of creating a new MO model were identified, and the directions of overcoming them were determined.
RESULTS: The content analysis of the depth of the successful implementation of MO activities identified the most frequently realized and completely unrealizable criteria of the new MO model. On this basis, three key problems of the application of the lean production principles in Russian medical institutions were identified: the lack of an integrated approach to the reorganization of activities, high formality of ongoing transformations, and insufficient involvement of all participants in providing medical services. These problems are possibly overcome by the following promising solutions: 1) informing medical staff about the results of alreadyimplemented projects and increasing the level of visualization in management, 2) preferential realization of shortterm, but effective projects, at the first stages, 3) application of the cascade principle of educating employees about the principles of lean production, 4) creation of a motivation system that supports continuous improvements, 5) expansion of the interaction between MO of different profiles, and 6) increasing the level of involvement of management, medical staff, and patients in MO processes.
CONCLUSION: The results of this study indicate the high awareness of the need to apply lean thinking in the activities of a modern MO. The degree of implementation of the principles of lean production becomes a determining condition for increasing the efficiency of their activities and competitiveness in the market of medical services.