Talk Preview – “Why Your Hospital Should be Like a Factory… Or At Least Some…”


When hospital people say they don't want to be a factory or “we don't want assembly-line medicine,” the statement often goes unchallenged. What is the statement or the anxiety behind such a statement? I sometimes challenge in a friendly way and ask who in a healthcare audience has ever been a factory. The answer, usually, is not many.

People fear or assume that a factory is a cold, heartless, mindless, monotonous, repetitive, dirty, unsafe place where robots dominate and stupid people are treated shabbily. This perception may have been true in the past and pop culture references reinforce that factories are generally nasty places to work, including:

And we had this WIRED Magazine factory bashing (they didn't print my letter to the editor after initially asking for my contact info).

In my talk, I set the stage that, of course, not all factories are terrible workplaces. I share examples like Toyota, Alcoa, FastCap, VIBCO, and Autoliv (the last two being factories where I've toured with healthcare leaders who learned a lot of great lessons about a quality and improvement culture).

I'm glad that a growing number of hospitals are open to learning from manufacturing, aviation, and other industries. This mindset change is still very much a work in progress and many healthcare organizations still say “only those with healthcare experience need apply.” There are, though, many job postings out there  from hospitals that WANT to hire those with Lean manufacturing experience.

Factories are, from my experience, very people-driven places, even when there are robots. They are socio-technical environments, often with a heavy focus on the social and political. Great factories treat everybody with respect (see Toyota's “Respect for People” principle). “The factory is not just a big machine,” as Paul says in the video with Dr. Wei.

So what are some of the Lean Mindsets (an earlier talk of mine) that can be learned and transferred from manufacturing to healthcare? Some of the aspects of a Lean factory that CAN benefit healthcare (without doing something silly like putting an operating room table on a moving line):

I'm not trying to say all factories are great (I worked in some bad ones) and I'm not saying healthcare should blindly copy from factories. But the reality in many cases is that factories can be more customer-focused (John Toussaint says that the Ariens snowblower factory treated their products better than the hospital treated patients) and factories can be great workplaces where the employee engagement and empowerment is often far higher than hospitals.

We can change the culture and approach in healthcare – combining newly developing operational excellence with the strong tradition of clinical and technical excellence. Lean helps hospitals EXCEL at what they want to be  – caring environments that provide the best patient care.

What are your thoughts and reactions, as a manufacturing reader or a healthcare reader? I can post more notes and thoughts after the talk too.

Here is a collection of links referenced in my talk at today's World Congress Leadership Summit on Process Improvement in Healthcare: “Why Your Hospital Should be Like a Factory… Or At Least Some…

The links below are for the benefit of the audience (to dig deeper into some slides and to see some videos I won't be showing), and it maybe provides some interesting reading and viewing for you…
Factory Imagery Videos: (Chaplin, I Love Lucy, Family Guy):

“Lean and Loving” in Dutch Healthcare:

ThedaCare “Nurse Server” Video:

Rightsized Capacity in Sweden:

Park Nicollet Cancer Center:

Paul Akers, from FastCap, shared a video he shot with a visiting physician. I might not have time to share the whole video during my talk, but take a look:

A second video with reflections from a doctor who visited FastCap:

VIBCO President Karl Wadensten on hosting visitors from healthcare:

Comments from healthcare visitors to VIBCO:

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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. In ThedaCare’s book On the Mend Dr. Toussaint describes the ThedaCare leadership team’s first visit to Ariens, a company that makes lawncare and snow removal equipment. They were very impressed with the goings on and in the book he commented how impressed they were and how the snowblowers were treated in many cases better than the patients they treated. I think it would be interesting to hear him explain on that but certainly the defect rate with snowblowers would likely be lower and there would be less delays. A senior leader in my own organization recently said to our leadership group that 98% quality (20,000 defects per million) in meeting CMS measures in no longer acceptable. This is in 2011! Healthcare has a long way to go. I wonder how many hospital CEOs would admit that there are likely factories down the road that treat their products better than their own organizations treat their patients.

  2. Having worked factory lines for many summers and healthcare for a while, there are parallels and differences, both can be respected and both can/should be improved.

    And having recently gone through some lean training (that did not emphasize respect of the worker and work, enough for me) the facilitator did the TPS factory model and then asked us visualize the hospital service delivery in the same way. Perhaps he had it backwards.

    What if you ask the audience to tell you what the sequence of healthcare service steps are, what is the patient’s condition prior to admission and (hopefully) at time of discharge. Graphically, it can be the same value stream model that TPS uses, however might want to keep all the language in ‘hospitalese’ Essentially do a virtual gemba eliciting what they do and convert it into lean graphic. One element to factor in is the PI/QI/QA components which are common to healthcare and tie in factory models for continuous improvement. Sometimes, in healthcare, the improvement piece is more reactive than proactive so there is opportunity there too. Once you have their healthcare flow graphic in place, under it place a factory flow model. Ask what they see as similarities and again respect the perceived differences.

    Hope it is a blast and goes well Mark, keep us posted!

  3. Intriguing topic for your keynote, Mark. As you know, I spent many years in factories. Now with an armful of experience in hospitals, I’ve been thinking lately that hospitals are more like manufacturing than people are willing to acknowledge. Regarding your Lean Mindsets, I’d add process focus. Excellent factories have great depth of knowledge of their processes. Hospitals generally do not. Hospitals tend to lack process discipline (in the broad sense) and heathcare leaders are not especially “process literate.” This is something that healthcare could learn from manufacturing.

    • Yes – process focus is definitely one of the running themes looking at the examples and stories I have in the talk. That’s a mindset that’s easy to just have in mind and not call out in a bullet point, though. I agree that hospitals often tend to focus on individual excellence and hard work and workarounds (being a hero) more than having repeatable processes.

  4. […] I’m honored to be a part of this program, a full day of timely topics and engaging speakers. I’ll be talking about the mindsets and management systems from Lean manufacturing that are beneficial in healthcare. We shouldn’t copy methods factories literally, but there are some cultural aspects of great  factories that healthcare has been learning from. It’s not about “turning the hospital into a factory.” It’s about using proven management methods to help hospitals be the best hospital they can be. Read a preview of the talk here. […]


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