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What is “Lean”?

New to Lean? We’ll Try to Help

Lean Healthcare Overview by Mark Graban (PDF)

Download the 1st Chapter of Lean Hospitals

If you’re visiting the blog because of a search and you’re not sure what this whole “lean” thing is about, we’ll try to introduce you. Keep in mind that this is just a starting point. There’s a reason that dozens of books have been written about lean. It’s not easy to fully understand all in one night. I have been learning about it for more than 15 years. Not that I’m holding myself up as the #1 expert on the topic. I learn about lean every day.

Lean is not about being skinny (don’t I know that).

Lean is not “mean” (although the words rhyme, unfortunately).

Lean does not mean cutting heads in the name of cutting costs (see “Lean is not mean”).

“Lean” is the set of management practices based on the Toyota Production System (TPS). The phrase “Lean Production” was coined by a group of MIT researchers who wrote the book The Machine That Changed the World What is Lean? lean.

Lean Production is basically the same thing as:

  • Lean Manufacturing
  • Lean Enterprise
  • Lean Thinking
  • Lean Healthcare
  • Lean Startups

Lean has been applied in manufacturing (factories, product design, and administrative functions) as well as service industries (including healthcare, banking, and government). The U.S. Army has an active “lean” program underway in 2006.


One way of defining Lean (“The Toyota Way” management system) has two parts:

  1. Eliminate waste and non-value-added activity (NVA) through continuous improvement
  2. Practice respect for people

The opposite of waste is value-added, which has a special lean definition. An activity is “value added” if, and only if, these three conditions are met:

  1. The customer must be willing to pay for the activity
  2. The activity must change the “form, fit, or function” of the product, making it closer to the end product that the customer wants and will pay for (in healthcare, this can mean moving the care process forward)
  3. The activity must be done right the first time.

I generally think of “value” in a patient care process to be the work that involves things like:

  • Comforting the patient
  • Examining them
  • Diagnosing them
  • Treating them
  • Educating them
  • Preventing future illness

“Respect for people” is much harder to define.  Lean isn’t about “being nice” and smiling all of the time. Respect means you challenge people to do their best because you believe in them and it also means that you collaborate and work together with them in improvement (the practice of “kaizen“). See this article about “respect for people in healthcare,” as well.

Lean leadership is about enabling and empowering people. Lean leadership is about helping people grow professionally and personally, allowing to take pride in their work. Lean leadership recognizes how a system operates (represented by the gears in the upper left). Lean leadership doesn’t set targets for people, go back to their office, and then yell at people when they don’t hit those targets. Lean leaders spend time coaching people. They spend very little time in their office. They lead people and see what is actually happening rather than managing metrics and reading reports.

Much of the “people side” of lean was adapted by the teachings of the American professor and consultant  W. Edwards Deming, who taught Toyota and other Japanese companies after World War II. Lean was also adapted from Toyota’s study of the early practices of Henry Ford and the Ford Motor Company. Note the emphasis on “early.” Lean is not strictly a Japanese invention, or is its use limited to Japan or Japanese companies.

Lean Resources and Reading

If you’re new to lean, welcome. I hope you’ll enjoy learning more about it.

You can also read about lean on the Wikipedia website. Here is a lean glossary, from our friend Bill Hanover.

Also, check out the Lean Enterprise Institute and their  “What is Lean?” pages.

Toyota’s Georgetown plant has a nice  Toyota Production System definitions page. Toyota’s corporate website has a nice set of TPS pages with some videos that explain core TPS concepts.

Please also check out my list of book recommendations on the left hand side of the page (scroll down). I also invite you to check out  my series of LeanBlog Podcasts, which include interviews with leading lean thinkers and writers.

Some other resources:

If you navigate the main menu of this blog, I also have links to many informative lean blogs, websites, books and videos. Check out my YouTube channel.

Some of my posts on core lean concepts:

This page is going to grow and evolve over time. It is hard to write a succinct definition of lean that captures all of its principles and philosophies (but here’s a post where we all tried).


Mark Graban 2011 Smaller What is Lean? leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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