Posted by: Knightbird | January 20, 2011

The Ethics of Ignoring Lean Healthcare

The National Indian Health Board and the Centers for Disease Control sent an email around inviting participation in a webinar to talk about medical ethics. The email says, in part:

“Dear National Indian Health Board Members:

The practice of public health often raises a number of important ethical concerns, such as how to best allocate limited resources, how to protect privacy and confidentiality, how to safeguard the public’s health while respecting individual and community rights, and how to best achieve social justice and lower health disparities.”

This started me thinking about the ethical issues regarding avoidance by healthcare executives of implementing Lean Healthcare in their organization. Isn’t one of the first considerations when talking about allocation of limited resources the possibility of expanding the ability of those limited resources we do have to more people and provide a greater range of services? Are health care executives under an ethical obligation to consider the comments by such distinguished executives as Dr. Dean Gruner in USA Today, 9/10/2009:

“ThedaCare, which runs four hospitals and dozens of clinics in Wisconsin, cut the cost of its in-patient care by 25%, says CEO Dr. Dean Gruner, who estimates $20 million was saved before they quit counting. He says if all hospitals achieve similar results, $400 billion could be saved on Medicare and another $1.3 trillion on the non-Medicare side.”

Or Dr. Patricia Gabow:

“Dr. Patricia Gabow, CEO of Denver Health, which provides health services to 25% of Denver’s population, started employing the Toyota system four years ago. She says Denver Health has saved $27 million on supplies and increased productivity.”

If, as Dr. Gruner postulates, there is $1.7 Trillion dollars of waste in our healthcare system, and we are discussing rationing health care, aren’t we violating our sense of medical ethics. I think so.

In our tiny rural health care system at Chugachmiut, we have freed up $1.5 million in cash (which means we have it available every year) and dedicated the funding to health care. We have increased access to care, most specifically oral health. This amounts to about 10% of the original budget we started out with when we began our lean healthcare journey. And these savings do not include the substantial performance improvements made along the way. While we are not ThedaCare or Denver Health (Park Nicollet, Virginia Mason, and our friends at Contra Costa Regional Medical Center and many others can be included in this as well), we are proud to be doing our part to expand the availability of health care to our patients. I try to imagine just how much additional services our Alaska Native Tribal Health Consortium could provide with it’s $405 million annual budget if it were to truly adopt Lean Healthcare as its management system. Dare I dream of $40.5 million in additional services annually, increased productivity that adds more services plus a substantial uptick in quality? Yes I do.


  1. And there’s also the moral imperative of quality improvement and patient safety… but far too many organizations are satisfied with where they are today. Thanks for inspiring others to improve…

  2. […] This post was mentioned on Twitter by Mark Graban, Diego Ize-Ludlow. Diego Ize-Ludlow said: RT @LeanBlog: Patrick Anderson: The Ethics of Ignoring Lean Healthcare #lean #CEO […]

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