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‘Lean methodologies overrated’?


Front entrance of Virginia Mason’s main building.

A Seattle hospital system has  long been taking a “systems approach” in improving healthcare quality and cutting costs, looking to emulate some of Toyota’s practices.

Virginia Mason Health System has been lauded as being an exemplar of “Lean” methodology, based on eliminating waste and focusing on always adding more value.

But a blogger for Med Page Today who (rather timidly) uses the nom de plume of “Skeptical Scalpel” says Lean may be grossly overrated. He/she writes:

“Attempts to incorporate Lean into healthcare have met with varying degrees of success. I blogged about this 6 years ago and pointed out that a literature review done back then found ‘significant gaps in the [Lean and Six Sigma] healthcare quality improvement literature and very weak evidence that [Lean and Six Sigma] improve healthcare quality.’

Randomized prospective trials of Lean in medicine are lacking. A recent “paper from the Journal of the American College of Radiology found only seven studies on the use of Lean in radiology and they showed ‘high rates of systematic bias and imprecision.’ The authors concluded there was ‘a pressing need to conduct high-quality studies in order to realize the true potential of these quality improvement methodologies [Lean and Six Sigma] in healthcare and radiology.’

“In 2010, Toyota had recalled more than 9 million vehicles for various defects. Nothing has improved. So far this year, Toyota has recalled over 11,654,000 vehicles….”

“Having adopted Lean methodology in 2002, Virginia Mason is not really a new story. How is it doing?

“About as well as Toyota.

“In May of this year, the Joint Commission paid a surprise visit to Virginia Mason Medical Center and found 29 instances where the hospital was out of compliance with standards. The Seattle Times wrote that among the problems were not having an adequate infection prevention and control plan, failure to store medication safely, and failure to provide a ‘care, treatment, services and an environment that pose[d] no risk of an immediate threat to health or safety.”‘


“{I}f Lean works so well in healthcare, can anyone tell me: how does a hospital that has been practicing Lean methodology for 14 years achieve 29 Joint Commission citations?”

To read the whole blog entry, please hit this link.


Ill. system turns to Lean Six Sigma


Memorial Health Center, in Springfield, Ill.,  the flagship of Memorial Health System.  Also, see graphic at the bottom of this piece.

Charles D. Callahan,  executive vice president and chief operating officer of Memorial Health System in Springfield, Ill.,  and Todd S. Roberts, vice president for quality and safety of Memorial Health System, write in a Hospitals & Health Networks piece about how the system implemented change to deal with the Affordable Care Act and other changes in the roiling healthcare sector.

They noted that the typical organization “squanders the equivalent of 30 percent of annual gross revenue due to defect-producing practices and overutilization of resources.”

They wrote: “{W}e determined to re-engineer our structures and processes as these are the necessary precursors to outcomes. We also recognized the need to find new ways to engage with our medical staff, and ultimately inform the training of next-generation physicians and health care professionals, to build a sustainable path.

“In response to these imperatives, we modified traditional administrative structures to better partner with high-influence physicians (i.e., “silverbacks”) via dyadic relationships and team roles and to identify and prioritize high-value opportunities. We then adopted Lean Six Sigma, a rapid-cycle, data-driven process change methodology from industry that produces quality, safety, service and cost benefits that matter to stakeholders.”

Lean Six Sigma is a methodology that relies on a collaborative team effort to improve performance by systematically removing waste. See graphic below.

“Six years later, over 300 Lean Six Sigma improvement projects yielding nearly $30 million in positive financial impact have transformed the Memorial culture,” the two executives write. “Today, our approach is known as “The 30/30/30 Solution”: in each of the last five years, we have trained and certified 30 percent more Lean Six Sigma process change experts (“belts”), completed 30 percent more projects, and achieved an average project improvement of at least 30 percent on any project undertaken.

“Projects have spread to all areas of the organization: clinical, financial, service, production, facilities, inventory and workforce management. ”

To read the whole piece, please hit this link.



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