Report: Regional Sharing of Lean Applications in Healthcare Seminar, 24-28 January 2011, Thailand

Site Tour of Participants in Thailand Hospitals demonstrating application of Lean Management Systems


Since one of the primary challenges of the healthcare sector today is the lack of quality assurance for operations and service delivery to communities and patients. Healthcare, like other service sub-sectors is under pressure to improve quality while reducing costs. Productivity-related initiatives could resolve many problems in healthcare service.

The project is a follow-up to the APO Study Mission to the USA on the Application of Business Excellence in Healthcare in 2008. Thus, the seminar was organized to showcase Thailand’s achievements in introducing lean management system in its healthcare sector through the APO demonstration project that was conducted from September 2008 to early 2010. It featured the practitioner’s views and experience shared by the five demonstration hospital, the lead experts in lean for healthcare and health professionals involved in the quality management in the health sector.


The Health Human Resource Development Bureau (HHRDB) has institutionalized its Quality Management System (QMS) to ensure quality service delivery, productivity and customer satisfaction. Being the first Office in the Department of Health to institutionalize QMS which satisfied the requirements and standards of ISO 9001:2008, HHRDB is expected to assist and provide guidance to other DOH Offices in the institutionalization of QMS certifiable to ISO 9001:2008. Hence, as one of the members of the HHRDB QMS Task Force and as designated Internal Quality Audit (IQA) Team Leader, my involvement in the institutionalization of the QMS in the different DOH offices is very vital through the provision of technical assistance/guidance and formulation of related policies.

Likewise, my expectations were: to learn the principles, different methods, processes and strategies of Lean Application in Healthcare to be able to apply/mainstream such system in the installation of QMS in the different offices/units of the Department of Health (DOH) especially the DOH Hospitals.

Also, that I will be able to learn how the model hospitals were able to address the challenges in the application of the lean management system in the facility.


There were 22 participants from other Asian Countries (Cambodia, China, India, Indonesia, Iran, Japan, Korea, Malaysia, Mongolia, Nepal, Pakistan, Singapore, Thailand and Vietnam), while 2 participants from the Philippines. A total of 24 participants including the participants from the Philippines attended the 5 day seminar.

The Participants from the Philippines are both from the government sector and private sector : Ms. Gwyn Grace M. Dacurawat, Supervising Administrative Officer, Health Human Resource Development Bureau, Department of Health, and Mr. Francisco E. Montillano, Vice-Chair and Member of the Board, Training & Education Committee, Philippines Society for Quality in Healthcare, Inc.


The following topics were discussed during the seminar:

Overview Application of Lean Thinking to Healthcare
Value vs Waste
Introducing ‘House of Lean’
Benefits of Continuous Flow
Build in Quality, Error Proof
Background to Impact of Lean to Thai Healthcare Industry
Lean Journey of Thai Healthcare
Leadership at all levels
Lean in Healthcare Logistics Management
Lean at Rouge Valley Health System: A Strategic Choice to Drive Quality Improvement


Lean Application Journey of the three demonstration hospitals visited on the 3rd and 4th day of the seminar were shared during the visits. Their experiences, lessons learned and impact of lean management system application were also imparted during the discussions. Tour in the different areas of the facility where lean management was implemented was also seen by the participants.

Site visit at Saohai Hospital – Site tour at DM Clinic, Site Tour at PCU (Banyang),
Site visit at Saint Louis Hospital – Site tour at OPD, Emergency Room, Cardiology Department
Site visit at Siriraj Hospital – Siriraj Lean & Lean R2R presentation (Associate Professor , Nopmaneejumruslers, Dr. Akarin Nimmannit, Routine to Research (R2R) Manager, Assistant Dean in Quality Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Visit Siriraj Medical Museum, Center of Applied Thai Traditional Medicine, Oncology ward, Trauma ward, Breast feeding VSM, Sharing Discussion on Siriraj Lean Application (Dr. Kelvin Loh, Prof. Philip Choo, Ms. Michele Jordan, Dr. Anuwat Supachutikul, Dr. Cherdchai Nopmaneejumruslers)

Case study presentation of Songklanagarind Hospital – Dr. Rungsin Bhurayanontachai, Dr. Nipat Aui-Aree Cherdchai.
Case study presentation of Suratthani Hospital – Dr. Suwicha Saringkarnpoonperm
Sharing discussion on ‘Future Trend of Healthcare Improvement’ – Dr. Anuwat Supachutikul, Prof. Philip Choo, Ms. Michele Jordan. Practical tips and guides in the implementation of lean management were shared by the experts.


The highlight of the Philippine country paper presentation was the Philippine healthcare system, health statistics, issues and concerns, its current direction towards health sector reforms. It was also discussed in the country report the experience of Department of Health, specifically the Health Human Resource Development Bureau’s journey towards ISO 9001:2008 Certification, a Quality Management System.

The country reports of the different participants were not discussed/presented during the seminar. However, copies of the country reports of participants were distributed for reference/perusal.


With the commitment and generosity of the resource persons to share expertise in their assigned topics, I was able to gain knowledge and understand the following: basic theories; principles; methods; processes; mechanisms; strategies; its benefits to the organization’s productivity and provision of quality services to ensure customer satisfaction and high morale for every member of the organizations. I’m glad that my expectations for the seminar were met and I am satisfied with the design of the activity as well as to how it was managed and organized by the FTPI and APO.


The general recommendation of the participants was for APO to provide support and assistance (financial and technical expert services) to the Lean Management System related activities that will be undertaken in their respective hospitals/countries. Likewise, the participants expect the APO member countries to be one of the networks in the implementation of lean application. Hence, open communication to member countries should be established to facilitate consultation and exchange of ideas.

Since the DOH is now in the process of institutionalizing its Quality Management System certifiable to ISO 9001:2008 in the entire bureaucracy, Lean Management Principles will be considered as one of the quality improvements in the review of the different processes of the offices/bureaus/unit most specifically the service processes of the different DOH hospitals.

However, support from the Philippine NPO (DAP) through the provision/hiring of Technical Expert Services (TES) to give a comprehensive orientation on lean management for the chief executives of the DOH is very critical towards the realization of the proposed action plan to generate multiplier effect. Such activity will serve as advocacy to the top management to generate support for the implementation/adoption of lean management system as one of the quality improvements that can be considered to be institutionalized in the organization. The Philippine NPO may also consider organizing similar activity for the private health sector.


Supervising Administrative Officer
Department of Health


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