Lean, Health Care, and Quality

A recent article appearing in the Quality Digest Daily e-newsletter (“Why Lean? Why Now?” by Dean Bliss http://www.qualitydigest.com/inside/health-care-news/why-lean-why-now.html) discusses the value of lean in a health care setting. In his editorial, Bliss writes about the manufacturing origins of lean and why he believes that lean tools translate so well into a health care environment.

If you scroll down to the “comments” section at the bottom of the article on our site, you’ll see an exchange between two Quality Digest columnists, Tripp Babbitt and Mark Graban (with some additional feedback from reader Chet Marchwinski). Babbitt and Graban often take opposing views on certain aspects of quality improvement, particularly relating to lean. Their comments on this particular article uncover a longstanding argument, namely, can lean tools be successfully adapted from manufacturing environments and applied to service industries such as health care?

Process improvement specialists are an imitative sort, and in many (but not all) of these cases, imitation is the sincerest form of flattery. “Benchmarking” is a hallowed tradition, practiced by practitioners of practically every stripe. It therefore makes sense that lean tools, first pioneered by Toyota within a manufacturing setting, would be adapted by organizations in various sectors, including service industries. Certainly, health care, in which success is often measured in lives (not just dollars) saved, was ripe for a lean revolution, and in a sense, that has happened in recent years.

The core of the argument isn’t the inherent value of lean; that’s pretty well established. My sense is that proponents seeking to define lean more narrowly feel that the practical results within manufacturing, such as a lessening of rejected parts, don’t apply to service, in which improvement often has to do with “softer” metrics like customer wait times. Those that support a wider view of lean believe that the methodology’s underlying philosophy dictates that pretty much anything and everything can be improved through a relentless focus on waste, however that phrase is defined for a particular process.

So, like many long-running debates within the quality industry, this one can be looked at as a matter of semantics. What constitutes waste, after all? Must it be a rejected product or part, or can it also be unnecessary time, steps, or effort? Can linked health care processes “flow” in the same manner as assembling an automobile or fabricating a semiconductor?

I don’t know the answers, but it’s fascinating to hear the experts duke it out. Their points are enlightening and well taken, and provide great food for thought. So what do you think? Is lean well suited to health care environments, or is it best left to manufacturing? If so, why? If not, why?

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