The healthcare system of today’s westernised civilisation holds a paradox: on the one hand, hospitals equipped with state-of-the-art-technology and well-educated staff working under best hygienic conditions is regarded standard. On the other hand, our healthcare system is ailing and cutbacks in capital spending, wages and personnel appear on the agenda. Accordingly, a more sophisticated approach that helps hospitals to work efficiently and effectively is needed. Among quality management tools, Lean is one suitable methodology that can help healthcare organisations out of the dilemma. Originally, Lean is a management methodology that goes back to production processes with the main aim to increase output by reducing input. The lean philosophy has its origin in the Japanese manufacturing industry and is strongly bound to the Toyota Production System (TPS). In hospitals, Lean is ideally based on three main pillars: process optimisation, patient-oriented management as well as engaging and leading employees. The first chapter of the book deals with the main principles and tools of Lean to give readers an overview about the basic ideas of this management philosophy. The understanding for waste and wasteful activities will be enhanced and tools such as Kanban, Kaizen and Value Stream Mapping, that are helpful for identification and elimination of waste, will be introduced. Furthermore, new terms and concepts such as Lean Sigma, telemedicine and e-health are examined. For Lean to tap its full potential, human aspects must be considered likewise. One of the most important aspects in hospitals is the successful management of patients. The second chapter concentrates on factors that positively influence the bottom line in a hospital. Thus, patient satisfaction, strategic alliances in the healthcare environment and hospital marketing are of main focus since all these aspects are considered value-adding steps that help to increase service quality and to streamline processes in hospitals. Additionally, effective lean management concentrates on successful leading and engaging employees. Lean management does not happen on its own: it needs visionary leadership and expert knowledge. Lean management calls for a reflected interaction with employees. Hence, the third chapter deals with employee satisfaction and motivation and how this contributes to a sound and proper basis for smooth implementation of lean processes. Implemented correctly, the Lean message is 100% positive because it can indeed create a win-win-win-situation: for the health care institution, the end users - above all patients - and medical staff. But a philosophical issue has to be incorporated into the DNA of the organisation to produce sustainable changes with resulting advantages.

Textprobe: Kapitel 3.3 Hospital Marketing: Marketing has become a central issue for the existence of hospitals and healthcare organisations. In general, marketing includes all activities of distribution of a product or service. In a healthcare environment, marketing first of all means a philosophy or concept to focus the hospital’s attention on its customers – mainly the patients – by using all resources, skills, products and thinking to understand and meet customer needs. With professional and correctly implemented marketing, interior and exterior hospital activities are streamlined and contribute to lean management. In fact, understanding the marketplace and designing a professional marketing plan will help to avoid inefficient and ineffective activities. Instead, valued resources (e. g. time, money) are identified and can be used in a more reasonable way. The Market: The healthcare sector is subject to a variety of difficulties and restrictions and can therefore not be regarded a common service industry. This is true, just because of the following reasons: first of all, the healthcare market itself does not offer homogenous goods due to local, personal, temporal or objective preferences of the patients. Second, hospitals and health systems are affected by political upheaval changes in government regulations declines in reimbursement the growth of alternative medicine the rise of consumerism an increase in competition from physician-owned specialty hospitals, retail clinics, and other business models and a host of other complications . In an international context, these factors must also be well-considered regarding socio-economic, cultural and legal conditions of the respective nation. In the following, the framework of the Federal Republic of Germany will provide an example. In the 21st century, two trends can be seen in the German healthcare market. On the one hand, there is a fast-growing development of a private market for healthcare services. On the other hand, progressive liberalisation of the public healthcare sector can be noticed. Both sectors have to cope with difficult market conditions. In recent years, the German government has enacted various healthcare regulations and reforms with the main aim to increase transparency and to identify inefficient sectors. For hospitals, this results in important consequences regarding their market orientation. According to Mayer, these consequences are mainly: cutbacks in public capital spending, decrease of overcapacities, deregulation of primary costs’ coverage, intensive interconnection of ambulant and stationary treatment, enlarged reporting obligation and the introduction of a total quality system with publishing duties. Furthermore, especially the public healthcare sector is restricted due to institutional interdependencies that originate from the German healthcare system itself. In general, patients are admitted to hospitals by physicians (either family doctor or specialist). The German association of health insurance companies controls and coordinates the compensation package and bills the provided performance to physicians, ambulant providers, clinics and hospitals. These procedures result in two disadvantages: first of all, hospitals have to cope with inflexible billing procedures and, furthermore, patients lack transparency of the cost-performance ratio. The Euro Healthcare Index 2007, carried out by the Health Consumer Powerhouse, underlines that lack of transparency regarding patient rights and information (please see appendix 2, page 61). The index represents survey results from the patients’ view carried out in several European countries. It consists of five sub-disciplines: patient rights and information, waiting times, outcomes, generosity of public healthcare systems and pharmaceuticals. According to the ranking, Germany has a clear need for improvement in the sub-discipline of patient rights and information because out of nine indicators 4 have been evaluated poor, 4 intermediary and only 1 good. For hospitals this means a real opportunity for quality improvement by adjusting their marketing activities to customer needs. When creating the marketing plan the above-mentioned circumstances have to be taken into consideration.

