INTERVIEW
How can Lean and VBHC
be combined?
Rob Dillmann & Fred van Eenennaam
By Tahita Ringers – VBHC Center Europe
What are the similarities between
products or some services but not for outcomes of
VBHC and Lean?
medical practice. That is why VBHC is so important: to
Rob: Both approaches have different roots but the core
improve informed consent and define relevant
goal is concordant: adding value to the patients. If you
outcomes. However, VBHC now lacks a system in which
look at hospitals that have worked with Lean (I prefer
processes that do not add value are being removed.
Continuous Improvement) you can see that the value
Thus Lean can reinforce VBHC by optimizing the
statement is leading in their execution, as is with
processes and experiences in order to improve the value
VBHC. In my opinion, the definitions of value by the
equation. If we look at our care chain with patients with
Mayo Clinic, Virginia Mason or Michael Porter are
colorectal carcinoma, 200 different professionals
identical. Thus it is important to first establish that
working with the same patient group, often not
both VBHC and Lean work with the same compass.
knowing what the others are doing. Hence, we also
need to map what process steps can be optimized in this
Fred: We can see that the starting point of both
journey. Lean can eliminate the waste by continuously
principles is similar: adding value. In that perspective
optimizing and improving the journey. I believe that in
they can greatly reinforce each other, but we must note
the process of operationalizing your strategy VBHC and
that there is a slight difference in how value in both
Lean can be great companions in creating added value
approaches is established. VBHC principles rely on the
to the patients.
co-creation of value, co-creation between the patient
and family and between the healthcare professionals
“It is important to establish that both VBHC
and the teams. Whereas Lean principles of value focus
and Lean work with the same compass”
on creating more value for patients or costumers with
fewer resources.
Fred: Both Lean and VBHC emphasize the importance
of value for the patient or consumer. This goes hand in
What are the differences between
hand with continuous improvement based on outcomes
VBHC and Lean?
within the team. Lean on the one hand, translates these
Rob: If we look at both concepts in their purest form,
improvements into process developments whereas
we encounter the misunderstanding in Lean thinking
VBHC translates improvement into interaction and
that if you focus on the process, the outcomes will
learning cycles. Furthermore, Lean emphasizes on
follow. In contrast, if we look at VBHC we see the
reducing unwanted/unnecessary variation and VBHC
misunderstanding that if you focus on the outcomes the
aims to create meaningful variation to the patients.
process will follow. Thus VBHC and Lean differ in the
Lastly, Lean optimizes activities from a process flow
way they operationalize their value statement as they
perspective, whereas VBHC starts with the patient,
have opposite starting points. In my opinion, both ways
family, health care professional and the team and the
of operationalizing are wrong. If we look at the distinct
way in which they organize the flow can differ. This
features of our healthcare system, the market decides
could be from a process flow perspective but other
what value is. This is easy to define with industrial
perspectives can also be considered.
22 VBHC THINKERS MAGAZINE – VBHC PRIZE 2018 EDITION | APRIL 2018
INTERVIEW
What is the biggest challenge?
Rob: The biggest challenge is breaking trough the silo’s
and rigid organisational structures that already exist,
that is one of the main problems in Dutch health care in
general. Thus the main question we have to answer is:
how do we defeat the internal friction in already
existing hospital structures? Because the electronic
patient systems are not up-to-date and our financial
systems are not there yet. In order to create more value
to the patients we therefore need to look differently at
our existing systems and deal with the internal friction,
a major challenge.
What is your best advice to other healthcare
“Lean: if you focus on the process, the
professionals?
outcomes will follow. In contrast, if we look at
Fred: I would suggest that we mainly focus on medical
VBHC we see that if you focus on the outcomes
conditions and patient variability, where Lean could
the process will follow”
beneficially reinforce VBHC. We must cautiously
consider that patient value is not identical in both tools
Can you name some examples in
and that Lean or VBHC can still be used exclusively. We
The Netherlands?
increasingly understand the added value of combining
Rob: At Isala we have incorporated Lean and VBHC
the tools and the possibilities they jointly have for the
into our care chain. We are well acquainted with Lean
future. Provided that together with the team, patients
for years and have developed some experience in VBHC
and family both value definitions facilitate better
of the past five years. We have started combining the
outcomes for patients and lower costs per patient
two approaches in our fertility clinic and oncological
journey, we are well on our way.
center, but are expanding to other departments as well.
I am sure that there are at least two other major
Rob: I would suggest combining Lean and VBHC. To
hospitals in The Netherlands that combine the two. I
illustrate my statement: last week there was some news
hope the number will grow in the coming years. .
regarding the treatment of depression and the
Personally I am a great supporter of the systematic
discussion which of the two treatments would be better.
combination of VBHC and Lean because I believe it to
In the end, after a lot of research, they discovered that a
be very logical.
combination of both works best. That is the same for
VBHC and Lean: combination therapy for the hospital.
APRIL 2018 | VBHC THINKERS MAGAZINE – VBHC PRIZE 2018 EDITION 23