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Focus on the customer: Lean in health care

Few ventures are as customer-centric as health care, and there's been a lively debate going on for nearly two months about Lean management's place in medicine.

First came this article in the prestigious New England Journal of Medicine mourning the loss of a human touch in health care and largely equating Lean with "Taylorism," an early industry efficiency program. (The admittedly stereotypical image of Taylorism is of executives with stopwatches watching an assembly line.) From the article:

"We believe that the standardization integral to Taylorism and the Toyota manufacturing process cannot be applied to many vital aspects of medicine. If patients were cars, we would all be used cars of different years and models, with different and often multiple problems, many of which had previously been repaired by various mechanics. Moreover, those cars would all communicate in different languages and express individual preferences regarding when, how, and even whether they wanted to be fixed."

That prompted an indignant response from many in the Lean community, including Lean legend John Shook, CEO of the Lean Enterprise institute.

"As Toyota – and others – have proven, a more effective system is a more stable system and a more stable system can indeed achieve outcomes with lower costs, made possible merely through that stability. But with stable effectiveness also come opportunities for efficiency which results in better care, lower costs, healthier patients and less-stressed providers.
So authors Hartzband and Groopman need not fear; Toyota-inspired lean experts will only pull out their stopwatches in order to diagnose the patient (the healthcare system), just as you pull out your stethoscope –to not inflict damage. Do no harm. Understand the patient. Conduct causal analysis, recommend a treatment plan to be run as an experiment, carefully observing the organization-as-patient to evaluate remedies for effectiveness.  Every organization is evaluated individually, just as is every patient."

Now Virginia Mason Health System's Gary Kaplan and C. Craig Blackmore have added to the discussion with their take on a new study that found that Lean management in health care wasn't associated with improvements in the patient experience. You read that right: Lean was NOT associated with patient improvements in the Swedish study. Virginia Mason has deeply incorporated patient-focused Lean principles throughout their entire organization. From Kaplan and Blackmore's article:

"Why did the patient experience not improve? Our tools to measure the patient experience are imperfect, and as the authors acknowledge, measurement error may contribute to the lack of positive results. However, more important is the qualitative information that the authors provide from the case study of two primary care centres that successfully adopted Lean. In both cases, interviews from the sites confirmed success in improving value from the standpoint of the customers. Unfortunately, the primary customers were not patients, but rather were the managers and providers. We do not question the value of improvement from the perspective of providers and staff or of improving the efficiency of the healthcare system. However, fundamentally, unless value from the standpoint of the patient is understood and prioritised, improvement in the patient experience cannot be expected. Thus, lack of improvement in patient satisfaction should not be seen as a failure of the Lean management system, but rather as the expected outcome when patient values and experience are not prioritised."

All are worth a read if you have time. Undoubtedly, there's more to come.