Problems like This Should be the Focus of “Lean Government”


The “Strong America Now” initiative has proposed there are opportunities to save $500 BILLION  a year from our U.S. federal government budget by using Lean and Six Sigma methods (I interviewed Mike George, the founder of the campaign here in a podcast). As an outsider, I'd believe that the OPPORTUNITY is there for such savings, but is it really POSSIBLE, with the government culture of “use it or lose it” budgets and internal politics?

That's one reason I don't get super jazzed up when it seems the “Lean Six Sigma for Government” movement seems to be focused so much on cost reduction. I understand the need for cost reduction, trust me, but can a Lean focus on time and quality lead to cost reduction and other important results?

It's often said that Lean is a time-based methodology, as Taiichi Ohno, one of the fathers of the Toyota Production System wrote in 1988:

“All we are doing is looking at the time line from the moment the customer gives us an order to the point when we collect the cash.   And we are reducing that time line by removing the non-value-added wastes.”

In healthcare, that same principle applies. If we focus on reducing the total timeline between a physician making a referral (or a patient requesting an appointment) to the time when the healthcare provider gets paid, that means care is provided to the patient in a more timely manner and all sorts of good things tend to happen, including cost reduction. But cost reduction is an end result. That's one way Lean/TPS is different than traditional cost cutting approaches that primarily focused on cost. The leading Lean hospitals are finding cost goes down as the end result of focusing on patient flow and quality, reducing waste instead of cutting cost.

One recent news article caught my eye as a potential opportunity to apply this time-based Lean view: “Army is behind in granting medical retirements to 20,000.”

The U.S. Amy has 20,000 soldiers who are unfit to serve. The Army cannot replace them with other soldiers until AFTER the 20,000 are medically discharged. Now there is an important problem that can impact our national security. Is this a “cost cutting” issue? No, it seems like quality and time-based issue.

From the article:

“[General Peter]  Chiarelli blames the delays on a military disability system that is “complex, disjointed and confusing.”

My Lean warning bells are starting to go off on that description. But, read on:

The process lasts an average of 400 days, and yet requires a soldier's participation only 10 to 30 of those days, says Army Col. Daniel Cassidy, a disability evaluation program director.

A similar delay occurs in other service branches, says Philip Burdette, a Pentagon director for wounded care.

Most of the time, Cassidy says, soldiers “are either waiting for a decision or waiting for an appointment.”

The ratio of what we might call “value adding” days (10 to 30) to total days (400) is very poor. Why can't that process be completed in 90 days, instead of 400? Can the Army apply Lean to reduce the delays in waiting for a decision or an appointment? Is there a patient throughput issue to be solved in the hospitals or clinics?

Again, from the article:

A key problem is a lack of medical personnel, particularly psychiatrists, who are necessary to analyze the growing number of post-traumatic stress disorder or depression cases coming from the war, he says.

I'm sure somebody will comment that the root cause of this problem is sending soldiers to war. But, given the current state, there seems to be a bottleneck in key clinical staffing areas.

Can the Army hire more medical professionals? Maybe. I'd like to see, first, the use of Lean principles to increase throughput in those medical specialities. As the Lean healthcare literature shows, the opportunities to increase throughput comes from reducing waste in the physician's day, not by asking them to race through appointments more quickly. Lean is not an approach for cutting corners. If we reduce waste, we might be able to have each physician see more patients in a day without undue burden.

There's already one time-based improvement that benefits wounded and sick soldiers:

One achievement, however, is that by Saturday, a system of jointly assessing troops for medical retirement and Department of Veterans affairs benefits will be fully underway, Army and VA officials say. This drastically reduces the amount of time veterans must wait for VA benefits.

The first benefits check will arrive 30 days after a soldier leaves the Army, far faster than the six months or more it took in the past, the VA says.

Getting benefits checks to discharged soldiers is the right thing to do. Is there a cost reduction or ROI involved? I doubt it. Do we care? How does doing the right thing for discharged soldiers improve morale throughout the ranks? Will that lead to motivation for other improvements that lead to cost reductions? We'll see?

I asked a question and got a mini-statement from the campaign of Newt Gingrich, one of the most outspoken proponents of Lean Six Sigma in government:

Newt2012HQ  Newt 2012 Campaign

@LeanBlog  You're right. Cost-cutting is just one benefit. We try to talk of the quality improvement Lean Six Sigma would lead to as well.

Quality and cost together – as the end result of compressing time from the “value streams” of government. Will it happen?

Note: this post should not be construed as an endorsement of Mr. Gingrich or any political party. I believe Lean Six Sigma would be, at its core, a nonpartisan methodology.

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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. I think you hit the nail on the head. As people/orgs try to implement methodologies like Lean or Six Sigma they focus on the cost cutting. Many times especially in Six Sigma, I think it is be a reaction to justify the project. Though cost cutting is important, if is the predominant theme, I think it really does hinder the project. Focusing on time and flow accelerates not only solving the product but I believe assist in sustainability.

  2. Lean six sigma is a non-partisan improvement. Sadly we don’t have a very good history adopting management improvements in government. There is lots of great stuff done over the decades normally by people far below the political appointees.


    One of the things I plan to do in the next few months is update my Public Sector Continuous Improvement site (which I started in 1997):

    • Newt has been a student of quality improvement methodologies and philosophies going back to Dr. W. Edwards Deming. Rather than trying to simply curry favor with people who work in Lean and/or Six Sigma companies, maybe he thinks the approach will actually work in the federal government?


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