Sharing Lean Six Sigma Journal Articles on Healthcare Improvement from Ireland


I was honored to be asked to participate in a supplement that was published by the journal The International Journal for Quality in Healthcare. The supplement is a collection of articles about the use of Lean or Lean Six Sigma in Irish hospitals.

I had the opportunity to serve as a reviewer for the submitted papers, and I was also asked to contribute a summarizing article as an “editorial” that appears at the start of the supplement.

Here is the link to my article:

 Lean: breaking down barriers for the sake of improvement

The article should be freely available through that link.

From the second paragraph of the article:

“Healthcare improvement quite often results from breaking down silos and crossing breaking barriers in many ways. Methodologies, practices and mindsets can be adopted (and adapted) from manufacturing to healthcare, as has occurred with Lean and Six Sigma over the past 20 years. People with varying backgrounds and perspectives can collaborate to create better, more affordable care–in Ireland and other countries around the world.”

I think the idea of breaking down silos is one of the more important contributions from the Lean philosophy. This idea of breaking down silos traces back also to W. Edwards Deming. We can break down barriers between departments, barriers between improvement methodologies, and barriers that prevent sharing across national borders.

After collaborating on the supplement, I had the opportunity to visit Dublin in November, meeting with some of the article authors, including SeÁn Paul Teeling, who invited me to participate and to visit.

Here is Sean introducing me before the presentation that I gave to a group in Dublin:

The other articles in the supplement are based on real improvement work related to healthcare quality and patient access:

Developing a university-accredited Lean Six Sigma curriculum to overcome system blindness

Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance

Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department

Optimizing nursing time in a day care unit: Quality improvement using Lean Six Sigma methodology

Enhancing efficiency in a cardiac investigations department by increasing remote patient monitoring

Zap it track it: the application of Lean Six Sigma methods to improve the screening system of low-grade mucinous neoplasms of the appendix in an acute hospital setting

Streamlining an existing hip fracture patient pathway in an acute tertiary adult Irish hospital to improve patient experience and outcomes

I hope you'll check out the articles. Here is a tweet with a photo of some of the authors:

You can also learn more about the UCD Mater Lean Academy and their work.

Below are two photos I took of a hospital's “Transformation Office” sign and the other side that has the Irish language version:

And the cover photo for this post is one that I took of the Ha'penny Bridge in Dublin:

Thanks again to my Irish friends for inviting me to their great city! And congratulations to all of them for their improvement work and their publications.

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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. I am a student at the University of Rhode Island in Karl Wadenstens class. I wanted to let you know that I really enjoyed your article. A few summers ago I had the opportunity to work with a start-up company that focused on emergency room scribes. The scribes are med students that follow the doctor around during the day to take their notes. But most importantly, the scribe inputs the patient’s data into the coding system for the hospital. Some of them are so contrived that they haven’t been updated in years and it was a great chance for a first-hand look at waste in a hospital. Thank you for illuminating some of the other difficulties hospitals face when trying to eliminate waste!


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