Posted by: Knightbird | May 24, 2011

Flavors of the Day

One management approach I have witnessed frequently in our Alaska tribal health system is a belief that if we benchmark and follow best practices, buying the best consultants available, we will achieve substantial improvements. In my years in the tribal health system, we have pursued Baldrige, Balanced Scorecard, Lean Tools, Six Sigma, Improving Patient Care and the Studer Group Tools. Consultants are frequent visitors to our health system. It is my opinion that they have not worked, and that the cost is a substantial investment that hasn’t  paid off. The results that do accrue are likely not sustainable at a very high level.

Steven Spear articulates the reason why this approach does not work.

“Unfortunately, many health care organizations continue to cling to the view that improvement can be achieved by purchasing one-off interventions. Their thinking: If they implement enough best-practice bundles here or there to remove the problem and hire enough outsiders to lead improvement projects, things should get good enough. But the sad reality is while this approach will generate improvements, they will not be significant and sustainable.” [i]

[i] Spear, Steven, “Why Best Practices Haven’t Fixed Health Care,” Harvard Business Publishing [] (January 3, 2011)


  1. This is the full “past flavors of the day” list that I normally present (sharing this list with a group in Ontario tomorrow):

    Scientific Management
    Training Within Industry
    Cost Cutting
    Total Quality Management
    Dr. Deming / PDSA
    Six Sigma
    Best Practices

    My discussion point is always this: Why did these “fail?” And how or why is Lean going to be different?

    People often say, and I agree, that Lean is more likely to be successful because it can do a better job of engaging all people.

  2. Any of the above methods will work just fine as long as they are applied to the right type of problem, like using the right tool in a repair. Also, sustained improvement takes resolve, not the “flavor of the month” short attention span fixes that we normally try in business and healthcare. The combination of the right application of improvement process as well as perseverance is an unbeatable combination.

  3. I agree with Bobby that those methods can work in any setting, but I think they would all have a better chance of succeeding if it’s a culture rather than being just a set of tools.

    One advantage with Lean is that it’s a pretty holistic culture and management system, maybe more so than the other approaches I listed.

  4. Well, given that the American Healthcare system is about as bloated as it can get, Lean is probably about as “sexy” a tool as you can use right now. I just don’t like to limit myself because it tends to drive decisions in one direction and less isn’t always more…just saying. Plus, lean tends to be a little “antiseptic” steering away from real clinical improvement and instead focuses on process. Lean isn’t unique in this shortcoming, but if you are able to attack a problem from different angles you have a higher likelihood of success.

    • Bobby,

      I agree with you that the American healthcare system is bloated and that less isn’t always more (depends upon the particular process, its flow, value to the patient/customer, etc.).

      I wouldn’t say that lean steers away from real clinical improvement, though. There are plenty of good examples of that: Pittsburgh Regional Healthcare Initiative practically eliminating central line infections, Thedacare reducing door to balloon time, hospitals in San Francisco dramatically reducing medication errors, and a hospital where I work cutting patient falls almost in half. There are plenty more, but whether or not a hospital engages lean thinking in clinical matters is a matter of choice. Lean works with clinical issues – it just needs to be moved in that direction by those choosing the project.

  5. Building on Mark W.’s point, there are more and more cases of physicians and surgeons using Lean principles in their own clinical care, publishing more often in the medical journals about this.

    See a list of some journal articles here:

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