What’s Changed in Lean Healthcare Since 2008?


It's been three years since the first edition  of my book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement  was published. The second edition  came out last week and I've tried to reflect a bit on what has changed in the past three years on the Lean healthcare front. I'm also curious to hear your thoughts on this.

  • There's definitely more talk of management system, not just tools and projects.  Years ago, there were more questions about how to get started and what tools to use. Now, thanks to the great example of ThedaCare and other organizations, more healthcare organizations realize that Lean is about culture and management systems. Their book On the Mend  and their DVD (both being projects I was involved with) set a great example for others.
  • There are more case example books. When my book was published, there were other introductory overview books. But, now you have great books from leading organizations including ThedaCare, Virginia Mason, and Seattle Children's. While my book had examples and small case studies from some leading organizations, it's great to see organizations sharing their stories (successes and setbacks) in longer form.
  • More people are coming from industry. While many healthcare organizations still require previous Lean healthcare experience for their positions, more hospitals and health systems are open to hiring people from other industries. These experienced Lean leaders provide fresh perspectives and new energy for being patient focused and improving care. Healthcare still has a lot of opportunities for improvement – if you're interested in helping, check out my “Move to Healthcare” online forum.
  • There's more focus on quality, not just cost.  At one hospital I recently visited, the CEO told  a large staff gathering that “Lean is a quality system,” thanks to their site visit to ThedaCare. Pat Hagan,    COO at Seattle Children's Hospital,  says they never talk about cost, yet cost is going down (as a result of focusing on quality through Lean). It's true in manufacturing and it's true in healthcare, that better quality leads to lower cost. This is different than the old “cost cutting” focus.
  • More organizations are focusing on daily kaizen not just events. As we document in our upcoming Healthcare Kaizen book, organizations like ThedaCare have shifted from a focus on weeklong events (“Rapid Improvement Events”) to also focus more on small daily continuous improvements. Weeklong events are fine, but they aren't sufficient for transforming an organization, as I wrote about in my article “Putting the Continuous Back in Continuous Improvement.
  • Lean healthcare is becoming even more  International. Lean Hospitals is being translated into seven languages and the most frequent recent visitors to my book's website are (in order): United States, Canada, India, Sweden, Netherlands, Finland, Chile, United Kingdom, Mexico, Austria, Italy, and France, among others (about 50% of site visitors are from outside of the U.S).
What trends am I missing? What have you seen happening with Lean in healthcare over the last three years? Let me know what you think by leaving a comment.

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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. Oddly enough, I was asking myself the same question as my organization prepares to re-release an RFP that was stalled in 2008 due to significant political and organizational changes.

    I have the same view on lean being more about quality than cost savings, but one thing I have found myself repeating is that one of the benefits of lean is that we more often then not are able to increase system capacity without additional costs. Being in Canada this is very important as our organizations do not have a profit motive and tend to not be focused on the “bottom line”. Any cost saving are immediately reinvested in improving capacity (shortening times on wait lists, for example)

    • PhysioWonk – that’s a great addition to the list. I’d concur with you that adding capacity is an increasingly common goal. People often associate Lean with shrinking and cutting, but being able to see more patients in the same space and with the same staffing is a great goal (and doing so without stressing out the staff). This is possible as the result of eliminating waste from the old process. Thanks for adding that.

  2. Great stuff, thanks for the update. I think it is critical for the success of health care improvement for us to cultivate long term successful organizations. What hospitals can do 10 years into a journey is much more than can be done 1 year in.

    Those trail-blazzing organizations produce all sorts of great benefits to the community. New examples and successful projects to learn from. Illustration of what matters for long term big impact success. Skilled and experienced people to help other organizations (take jobs in other orgs and bring their experience with them). An illustration of what is possible, so those other orgs that did adopt some lean ideas but are not taking the ideas to heart can see what they are missing…

    Keep up the good work.

  3. Hi Mark,

    What strikes me (being in the “international group”) is the interest from Sweeden and Finland. Those countries are often sited as examples (in the UK at least) of providing high quality healthcare.

    In the UK the perception I have is there are some Hospitals and Trusts (both NHS and Private) which are more forward thinking and recognise they need to really change how they deliver healthcare to significantly improve the overall quality for patients.

    There is certainly more awareness and media coverage that I have seen giving solid examples of trying to apply at least some parts of lean thinking. I would add that there are other examples of looking outside of healthcare.

    An interesting example I seen was Great Ormand Street using Mclarens F1 engineers to help improve the handover process when patients come out theate and into intensive care. This came about when a doctor was watching a grand prix one afternoon and was really impressed at how effectively the teams did tyre changes and wondered if they could help. Many of the improvments quoted no doubt be recognised as “lean” (checklist, single point of accountablity, clear process, training), but it was the willingness to look outside of healthcare for solutions which really impressed me.


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