Does the Size of a Hospital Matter for Quality of Surgery?


I'm away on vacation through October 10th, but I've scheduled the posting of an article of interest most weekdays. Feel free to comment and share your thoughts on each and I hope you keep up your daily habit of reading the blog.

This article caught my eye recently:

Doctors usually think bigger hospitals offer better surgery. Turns out, we're wrong.

(via Vox)


From the early section of the article:

It turns out my mom's hunch was right: My colleagues and I have found through research that big, academic medical centers don't outperform local hospitals when it comes to common procedures. This upends some of health care's most conventional wisdom — that the places with the highest volume of care provide the best quality — and suggests a different mindset for patients shopping for care.

We usually think large, academic hospitals are best. That's not always right.

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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. Hi Mark

    There is evidence of a quality/volume relationship but it is about individual surgeons not centres. And that relationship is not linear. Below about 20 procedures per year per type of procedure quality drops off (mortality increases). Above 20 and the volume itself does not make much difference and other factors come into play.

  2. why do you think that large hospitals do not necessarily have better quality? is it because they tend to use lean and cute waste so much that they decrease quality to be more profitable? or is it because smaller hospitals have fewer cases and patients that they have more time and can use more resources instead of dividing those on larger population. Also, isn’t there a relationship between the size of the hospital and the talent it attracts? with that better doctors?

    • Regragui –

      If some large hospitals have poor quality, it wouldn’t be because of Lean.

      Lean puts quality first.

      Hospitals have traditionally placed a large emphasis and cost. That’s not Lean’s fault. That’s what we are trying to change.

      I’m not sure about those relationships between size and quality or size of attracting talent. I wouldn’t assume that “better talent” necessarily equals better outcomes. That depends on so many different factors, including systems and processes.

      No easy answers…



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