The joint use of resilience engineering and lean production for work system design: A study in healthcare

Appl Ergon. 2018 Sep;71:45-56. doi: 10.1016/j.apergo.2018.04.004.


Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient.

Keywords: Design science research; Emergency department; Healthcare; Lean production; Resilience engineering.

MeSH terms

  • Efficiency, Organizational
  • Emergency Service, Hospital / organization & administration*
  • Humans
  • Intensive Care Units / organization & administration*
  • Patient Transfer / organization & administration*
  • Systems Integration*
  • Systems Theory*