• Process Optimisation

• Value Stream Mapping

• Hospital

• Telemedicine

• Patient-Oriented

• Healthcare Environment

• Lean Management

Verena Lindenau-Stockfisch was born on February 6, 1976 in Meißen (Saxony) and grew up in the today’s known New Laender in Germany. After her graduation as an International Management Assistant in 2003, she was working in an export company, specialised on turn-key hospital projects mainly in the Middle East. In 2009, she graduated from her extra-occupational but full-time BA studies that were important to improve her professional skills in the fields of Business Administration. Various stays abroad, among others in Great Britain and South Africa, as well as the BA studies mainly held in English, contributed to her language skills and enabled her to work on an academic level. Already during her work as a Project Manager, she gained comprehensive experience with regard to structuring, elaboration and budgeting of international hospital projects. Above all, her position demanded the ability of leading a project team and cooperation with engineers, medical planners and architects and to ensure optimal process structuring in a hospital from the very beginning. At a German-Arabic Health & Economy Congress in 2006, she became first acquainted with the definition Lean Healthcare. Since that day, she has been fascinated and intensively studied the topic Lean Management in Hospitals. Since January 2011, Ms Lindenau-Stockfisch has been working for a hospital near Leipzig. In her position as a Manager for Strategic Planning she is accepting the challenge of introducing and implementing the Lean Methodology there. Verena Lindenau-Stockfisch wurde 1976 in Meißen geboren und wuchs in den heutigen neuen Bundesländern auf. Nach ihrem Abschluss zur Internationalen Managementassistentin im Frühjahr 2003 arbeitet Frau Lindenau-Stockfisch bei einem Exportunternehmen für Medizintechnik, welches auf die Komplettausstattung von Krankenhäusern, hauptsächlich im Mittleren Osten, spezialisiert ist. Um ihre fachlichen Qualifikationen im Bereich der Betriebswirtschaft weiter auszubauen, entschied sie sich für ein berufsbegleitendes Vollzeitstudium, welches sie 2009 erfolgreich abschloss. Ihre sprachlichen Kenntnisse optimierte sie bei verschiedenen Auslandsaufenthalten, u. a. in Großbritannien und Südafrika, und durch das hauptsächlich englischsprachige BA-Studium. Bereits während ihrer Arbeit als Projektleiterin sammelte die Autorin umfangreiche praktische Erfahrungen hinsichtlich der Strukturierung, Ausarbeitung und Budgetierung internationaler Krankenhausprojekte. In Zusammenarbeit mit Medizinplanern, Architekten und Ingenieuren steuert sie das Projektteam bei der Ausarbeitung der Ausschreibungsunterlagen, um die optimale Strukturierung der Prozessabläufe im Krankenhaus von Anfang an zu gewährleisten. Während eines Aufenthalts beim Deutsch-Arabischen Wirtschaftsforum 2006 kam sie erstmals mit dem Begriff Lean Healthcare in Kontakt und verfolgt seither mit regem Interesse das Thema Lean Management in Krankenhäusern. Seit Januar 2011 arbeitet Frau Lindenau-Stockfisch in einem Krankenhaus nahe Leipzig. In ihrer Position als Leiterin für Strategische Unternehmensplanung ist sie dort für die Einführung und Umsetzung der Lean-Methodik zuständig.