We’re ALL Done With Batching?


I'm watching a web presentation on improving patient flow from the Institute for Healthcare Improvement (IHI). I'm doing lean healthcare work now and the IHI is an excellent resource, including Steve Spear, formerly of Harvard (and referenced by Mike Lopez earlier).

In the presentation, a medical doctor is talking about improving flow and reducing batching in the patient discharge process. He's generalizing, but he says:

“Industry no longer uses the batch concept. They no longer use the batch concept because it's inefficient, costly, and it doesn't take into consideration demand and capacity.”

Well, I'm glad that battle has been won ;-) Many factories and managers in the industrial world are still addicted to batches and addicted to their excuses for having them. Are you beyond batches? Or still addicted?

Some hospitals are adding a step to the discharge process, a “discharge lounge.” That sounds like yet another waiting room, but at the end of the process. The Cleveland Clinic has a brochure that talks about their waiting, I mean discharge, lounge. They go on to claim the process is “STREAMLINED” (their word, my shouting) by discharging ALL patients at 11 AM.

That's a huge batch process and, as the doctor from IHI would point out, that does not streamline the process. That batch process does not move the hospital and patients toward continuous flow. The IHI seminar is rightly arguing that hospitals need more continuous flow, not more batching.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. A couple of weeks ago, I attended a presentation by Martin Tobias, CEO of Seattle Biodiesel. The company is a pioneer in the production of biodiesel in the Pacific Northwest.

    In my chemical engineering thesis(1991)I had to design a continuous process for the production of biodiesel. So, I was quite interested in hearing from Mr. Tobias’company.

    I was very surprised to hear that Seattle Biodiesel is currently using a batch process to produce biodiesel. I asked Mr. Tobias if the company had any plans to convert into a continuous process.

    I was surprised to hear that the idea of a continuous process is not being considered.

  2. I got a note from a healthcare person who said “don’t give up on us.” I haven’t, trust me. There is so much opportunity in healthcare and the rewards are so satisfying, the opportunity to impact patient care and people’s lives. I transitioned from manufacturing to healthcare improvement last year, I might never go back.

  3. other than Virginia Mason’s hyperbaric chamber example, do you know of any practical examples of lean in healthcare?

  4. A significant number of patients that are discharged spend innumerable hours waiting in their beds for a ride home. Moving them from an acute care area to a waiting area is probably the best option (unless your facility would care to provide free transport) Even the best run factories have areas where they stockpile completed goods for transport. Isn’t a “discharge lounge” basically the same thing?


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