Good News: UCSF to Teach Lean to Residents


I was happy to see this announcement the other day:

UCSF to Train Residents in Lean Management and Process Improvement

From the announcement:

“UC San Francisco will train medical residents and fellows in Lean management principles, as part of a broader institutional commitment to continuous quality improvement. The effort is being supported in part with a grant from the Accreditation Council for Graduate Medical Education (ACGME) through its Pursuing Excellence in Clinical Learning Environments initiative. UCSF was one of eight medical training sites nationally to receive the competitive grant.”

It's great to see residents exposed to Lean thinking and process improvement. As we discussed in a webinar that Dr. Jack Billi and I did earlier this year, PDSA and scientific improvement methods should come naturally to physicians, as scientists. We are also working with Dr. John Toussaint on an article for the European Medical Journal on this theme of medical science and improvement science.

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It still seems like most residents don't get the opportunity to learn about Lean — as a process improvement methodology or as (more importantly) a management system and culture.

When I worked for LEI in Boston back in 2009-2010, I was invited to come teach a session on Lean for residents at Beth Israel Deaconess Medical Center, as I blogged about here. They also had a patient there to learn and participate, and it was none other than e-Patient Dave de Bronkart. I linked to his multiple posts about the “Lean Retreat” there in my post. Man, I had a lot less grey hair then.

Dr. Greg Jacobson, CEO of KaiNexus, was introduced to Kaizen principles (and Masaaki Imai's seminal book KAIZEN) when he was an emergency medicine resident. That led to the publication of this journal article and to the founding of the company.

Greg was very much the exception, rather than the rule, when he was a resident not that long ago.

What does UCSF hope will come out of the education for residents?

“Residents will emerge better prepared for the evolving value-based payment environment, and patients will experience care that is more effective, safe, timely, patient-centered and equitable.”

Great goals!

How much of this is happening out there in residency programs these days? Leave a comment and share your perspectives and observations.

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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. Because of ACGME accreditation, and as part of the CLER requirements, Academic Medical Centers are in a way required to “engage” residents in quality improvement and patients safety. This of course varies dramatically even within the institutions. For example in my organizations some departments have been teaching residents process improvement methodology, leadership skills, and patient safety through didactic and project works for years. Others are late comers, but have involved my department (Value Engineering) to create a standardized approach to residents learning and application of QI principles. One of the things we are currently working on is to take the lessons learned over the last few years and create an integrated learning approach. as UCSF is probably realizing, having a goal to teach hundreds of residents QI and engage them is very noble, but the real challenge is that the thousands of attending providers that should mentor them, aren’t always up to the task. So the real opportunity is to teach the teacher so they can then engage the students.

    • Thanks for your comment, Luca.

      Training residents is probably good, but not fully sufficient. What happens when they end up in workplaces that have traditional organizational cultures or, at worse, bullying leaders??

      How do we change the existing culture that the residents are going to be going into?

  2. I too have been encouraged to learn about UCSF’s participation in this program and this it’s great that some medical schools are starting to engage their residents in learning about lean at the start of their medical training. I was at UCSF last month to teach some of their executives in the healthcare system and medical school A3 thinking. I predict great things for UCSF!


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