Exec from Seattle Children’s on Lean Healthcare in the Washington Post


    Patrick Hagan: Waste Not, Want Not: The Key to Reducing Costs – washingtonpost.com

    Here is an outstanding piece from the President & Chief Operating Officer of Seattle Children's Hospital, Pat Hagan. Coincidentally, I just recorded a podcast today with Joan Wellman, a Lean healthcare consultant who helped get them going on their journey.

    I had a chance to visit Seattle Children's earlier this summer and I was very impressed with what I saw and heard. This is the real deal, one of the top Lean hospitals in the U.S., if not the world. It's great that one of their leaders would help spread the word about healthcare process improvement during all of this debate about insurance reform.

    The results that Hagan cites from Seattle Children's are impressive, including:

    • “Patient days on ventilators have been safely reduced by 26 percent” (which reduces risks of infection)
    • Saving $2.5 million on supplies in the first year alone
    • “Reduced cardiac surgical site infections and hospital-acquired blood stream infection rates by 50 percent in just three years”
    • “Seattle Children's has reduced direct per-patient costs by 3.7 percent”

    In his piece, Hagan references Toyota and a number of Lean management methods, including:

    • Standardized work
    • Error proofing
    • Visual management

    He perfectly sums up the idea that Lean concepts are easy to understand, but hard to instill into an organization:

    These results came from standardizing the way dressings are changed, central lines are managed and medication is administered. Simple, straightforward and very hard work.

    The management side — the discipline and attention that's required, the leadership that's involved… that's much tougher than just putting tools in place. Seattle Children's has been working at this for more than ten years — very impressive.

    As always, the reader comments (now closed) are interesting. There's the usual mix of praise for ThedaCare (from one reader who is a patient there), political shouting, a comment that people shouldn't be treated like car bumpers, and a final question asking how Hagan could claim 95% of healthcare activity is waste but they only reduced 3.7% of cost.

    1. I think there's a difference between “activity” and “cost”
    2. A good deal of the “waste” is required in the current system and can't be eliminated
    3. I think 95% is a very high estimate. That's the only thing I could take issue with in the piece. Dr. Don Berwick from IHI says 30 to 40% of what we do in healthcare is waste. I've heard others say 30 to 50%. 95% of the time in some processes (as percent of cycle time, length of stay, or turnaround time) is waste, but not necessarily 95% of the hospital's labor activity (including management and overhead).

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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. Thanks for the comments on the article. Lean is a very exciting addition to the healthcare arena and will drive quality to continue to be a focal point, even in these times of cost reduction.

    2. I think that Pat Hagan is using Value Added vs. Non Value Added time as his measure of waste in Healthcare. By this metric, there are very few businesses which have more than 5% Value Added (or less than 95% waste). The only value added in healthcare is in the time spent in the correct diagnosis and successful treatment of medical conditions. This is a very small fraction of the total time. All the rest is waste.


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