Modified Approach

time.”1 Anyone who has struggled with a poorly designed process can relate. A bad system grinds people down until they no longer care about the quality of the product or service delivered to the customer. People using a bad system take out their frustrations on customers, who complain about the poor quality they receive. This is a never-ending, destructive cycle for the person using the bad process and those receiving the low-quality product or service. The stress created by a poorly designed system is even more pronounced in the arenas of public health and local government, both of which have seen budgets slashed during the recent economic downturn. The result is a reduction in the workforce and an increase in workload related to community needs. This untenable situation has fostered a workday replete with interruptions, an environment exacerbated by the increasing use of mobile communication. But even in this rapidly changing environment, lean principles are well designed to spur improvement. Loosely defined, lean is the relentless elimination of waste throughout the entire value stream, in which waste is any nonvalue-added activities from the customer’s perspective. Lean concepts were initially documented in manufacturing environments and, as a result, most of the terminology used to describe the system and associated tools are based on functions of the shop floor.2 But there is potential for waste in all processes, which is why lean also works well in service and transactional environments. The essence of lean is to build a better, faster, more efficient and streamlined process.3 Basically, lean is centered on preserving value with less work and is a variation on the theme of efficiency based on optimizing flow. It is a present-day instance of the recurring theme in human history toward increasing efficiency, decreasing waste and using empirical methods to decide what matters, rather than uncritically accepting preexisting ideas.4 Using lean in a highly interruption-driven environment that requires rapid turnaround, such as emergency response, does not mean all activity must be planned strategically to achieve effective outcomes. Although it is true that system planning is the basis for long-term performance improvement, individual tasks can be performed quickly and on short notice, bolstered by a solid infrastructure of resources and policy.