A Week of Lean and Patient Involvement at BIDMC


I had the opportunity to finally meet “e-Patient Dave” at the HIMSS conference about 10 days ago, where he spoke on the topic of patient involvement and the patient's right to their own medical data. As  he describes on his website, Dave beat stage 4 kidney cancer, thanks to clinicians and staff at Boston's Beth Israel  Deaconess  Medical Center, where Paul Levy (of the “Running a Hospital” blog) is CEO. Dave is a frequent commenter on Paul's blog, which is where I first ran across him.  Dave and Paul share connections back to their days at MIT.

This week, BIDMC has been holding their annual Lean and Quality Improvement Retreat, a week of training and exercises held primarily for residents (along with nurses and some managers and staff). What a great investment of time and what a great educational opportunity — here is one at example, at least, that runs counter to the  report this week from Lucian Leape that medical schools aren't doing enough to teach patient safety concepts and team skills.

Dave and I were both able to participate, in different ways, in that retreat this week…

I was able to be there Monday morning, to see and hear some of the introductory Lean discussion and the questions that the residents had about Lean. I also gave a talk about Lean over their working lunch.

e-Patient Dave was there for the whole week. In fact, he was one of TWO patients who participated in the learning, discussion, and value stream analysis activities. Here's a picture of the two of us, at left.

Since Lean is a very customer-focused philosophy, it's really outstanding that BIDMC has real patient voices involved here, actively participating. Other healthcare organizations, like ThedaCare, have patients directly participating in week-long kaizen events – another best practice, I'd say.

Dave blogged about each day of the retreat. I'm going to share the links and invite you read and comment, either here or on Dave's blog. I've had a few good chats with Dave – he's very  enthusiastic  about Lean because it's patient-focused and he's the type of guy who is just wired in a way where Lean makes sense. It's intuitive based on his previous business career – but now Dave is a full-time advocate for patients and “e-patients.” Check out his site, as he has a lot of videos and presentations, including “Gimme my damn data.”

And I'm sure there will be a post for the final day today, I'll add that here, as well.

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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. It’s encouraging to ready e-patient Dave’s reports and see what look like good training sessions introducing lean to developing medical professionals. It would be great to hear follow up from the hospital workplace as lessons are applied.

    Knowing (from all we’ve read here and elsewhere) that BIDMC is genuinely engaged in organizational transformation I expect this workshop will lead to something important at the hospital and (possibly more significantly) in the the future workplaces of the residents exposed to the training. That people who will ultimately be practicing medicine elsewhere and can take this learning with them were part of the training is important. BIDMC is not just working on itself. If these lessons are well learned and practiced it is helping to nurture improvement in healthcare in a broader sphere.

    Is it possible to carry this a step further and teach it in medical schools? What could lead to that change? What are the barriers?

  2. Andrew – as for medical schools… John Toussaint sort of addresses this on his blog:


    John is trying to change this and influence the medical schools, he describes some of the problem:

    For example, the fact that professors of medicine are allowed to berate,belittle, and attack medical students in public forums is appalling. It is fundamentally disrespectful and it fosters ill will and a culture of hiding mistakes. We all have our stories of this behavior manifested in our teachers. How many of us had teachers that encouraged us to discuss our mistakes or taught us how to solve a problem or root cause an error. In 4 years of medical school it never happened once to me.

    Seems like a lot of room for improvement in this regard.


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