Joint Commission to Investigate Use of Lean & Six Sigma


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For those not in healthcare, the Joint Commission is a non-profit hospital accreditation organization. You might remember that Paul Levy and Beth Israel Deaconess Hospital posted their full Joint Commission report online last year. They conduct assessments and make recommendations that are supposed to help improve safety and quality. They are also pretty universally complained about in response to their sometimes heavy-handed mandates that are forced on hospitals and caregivers.

From the articles:

The Joint Commission is studying how to implement quality processes such as Lean and Six Sigma into its business functions as a way to improve internal operations.

Throughout the rest of the year, the commission will explore training opportunities and start to develop programs that embed processes into daily routine, said Mark Chassin, physician president of the accrediting body. Changes will be implemented across the organization, including Joint Commission Resources and Joint Commission International. An ongoing challenge is to ensure that standards are effective, Chassin said. The commission's obligation is to maintain the “highest confidence” that its standards effect change, and applying processes that have been successful in other industries to its own practices will advance that goal, he said. “When you improve on our measures, health outcomes will improve directly as a result.”

In addition, the commission will determine if its next generation of standards might also include an assessment of how well healthcare facilities are using similar quality processes, said Chassin, who gave a keynote speech to open a Joint Commission International standards practicum in Chicago today. About 100 people from around the world are studying the commission's international standards during the practicum, which is continuing all week.

That's all well and good that they want to use Lean internally. Lean methods can apply to any process, including internal office processes for an organization. I won't begrudge them that.

But, I do wish the Joint Commission would start by doing more to promote Lean methods IN HOSPITALS. I'm not an expert on the Joint Commission. They do require the use of “time outs” and other standard protocols that you could argue are in keeping with Lean princples. A search of their web page shows one blurb about how Lean can help in healthcare:

But waste in health care is vividly apparent, and its potential reduction is actionable at various levels. Opportunity areas include systems redesign in health care organizations, such as through adoption of the Toyota Lean methodology; implementation of electronic health records; placing evidence-based limitations on the deployment and use of new technologies; and payment system reform. Virtually all of these opportunities create corresponding new opportunities to improve patient safety and health care quality.

The page reeks of them forming a committee to study the issue… they'll get back to us. But those in the know realize that Lean *does* work and requires more action than study at this point.

To my healthcare readers — what are your impressions about the Joint Commission and Lean? Could they do more to help promote Lean methods?

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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. On the surface, it looks like it could be a blessing and a curse. The blessing: having JCAHO recognize and legitimize our improvement techniques. The curse: getting “help” on a possible regulatory manner. My hope is that as JCAHO “studies” continuous improvement, they engage those who have been successful and gain some unerstanding that Lean and Six Sigma are not “cookie-cutter” programs that can be mandated and implemented in a dictated way. And that the results are what matter, not which tools and techniques are being used. My hope is that the “blessing” outweighs the “curse” and that the involvement of JCAHO results in positive change.

  2. I hope this will be a good thing. Currently Joint Commission gives you not only the goals but also a process to implement. Because the solution was not developed internally, there is no buy in from the staff and no learning from development. Also they provide little leeway for developing a better process. For instance, surgical “time outs”. If a better process is developed for ensuring correct patient, side, and procedure; they would still expect the “time out” to be done.

    Joint Commission plays a great role in encouraging a higher level of care. I hope their adoption of lean and six sigma ideas will encourage others throughout healthcare recognize the value in a systematic approach to improvement.

  3. I think it is unlikely that the Joint Commission will disparage Lean or Six Sigma methodologies. They have been proven to be effective time and again.


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