Lean Healthcare “Success” Without Benefits? What?


I saw the following in a submission for a session at the 2012 Society for Health Systems conference, where I'm the Lean track chair.

One submission said the following:

“Lean efforts often succeed but do not always provide meaningful benefits”

What? If there are no meaningful benefits, how is that a success?

That's mind boggling to me what anybody would consider their Lean efforts as “a success” if there are no benefits in safety, quality, waiting times, cost, staff morale, etc.

If somebody is gauging success in terms of how many projects they ran, how many value stream maps, they created, how many people they trained, or how much 5S they did, those are the wrong success measures.

You can have “meaningful benefits” without hard financial savings. I'm not equating “meaningful benefits” to short-term ROI, but there's really no point to Lean if you aren't making things better for patients, staff, physicians, and the healthcare organization itself. If there are no meaningful benefits, that's not Lean, that's L.A.M.E.

How else would you interpret that quote?

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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. Beats me. Perhaps they all felt warm and fuzzy from doing Lean? Or perhaps they could put Lean on their resume?

    If you are the track chair give them a call and ask them.


  2. My guess (which is similar to yours Mark) is that maybe they are only equating success into financial bottom line. Is it a CFO’s thinking that if we are reimbursed well for certain test, procedures or patient visits why would we want to eliminate them even if they are non-value added?

  3. I totally agree with Isaac’s comment.

    If the norm at an organization is to only consider bottom-line/ROI type benefits as “meaningful benefits,” then that’s what the employees are likely to think. As a full-time employee dedicated to one organization, I will freely admit that I am prone to tunnel-vision and forgetting that there are other ways of seeing things than the way we see them at our organization. That’s why it’s sometimes helpful to have an external resource come in and breath some sanity into the organization. And reading blogs like yours, Mark, is tremendously helpful in maintaining a sane outlook. So, thanks!

  4. I think you probably have it about right, Mark.

    It seems as though a lot of the effort I detect on some other sites (e.g. the LinkedIn lean healthcare stuff) is driven by people who are eager to apply tools without orientation to what the important systematic problems may be. These mostly look like ~midlevel folks, “lean specialists”, or the occasional “belted” types.

    Could it be that when walking around with a hammer, if they find a nail and hit it, that is defined as success (“we have kanban in supplies in Unit X”), even though the system as a whole doesn’t benefit (patients waiting, patients injured, capacity problems, etc.)?

    It’s the familiar “tools approach” failure mode with a twist: someone is seeing success at the project or tool level as “lean efforts succeeding” even though the implementation has not yielded “meaningful benefits”.

    This is an unsurprising scenario when there isn’t someone at the top integrating the lean deployment with a concern for strategy and systemic problems.

    • Andrew – I also get a dismayed by some of that LinkedIn group discussion. I cringe when the well-intended belts and lean specialists are sent out by their leaders to “make us lean.” Without direct senior leadership and medical leadership, you run the risk of “5S-ing deck chairs on the Titanic.”

      You have to start somewhere, but doing 5S at nurses’ stations misses the larger issues that might exist, like patients dying in the emergency room hallway because of poor patient flow or situations where nurses face a daily scramble to find the equipment and medications needed to treat their patients.

      There are some very deadly serious issues in healthcare that need addressing. We need to get the right people on board.

  5. While we have had substantial financial savings at Chugachmiut, my focus has never been financial. We redirect our savings into many unmet needs. As I discuss in a recent blog, after 7 years of lean implementation, we have just identified a potential $1 million in value that can be captured. But our purpose for doing so is to enhance our capacity to withstand an uncertain future funding source-the federal government. In my mind, if you can’t see substantial benefits-in quality, in performance, in freed up cash resources, in increased receipts-you have no clue what a true lean implementation is.

    • Patrick – thanks for your comment. Reminds me of the COO at Seattle Children’s Hospital, Pat Hagan, who says they never talk about cost, yet cost is going down (as a result of focusing on quality).

  6. I used to cringe when I’d hear about people claiming how many people they’ve trained or how many 5S events they’ve completed. While I agree, that ultimately our efforts must show up in the key measures (quality, cost, etc.), aren’t we also trying to create a lean culture? Isn’t “# of pdca’s completed” a measure of behaviors we’re trying to integrate into our culture? Isn’t this a process metric that, if moving in the right direction, should result in an impact on the measures that really matter?

    • Steve – you make a good point that there are process metrics, like # of improvements, that should eventually contribute to the long-term measurable results.

      But healthcare is in such a state of crisis, I’d expect that if a Lean program can’t come up with a few significant costs savings and/or a few improvements that dramatically improve quality, safety, and patient care in the first year, then senior leaders won’t have much patience for the long-term journey.

      I think you can have (and need) both short-term and long-term results. The patients, staff, and hospital need the improvement now. Lean lets us get that improvement in a way that’s better than old traditional cost cutting.

  7. Agree Mark. Ultimatly, Lean needs to deliver bottome line results or senior leaders lose interest but these need to be more than just the financials. Business results also need to include Safety for both employees and patients and Quality of patient care.
    Most of these are lagging indicators so we often use leading indicators of cycle time, length of stay, capability development that front line staff can see move quickly with their improvement effforts. The key is that the two groups of metrics are tied together so changes in one impact the other.

  8. All too often if there is not an immediate ‘bottom line’ result, people assume there is no meaningful benefit. Please consider the changes required in the culture to maintain any bottom line result. Some Lean activities that engage ‘value-adders’ in the change process may not have a measureable bottom line result, but forcing bottom line improvements without them is typically short lived. Just another perspective.

  9. I agree with the sentiments of Lani & Steve above, with the additional clarifcation that it should be both/and not either/or:

    1) Culture change is essential for sustaining change and building momentum over time. It is tough to measure or document so not typically a “bottom line” impact (though it IS impressive when you walk in and meet it face-to-face).


    2) While training and working with people to develop a continuous improvement culture we should be solving important problems.


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