A Survey Would Show 83% of Surveys about Lean Healthcare are Dubious?


Last month, I saw a headline flying around Twitter about a survey that says a majority of hospital pharmacies are embracing Lean. A statement like that, of course, begs the question of what “embracing” means and we might also ask what “Lean” means in this concept. Hooray, they are doing 5S?

Here is the web page people were linking to, which has a headline that most readers here would agree with:

Healthcare needs lean management

A company, Kit Health, surveyed 600 pharmacy directors to ask them what they think.

This approach introduces a lot of biases and self-reporting error into the mix. There's no verification (which would be hard to do)… so we'll ask people.

Their summary:

You can imagine how surprised we were that 78% of the 600 hospital pharmacies surveyed were using Lean Management in select areas and 37% consider it part of their core philosophy.

A number like 78% is nice to put into a headline:

“78% of pharmacies now using Lean Management!”

Again, what does “using Lean Management” mean? They've done a value stream map? Or, they've completely transformed their culture… or points in between.

The “in select areas” is a red flag that the pharmacy directors, while well intended, maybe aren't telling the truth, the whole truth, and nothing but the truth (or it means the 78% headlines should be toned down). The headline might say:

“78% of pharmacies sort of use Lean Management where it doesn't challenge existing practices too much”


“78% of pharmacies have told employees to ‘standardize' their work”


“78% of pharmacies have a Kanban system for a few supplies that never worked that well”

The surveyors were also surprised, probably, about the 37% number. What does “it's part of our core philosophy mean?”

People often hear a little bit about Lean and they then say things like, “Oh that Lean stuff… that's just the way we've always done things around here.”


It's easy to overstate “how Lean you are” (however you would measure that).

There's a bias and a peer pressure, when asked a question about Lean, to say “Oh yeah, we do that.” It's easy to say. The surveyor can't prove you wrong.

What surprises me is that 5.62% of attendees said they don't know what Lean is. They were honest enough to admit it.

Surveys like this might drive traffic to a web site, but what do they really tell us? Nothing, really.

Is a pharmacy director (or a hospital CEO) going to be curious about Lean because it's popular or trendy? If that's the reason they embraced Lean, I'd bet that correlates with giving up on Lean very quickly when some trendy new thing comes around.

Back in 2009, I criticized an ASQ survey that said 50% of hospitals are using Lean methods.

Instead of thinking about numbers and surveys, we should get back to work on our own departments and hospitals.

Maybe I shouldn't have even written about this. Sorry… back to work.

Do you believe the results of the survey? Am I being too cynical? How do you think your pharmacy would honest rate in that scale of whether they are really using Lean methods or if they've really baked it into their “core philosophy?”

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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. That’s definitely a pretty audacious survey, Mark! Thankfully, I’ve been fortunate enough to work with much more humble and less boastful Pharmacy teams.

  2. I’ve been working in the Ohio healthcare industry the majority of the year, and I can say from all the waiting in comparison to the value-added time, the institutions are not even considering. I have seen some amber lights in the exam rooms, but that’s about it.

  3. Mark – great article. As the sponsor of the survey you cited we were surprised by the result but also recognize that it is self-reporting. I ran supply chain consulting practices for several years and occasionally came across organizations with a one completed project by a green belt and the claim was the organization had implemented six sigma. Definitions are important.

    I think you can look at the results of this survey in two ways. One way would suggest the pharmacy directors don’t understand what it means to be lean and claimed more allegiance to the approach than is reality. There is a good argument to be made here. Although most of the respondents are highly educated with at least Master Degrees and many PharmD’s, they were never trained in operations disciplines and therefore don’t know what they don’t know. They may well be overstating their lean management maturity depending on the definition. Given that their individual answers were not made public, there was no incentive for them to bias their response nor is that a common trait among this profession. My experience is that pharmacy leaders “tell it like it is.” Your comment around definition is the right one. Two people may answer the same question differently based on their perspective.

    Another way to look at the results is that awareness and interest of lean methods are strong among hospital pharmacy directors. There is no action without awareness and interest. As someone who believes we need more operational efficiency in healthcare, I was heartened that so many pharmacy directors appear enthusiastic about lean management.

    I hope this bodes well for your work in lean hospitals. Maybe its an indicator of increasing receptivity to operational efficiency.

    • HI Bret-

      Thanks for your comment. Thanks for doing the survey… my constructive criticism was directed more at the respondents and the hospitals.

      I *do* hope that increased awareness of Lean bodes well for the future. We have to start somewhere and awareness is the first step. Part of that awareness hopefully means that people realize they won’t be Lean and done in a year or something. There’s a lot of hard work to do and lots of leadership needed.

      Thanks for sharing your perspective on the survey.


    • Mark how could all these “studies’ NOT BE? AS W.E Deming would say, “how could they know?”

      Furthermore to use one of his favorite words… “NONSENSE.”

      (A Demingite who knew him)


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