St. Louis Paper Features Lean at Barnes-Jewish Hospital


St. LouisJust before the new year, the St. Louis Post-Dispatch featured the Lean efforts at Barnes-Jewish Hospital (“St. Louis hospital among handful using efficiency to aid patients“). I think it's more than a “handful” of hospitals around the world using Lean (based on this map), but it's nice to see them featured – you might remember my Podcast with Dr. David Jaques from Barnes-Jewish.

Barnes-Jewish is also a member of the Healthcare Value Leaders Network efforts I'm involved with.

I'll give a hat tip to the writer for this insight, the emphasis mine:

“Like a few others across the country, Barnes-Jewish has embraced a novel approach to “patient-centered care.” Though that might sound like empty jargon — what else would any good hospital “center” on? — the name represents a systematic, data-driven process organizing functions across the hospital, from surgery to the emergency room to intensive care.”

Sadly, things are often organized around the physicians or the hospital itself… Lean is inherently and rabidly customer focused and that extends to Lean hospitals re-emphasizing their emphasis on the patient and their families.

Why use Lean for this focus?

“We want to hard-wire safety, quality and service through our processes,” said Dr. John Lynch, vice president and chief medical officer. “We don't want to leave anything to chance. … It's one of the ways we're trying to control the cost of health care.”

The article talks about their use of Lean methods and phrases that are probably familiar to you: value stream maps and a multitude of Japanese words, like kaizen and kanban (these things always sound odd to the newspaper reporters who get a peek into Lean).

Again, from the article:

Barnes-Jewish officials, who first started exploring such management principals about five years ago, say the effort has already paid off: Streamlining its preparations for surgery — just one facet of a larger strategy — saved about $1 million this year, hospital officials said. In another example, standardizing the installation of patients' intravenous lines, Lynch said, lowered the hospital's central line bloodstream infection rate by 40 percent in the last year.

Another case where standardized work benefits patients and the hospitals (not to mention how it benefits the staff, who feel better because patients aren't getting as many infections). The article also cites reductions in bed sores and the use of mistake proofing methods to improve quality.

Is standardization bad for healthcare? Not according to Barnes-Jewish (and I agree with their approach):

“Some people talk about cookie-cutter medicine,” Lynch said, “but we only use standardization when it makes sense.”

Comparing the hospital to a motor vehicle assembly line, he said, misses the point.

“We're more like a body shop, where every car comes in with its own problems,” he said. “We always allow room for individual patient variation. We're not telling the surgeon where to cut.”

A favorite healthcare author of mine, Charles Kenney, is quoted in the article:

“It takes a lot of courage for people at a hospital with a lot of challenges to go down this road,” said Charles Kenney, author of “Transforming Health Care,” a new book that chronicles Virginia Mason's efforts. “You expose yourself to greater scrutiny and potential ridicule. But in the cases I know, it pays off.”

There are other details in the article, including a discussion of freeing up nursing time for patient care. Take a read, check out their pictures, and leave your comments here. As always, the news site's comments are interesting, including one person who says that Lean, for their hospital, became all about profits. That would be, of course, “L.A.M.E.” not Lean. Lean – at Toyota or at hospitals like ThedaCare, is about a balanced set of measures – Safety, Quality, Delivery/Time, Cost, and Morale.

Creative Commons License photo credit: Claudia Castro


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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. Anonymous says

    Kudos to Barnes Jewish for taking the lean leap. Ironically the only photo in the web article is of a sterile processing technician BATCHING surgical hemostats. Maybe Barnes Jewish doesn’t understand the concept of 1×1 flow. It is all part of the journey.

    1. Mark Graban says

      Batching…. waiting…. sorting = waste.

      But I’m sure they will get there…

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