A Lean Hospital Example in Houston


St. Luke's adopts business approach to efficiency | Houston Chronicle

Here's a nice case study / profile article in the news about St. Luke's Episcopal Hospital in Houston, Texas.

The first photo caption has a great example of using Lean to improve patient care:

“Studies show us time and again if you walk into the emergency room with chest pains there's a 90-minute window where you get the best outcome … This lean system has helped us hit that target every time now for 10 months.

Dr. David Pate, the CEO of the hospital, touches on some really key points, including the need to improve value streams instead of just suboptimizing departments:

First, it's important to understand the whole system. We map everything that happens to patients. Then we want to identify and eliminate all the bottlenecks and wasteful processes.

We don't want to optimize departments. If I put pressure on the cath lab people to make it the most efficient and profitable it can be, their cost-cutting will cause problems in another unit. We won't have the staffing we need to give people great care no matter what time of day they come in.

So optimizing a department is useless. What we need is the ER and the cath lab working together as fast and best as they can. (Doctors in the cath lab run a line through a blood vessel and to a patient's heart to diagnose and possibly treat blockages.)

He talks about the “customers” in the system:

We're shifting the whole model. We used to build everything around what worked for the caregivers. Now we make it work for us (the hospital generally) and the patient.

Our customer is the patient and, in many cases, our secondary customer is the physician. You know, they could choose to practice anywhere. So it takes lot of work to bring physicians on board, but our physicians have stepped up. In fact, they're the reason this is working.

The article also touches on Lean methods including eliminating wasteful steps in processes and using 5S to improve organization of supplies and equipment.

Why should a nurse have to leave a patient's room to go down the hallway to get tape for the IV when we know that will be needed every time? Now every room is set up with specific supply drawers. What is stocked is uniform.

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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. I really would like to see hospitals embrace the systems that they pay big bucks for (Lean Six Sigma) and not only utilize them to their fullest but to nurture and add to them over the long haul. Unfortunately, once the consultants/trainers leave the systems tend to deteriorate, stall or become forgotten until some other Flavor of the Industry comes in to replace it.

    I think the only way that these system can stay in place is to start to develop better software to integrate with the exisiting systems inside the hospitals. Not just spreadsheets but robust applications that assist hospitals in the whole Lean Six Sigma initiative and can help monitor and help identify areas of improvement and cost management over the long run. With software like this then they can become MISSION CRITICAL and not just something that could or can be brushed aside if something else comes along.

    Would a hospital brush aside their ERP system or Surgery Management System, no way! Why not, because they are mission critical.

    Keep up the good work Mark!

  2. Bobhere – you sound like an ERP software salesperson. I’d agree that hospitals should make a committment to Lean and Six Sigma. How, do tell, would a software platform create leadership committment or attention span? How can software make up for the failings of poor leadership??? Has this ever worked in factories? Why would you expect that to work in hospitals? I hope you’d tell us more.

  3. Neutron…actually a 17 year healthcare supply chain consultant.

    As for how would software create leadership or attention span, well that is tough in any marketplace including healthcare. I would say that is the biggest challenge. Who is to say that when you implement the Lean or Six Sigma program (with your customers) that you really had any commitment (leadership from the client) to the program in the first place. When we implement programs I sometimes wonder if we the consultants/trainers are the leaders who are committed to the program and it is our due diligence that keeps the Lean or supply chain consulting programs on-track. Because we have to guarantee results and performance improvements, basically we use our battle proven project management skills to keep our Lean Six Sigma programs rolling. But what really happens when we go away?

    Now with that said, I find it hard to get the technology and the mindset to TRANSFER to our customers fully accomplished. Yes they will keep the Lean or Six Sigma program going yet you will see old habits fall back into place. These old habits can be prevented by Lean and Six Sigma aligned Software that will model the processes and systems (congruent) with what each consultant is teaching.

    Bob Yokl

  4. Bob – let me chime in, as someone who does Lean work in hospitals.

    I’m not seeing, either, the point about software. Hospitals have the equivalent of ERP systems, Hospital Information Systems, like Cerner or Epic. I’ve never seen or heard of anything in that software that supports Lean or would help with sustainment.

    As for the sustainment challenge, I think a reputable consultant would make sure there is leadership commitment to Lean. I don’t want to do work that doesn’t sustain, that’s a waste of time and it’s bad for the Lean movement. As consultants, we have to teach leaders how to sustain Lean methods. We have to teach them to spend time in the “gemba”, observing processes to see if things are happening the way they should.

    If they can’t do that, it’s ultimately their responsibility. But, we have to teach them.

  5. Mark, what I am saying is that we NEED Software that supports Lean and all the tools, systems and methodologies that are becoming popular…not spreadsheets… real database driven applications… 90% of hospital information management programs are transactionally based, meaning they only handle their own respective transactions.

  6. I get what bobhere is wishing for, but I think that he’s missing the point that a premature deployment of any process management software tends to “harden the arteries” of any system, adding a complication to further continuous improvement (and the wider the scope of the software, the bigger the complications).

    Mark and Neutron are correct in pointing out that the the deterioration that bobhere lamented can be laid squarely at the door of the organization’s top leader(s) and their lack of commitment to a true lean transformation.

    None of this is to say that software systems can’t be useful for process management–I’d just recommend delaying that step for as many CI cycles as is possible (ideally not until you’ve got your full value chain rationalized) and keep the software architecture modularized as much as possible (to reduce the inertia that monolithic systems impose).

    But the bottom line issue is still the lack of leadership.

  7. I remember an acronym I found years ago: U.S.A.

    U – Understand – map, observe, root-cause analysis
    S – Simplify – improve flow, connections, work structure
    A – Automate – only after Understanding and Simplifying to remove waste should an organization automate. Failing to simplify before automation merely automates waste.

    I can see where this could easily relate to software.


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