Lame Survey about Lean in Healthcare?


Hospitals See Benefits of Lean and Six Sigma

Regular readers know I often write about what I termed “L.A.M.E.” — Lean as Misguidedly Executed. The ASQ (American Society for Quality) survey that I linked to at the top probably just qualifies as “lame” (not the cute acronym) — poorly done or ineffective.

When I first saw the summary for the survey (thanks to Pete, who forwarded it from Twitter), I was thrilled. 50% of hospitals are using Lean methods?? Really? If so, that's great! Previous surveys I've seen indicated that 20% of hospitals were using Lean methods. I'm not sure if I believe the ASQ numbers.

One problem with surveys like these is questions about the definition of “using Lean” or “implementing Lean.” It can run the gamut from a hospital like ThedaCare that's using Lean throughout the hospital to those who are just tinkering around with 5S.

The other problem with surveys is getting a good sample size. There are over 5,000 hospitals in the U.S. alone. I've done some online surveys and have always labeled them as such — unscientific online surveys. The ASQ survey, as it turns out, is just an online survey that 77 hospitals responded to. So there's bound to be self-selection error. It's like asking readers of “Cat Fancy” magazine if they like calicos (no, I don't have a cat or read that magazine…)

So the ASQ write up says:

Hospitals across the United States are beginning to embrace lean and Six Sigma business management strategies in attempts to reduce costs and improve productivity, according to a new national benchmarking study by ASQ.

Cost and productivity are fine, but what about… QUALITY? This is the American Society for Quality, not the ASCC (American Society for Cost Cutting).

While applied in manufacturing extensively—and applicable to all industries—these management methods have moved into healthcare recently, but with little substantive data available for hospitals to assess the worth of the methods.

Now this is just lazy on the ASQ's part. What's lacking is good data on the percentages of Lean adoption around the world. Data on the benefits and the worth of Lean healthcare are abundant, if you just looked. There have been many articles lately about ThedaCare and how they've saved
$27 million over the past few years, while also improving quality.

According to the ASQ study, 53 percent of hospitals report some level (“minor,” “moderate” or “full”) of lean deployment, and 42 percent of hospitals report some level of Six Sigma deployment. Few hospitals participating in the study report “full deployment” of either lean (4 percent of hospitals) or Six Sigma (8 percent). The reasons that neither method has been deployed in hospitals include: the need for resources (59 percent of hospitals), lack of information (41 percent), and leadership buy-in (30 percent). Eleven percent of hospitals surveyed were not familiar with either method.

It's hard for me to give a better estimate. Although I work with many hospitals, it's also a self selecting group (those who have hired a consultant or those who are considering it). What do you think about the reasons given for NOT deploying Lean? Lack of resources, information, or leadership? Aren't the first two caused by a lack of leadership?

For those of you in healthcare, do you think 11% of hospitals are, at this point, unaware of Lean OR Six Sigma?

I really wish people wouldn't call Lean “cost cutting” tools (again, especially in a “Quality” publication):

…[says] James Levett, chair of ASQ's Healthcare Division and chief medical officer for the Physicians' Clinic of Iowa. “This study indicates that many healthcare systems are still in the ‘infancy stage' when it comes to using these vital cost-cutting tools.”

Now, to the be fair, the survey does show that just over 50% of respondents said they were using Lean or Six Sigma for improving quality (you can see that at the ASQ web page I've linked to up top). Good, recognizing quality, but why not focus on that earlier? Again, you are a quality society. Puzzling.

Anyway, I've quoted them enough, so you can also visit the ASQ website to see their take, in a statistically insignificant way, on where hospitals are using Lean and Six Sigma. At least they finally admit the statistically questionable results — you'd expect better from a statistical quality society?

While the data returned is for a small sample of hospitals that have actually deployed Six Sigma and lean (and, thus, statistically has a wide margin of error), it nonetheless provides a starting benchmark for the industry for location of efforts and potential for returns.

The survey's not much better than anecdotal data. Lame, but better than nothing.

One other question — do you believe self-reported Lean success rates of 95 or 100%?

Hospitals deploying in the following areas report the following success rates:

Clinical success (“somewhat” or “highly” successful)

  • Lean: Operating rooms (95 percent of hospitals) and emergency rooms (86 percent)
  • Six Sigma: Operating room (95 percent) and in-patient areas not including mental health, rehab or ICU (95 percent)

As Jim Womack likes to say, if what you're doing seems easy, you aren't really doing Lean. My colleagues have always reported that doing Lean work in the O.R. is very challenging. Does a 95% success rate imply that the hospitals are just tinkering around the edges and calling that success? I don't think manufacturers have ever had 95% success rates with Lean…

For those readers from healthcare, what number would you guess for what percentage of hospitals are trying Lean in your country?

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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. To me, this survey is not unlike many others I’ve seen in manufacturing – many say they are “doing” Lean or Six Sigma, but few say they have “full deployment”, whatever that means. As those of us who do this for a living know, the more we learn, the less “deployed” we think our organizations are. In Iowa, we have many hospitals trying the Lean methods and philosophies, but I would say that few of them are using the philosophy in all areas of the facility. On the other hand, we also know that Lean is expanding in health care, which is good news for us all. My guess is that we will go through the same type of transition (maybe even slower) than our manufacturing bretheren did when Lean first became popular.


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