Hospitals and Lean


STLtoday – Business – Story

Here is an overview and general awareness article from the St. Louis paper. It's always nice to see lean (and lean healthcare) in the general media.

The goal is to map out and retool processes to save time and money while improving patient satisfaction. “What we're trying to do is look at every component of the patients' experience,” said Steve Lipstein, chief executive of BJC HealthCare. “One of the things that frustrates people about the American health care system is how long they have to wait for it.”

The processes examined can be as specific as how many steps a nurse must take to reach a medicine cart or a patient's chart.

The article is right — lean in healthcare is about reducing waste from the patient perspective (waiting time, errors, and cost) and from the employee perspective. Lean is about improving service, not just reducing cost, and the article gets that right. The article, unfortunately, misses the quality component of lean, making sure things get done right the first time.

One of my pet peeves is how the media downplays the complexity of manufacturing and we see it yet again. Yes, there is some sensitivity required to bring practices in from outside the healthcare world — hospitals ARE different than factories. But, especially from the people side, hospitals are more like factories than not.

The article says:

Redford and others said applying manufacturing techniques to health care requires some finesse. Standardization, for example, is a theme throughout lean manufacturing and Six Sigma.

However, setting up uniform processes is more difficult in health care because it involves unique individuals rather than identical widgets. So the focus is on making sure patients receive evidence-based medicine, or treatments and tests research has proven work best.

“We're not making every car alike — every patient is different,” Redford said. “That's the negative. The positive is there's so much opportunity to make improvements.”

How many of you work in factories that simply crank out “identical widgets?” Even if you work at Toyota, you're not cranking out identical cars. Is there more variation in terms of the healthcare “product”? Sure, but that doesn't mean that all of underlying hospital processes have as much variation as there is in the product (the patient).

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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. Mark,

    I couldn’t agree with you more!

    I used to come from a financial services company in the UK (Lloyds TSB) and we managed to do some great Lean improvement even though it’s not like the original manufacturing type lean environment. Now I am consulting for a little company in Spain (Kairos Management) and we are fortunate enough to have great variety of customers, most of them from manufacturing. In both of these jobs I have never seen a process with no variation in the product produced or service rendered (I am not talking about quality variation here, of course).

    Yes, it may be true that variation in widget processing and product requirements in health care is naturally high, but that doesn’t mean that a major part of Lean Toolbox doesn’t work. What’s more, Lean is not just the aforementioned toolbox, it’s the culture behind it that delivers the greatest results.

    I have been observing the health care sector across Europe for some time and it is great to see that slowly recognition is creeping up that things CAN be done better. From my perspective, having experiences and done lean in some completely different environments, I don’t see any reason why it couldn’t be done.

    And what would be so bad if nurses and doctors would have more actual time for their patients and if patients could concentrate on healing and minimizing the time they are taken out of their work, private and family lives?

    Finally, I truly enjoy reading the lean blog and others and your, sometimes opiniated (but it isn’t this point), entries. Keep it up!

  2. Here in the UK the NHS needs to look beyond setting targets and budgets in attempt to improve performance. Two recipes for fixing the NHS have been on offer in the media recently. Sir Gerry Robinson’s attempt to galvanise Rotherham General Hospital was rather like a reality TV show, and his idea that one brilliant manager can get the service into shape is dangerous and deluded. Far more encouraging was Peter Day’s In Business programme on Radio 4, which asked the seemingly unlikely question of whether Toyota’s production principles could be applied to healthcare. Rather than seeking efficiency by speeding up individual activities, adopting the Toyota approach ensures that the focus is on improving the flow throughout the whole system, concentrating rigorously on customer demand. This system flies in the face of the current policy of fragmenting the NHS and hiving out activities to private companies. But it demonstrates that large size is no barrier to efficiency. This leaflet elaborates further:

    Rob (lean) (six sigma)


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