Looking for Muda in Hospitals


Institute for Healthcare Improvement Article

This article from the IHI talks about the need to find “muda” (waste) in hospitals. They say:

“In the health care arena, not a patient among us — or nurse, receptionist, surgeon, physical therapist, attendant or executive — is immune from muda. It is so pervasive and deeply rooted in the machinery of care delivery that we expect it, become skilled at accommodating it, dutifully suffering the consequences.”

Yes. We have to help people in hospitals identify waste and to fix the root causes of the problems they fight every day. Too many people unfortunately define working around the system as “their job” instead of something that gets in the way of providing care to patients (or providing services that support those caregivers). People are fighting the same fires everyday — Lean helps them identify how to prevent the fire from coming back the next day.

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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. My wife is a PT at an ALF. I’m a Lean consultant and a certified Six Sigma Black Belt. My background is in aerospace and manufacturing. Right now I see all the waste in the facility and would love to go in and fix it. My wife complains about all the paperwork and ineffiecient runs on other processes.

  2. Hi Folks,

    We just welcomed a new baby into our family yesterday…#8. A beautiful 8lb 8oz. boy.

    My wife probably wouldn’t like me telling her about all the Lean improvements I have noticed in our local hospital since our previous child was born, but there are quite a few.

    For instance, there were several new (and very good) visual aids in use about proper hand-washing, dealing with sharps, soiled linens, reusable devices, etc.

    I also noticed significant improvements in the labeling and organization of various carts and supplies.

    Because this is a local hospital, and I know a couple of administrators there, I also know they haven’t begun any formal Lean implementation. That said, they know some Lean lingo, and how to apply waste reduction and Kaizen in various forms without a structured process.

    One of the administrators told me they weren’t “doing Lean,” but they had read about it, and knew of another hospital that was “doing lots of Lean.”

    It’s probably only a matter of time before they want more and more of a good thing. For now, they seem content to trickle along with a little improvement here and there; but I think that will change.

    It strikes me how much people can do after a little reading, seeing a few examples, and taking action.

    All the Best,


  3. Congratulations on your baby.

    I’m glad hospitals are using lean methods, but I hope they move beyond “doing lean.” Doing lean instead of focusing on your business improvement can lead to problems. I hope hospitals don’t just use lean tools.

    One other question — is posting a bunch of signs really good enough? Posting signs about washing hands… who is supervising the people and the process?

  4. You know, I’ve been part of the “Lean Tools” vs. “Lean Program” vs. “Lean System” etc. debate for a long time.

    For me, it comes down to this; ya gotta start somewhere.

    Even the companies that start off just using “Lean Tools” realize genuine benefits. I say “Go for it!”

    People, and companies, typically do more of what works for them. It is not unnatural or wrong to dip your company’s toe into the Lean waters by implementing SMED, TPM, 5S, and the like, and seeing what happens.

    I find that is often how initial Lean successes are realized, and long-term, “REAL” commitment to “Big-Picture Lean” is generated.

    The point is…a “Culture of Continuous Improvement” is cultivated through commitment and successes over time.

    Eventually, Lean will touch / influence every aspect of a business, but it all starts with a few good “wins,” (often from taking a “leap of faith,”) and a little experimentation.

    In 12 years of consulting, I have helped companies implement “Lean Tools” and “Lean Systems” and a few “Hybrids” for that matter.

    Can you “screw-up” a Lean transformation? Sure you can, but I don’t generally find failures to be the results of implementing “Lean Tools” vs. a “Lean System,” rather, a lack of committed and visionary leadership.

    I know I have not covered every possible argument here, so I realize some will be critical of these comments. That’s ok by me. “Anal Lean” I am not! ; – )

    All the Best,


  5. Good point, Bill. As much as people rail against the “Tool Heads,” tools are indeed necessary. You can’t just focus on culture change alone. Toyota illustrates their system as the combination of technical (tools), philosophy, and managerial methods. It takes all three together.

  6. I did a presentation for a local conference last week about how to start Lean in a non-factory environment, and I used health care as an example. Though many of the presentation evaluations were positive, I had several who said “why didn’t you talk more about the tools, and less about culture?” We’re still battling the perception that “Lean equals tools”, so every chance I get, I speak about the organization’s culture/environment/leadership as a must-have for Lean success.

  7. Dean – I wonder if you’re from my state? I too attended a local 1-day conference last week. There, unfortunately, I felt the speakers knew less about Lean than I do, and most of them had less experience with Lean (maybe I should get into the conference arena!)

    Almost as a theme to the case studies and presenters, everyone used the tools but really lacked the culture. To a company, each case study group now said they are attempting to go back and instill the culture.

    My opinion, and it is an opinion only, is that tools can be a great way to introduce Lean to a business. However, there are risks. If the tools only are introduced, you will achieve short-term success at the expense of being labeled “flavor-of-the-day”. Also, the tools have to be introduced in such a way as to breed responsibility into the lowest level of the organization. If I force tools down someone’s throat, I’m no better off than before.

    I think the value of those tools can only be realized in combination with cultural improvement. That improvement needs to be fostered either during or IMMEDIATELY after the introduction of the tools. Too many companies wait too long to foster the cultural change.

    Last opinion, management’s actions must support both the tools and the culture you are trying to establish. Managers can say whatever they want, but subordinates will view their actions as the true path. That’s the difference between managers and leaders.

    Regardless, Bill – you are right, “ya gotta start somewhere.”


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