Lean Healthcare is About Quality – a Falsehood, a Wise CEO, and JAMA Data
I always get annoyed when people spread the false dichotomy of “Lean is about efficiency and Six Sigma is for quality.” Replace the word “efficiency” with “speed” or “flow” and it's still wrong.
Here is an example of this falsehood in a book from a major publisher… this author refers to Lean addressing the first six types of waste, with Six Sigma addressing the waste of Defects. Ugh. Wrong.
The author repeats this falsehood in different ways throughout the book. The book also incorrect states that Virginia Mason Medical Center used Lean/TPS *and* Six Sigma. At least the VMMC CEO Dr. Gary Kaplan and other leading Lean healthcare CEOs learned correctly that Lean (coming from Toyota) is about Cost AND Quality, as we'll read about below.
Here is a recent piece by Dr. Kaplan:
While he doesn't share specific data, Kaplan ends the piece with:
We are achieving the seemingly contradictory outcomes of lower costs and higher quality.
All of us in healthcare have a moral imperative to make care better, faster and more affordable. Using the tools of the Virginia Mason Production System, we are finding that the pathway to higher quality and lower costs is the same.
The Journal of the American Medical Association (JAMA) recently published an article that shows a correlation between Lean management practices and lower cardiac morality rates.
Researchers from OHSU (in Oregon) studied 600 units and found only 20% had best practice management practices (based on manufacturing, namely Lean/TPS) and those units had lower (better) mortality.
Leading organizations had a formal method for continuous improvement (or “kaizen“), with those scoring highest having a system where they:
Exposing problems in a structured way is integral to individuals' responsibilities and resolution involves all staff groups, along the entire patient pathway; exposing and resolving problems is a part of a regular business process rather than being the result of extraordinary efforts.
As Dr. Atul Gawande tweeted:
Vital study of 600 cardiac units: <20% had standardized, factory-like best practices, but had 17% lower death rates http://bit.ly/WPPgEW
Update: Gawande was INCORRECT. It was only a 0.17% lower rate. Shame on me for not confirming that, but I didn't have access to the whole article.
The article concluded:
Conclusions and Relevance The use of management practices adopted from manufacturing sectors is associated with higher process-of-care measures and lower 30-day AMI mortality. Given the wide differences in management practices across hospitals, dissemination of these practices may be beneficial in achieving high-quality outcomes.
If you don't have access to JAMA through your organization, you can read the OHSU press release here.
Six Sigma CAN help. But it's certainly not necessary for improving healthcare quality.