What is Lean Sigma? Video from Johns Hopkins


Here is a short video from Johns Hopkins Medicine, a member of the Healthcare Value Network, an effort I help facilitate through the Lean Enterprise Institute. This video is from the Johns Hopkins Center for Innovation in Quality Patient Care.

I particularly like the comment about how, in a process, the average is what a hospital typically measures, but it's the variation that the customer (patient) experiences. That's a great argument for measuring variation in a process, whether you are formally using Six Sigma or not.

I've seen, for example, hospital laboratories not just measure the average turnaround time for test results, but some measure of variation, such as:

  • What percentage are completed in 60 minutes?
  • What is the standard deviation of the turnaround times?

Even once a process has been improved so the average is better (lower TAT for a lab, there are still often process improvement opportunities that allow you to decrease variation so everybody gets a high quality experience.

What are your thoughts on the video or the idea of reducing variation in a process?


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

  1. Dragan Bosnjak says

    The averages hide problems. Before using them you must have a stable process and use them not for the daily management but for other uses.
    What counts in daily work is the real time data which tells you exactly what is happening in the process

    Dragan Bosnjak

  2. Andrew Bishop says

    The video did a nice job of bringing the vocabulary of waste into a healthcare setting – a critical early step in learning. Whether people will really see waste in their own workplace without being taken by the hand to “go see” is another question. Interesting that you link to “Toast Kaizen” as a related post. The “Toast Kaizen” video is one of our basic tools teaching the vocabulary of waste.

    Also, the video is a nice introduction to the significance of reduction in variation. Without joining in the lean/six sigma chicken-or-the-egg argument, those of us focused on lean transformation should never forget that “variation is the enemy of quality” (quiz time: who said that?) With reduced variation the average becomes more representative of the experience and defects (or bad experiences) become less frequent without having to work on raising the average. Very interesting to see the discussion in the medical setting, where so much of quality is conceived of in qualitative terms, I expect. If it drives systems toward recognizing the quantitative side of patient experience (e.g., waiting time) it makes a lot of sense to me. I’d be interested in hearing more about the particular quantitative measures of process and quality they are developing and going after with these projects.

  3. Mark Graban says

    Hi Andrew – thanks for adding your comments. The “related posts” is generated automatically, seems like the software picked other posts with video in them. I *love* Toast Kaizen for healthcare settings, it’s a very effective and fun training tool, I’ve found. It introduces waste, then, like you said, the challenge is translating that to *your* work.

    Healthcare is actually working very hard to quantify quality. You have, on one hand, a huge effort to quantify “patient satisfaction,” normally related to service and experience. But, these surveys are often manipulated (subtlely pressuring patients to give the hospital high marks through posted signs, etc.).

    Then there’s the whole quantitative measure of care outcomes. ThedaCare and John Toussaint have been, for one, very involved in Wisconsin measurement efforts through this organization:


    Our Healthcare Value Leaders Network has representatives from each hospital working on apples-to-apples measures that show the impact of lean and process improvement on clinical outcomes. Look for more announcements this year.

    There are lots of efforts… but it’s still hard for the public to choose a surgeon or hospital based on, for example, who has the lowest infection rates post surgery? Lots of effort, but a long way to go.

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