Radiology Patient Flow Improvement Using Lean at a German Hospital


This is the first Lean article or case study I recall seeing about a German hospital: “JACR: Lean Six Sigma increases MRI productivity.” The article clearly articulates the benefits for patients, staff, and the hospital –  University Hospital Giessen and Marburg.

The hospital, using “Lean Six Sigma” was able to “double the percentage of patients receiving an MRI scan within 24 hours, thereby increasing scanner productivity by one-third and probably saving hundreds of thousands of dollars a year.”

Part of the problem statement (or a bit of the root cause) from the article:

“Many health care organizations do not measure key parameters such as demand, capacity, patient access, process efficiency, and productivity,” write the authors, led by Li Zhang, with the 1,200-bed German hospital. “They are run like cottage industries of nonintegrated and dedicated artisans. Among the consequences are underutilization of very expensive resources and long patient delays.”

The team was able to identify waste and causes of delay:

They say they identified 33 “failure modes,” or process snags leading to waste, and they fixed the 14 most critical ones. Fixes included increasing staffing levels to prevent personnel from being overloaded, eliminating redundant examinations, and getting rid of superfluous documentation to drop the radiology information system completion time from nearly 3 minutes per exam to under a minute.

90 percent of patients were able to get an MRI within 24 hours and department throughput was increased by 38 percent.

Did you noticed that they INCREASED staffing levels? Everybody who complains about Lean being just about driving layoffs doesn't consider that Lean is really about finding the RIGHT staffing levels. It's like Goldilocks — not too many people and not too few. There are many cases where Lean results in productivity improvement, but Lean organizations find better ways of utilizing and developing people in lieu of just laying them off.

I've been involved in a few projects where the data on workloads and volumes showed the department or area in question was indeed understaffed. Even after reducing waste and improving the process, there weren't enough people to get the work done the right way and without overtime. You can't just “throw people at the problem,” but you have to address situations where people are legitimately understaffed. Hospitals often rely on benchmarks or budgets, instead of basic industrial engineering principles, to determine their staffing levels. Sometimes they guess wrong in the direction of overstaffing and sometimes they guess wrong in the other direction.

Congratulations to the team in Germany for their improvements that create better patient care and a better work environment.

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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 amazing that as you watch the flow of work in a Lean organization, you see people who are working at a steady pace; not too fast and certainly not waiting. The flow of peple has been stabilized so people have time to identify problems proactively rather than just hurry to get to the next patient.
    As Mark points out – to achieve this, sometimes we need to add people in addition to removing waste.
    Stabilize & Standardize the flow first then work on driving productivity improvements.


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