Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition

“Lean” is a way of thinking about business and business operations based on the Toyota Production Method. Often linked with Six Sigma much trumpeted by GE, Lean focuses more on employee engagement than the statistical analysis of Six Sigma.A full description of the benefits of Lean, or even Lean Vs. Six Sigma, or Lean Six Sigma are out side the scope of this blog post (for that you can check out the author’s own excellent blog post on the subject of Lean Sigma and Lean plus Six Sigma here.) However, I should probably give some background on why I want to read this book and my interest in lean.The simple answer is that I had become aware of the short comings of much of the veterinary specific continuing education when it comes to larger hospitals – particularly when it comes to employee engagement and communication. I’ll never forget sitting in on a not very good seminar on internal communication at a veterinary conference and then finding out that the speaker’s hospital had less than ten employees. There is nothing wrong with practices of that size, but the ideas were not scalable – I have supervisor meetings larger than ten people! Because of these issues I started to look to the human healthcare world for ideas and inspiration.I did this with some trepidation.Human healthcare has some serous issues and in many ways could learn a lot from the veterinary world – not lease in the use of resources and customer service which seems at times to be virtually non-existent. Having said that, lots of others have similar feelings about human healthcare and there are a number of people trying to make major changes hospital wide.One of those people that I came across was Mark Graban, the author of Lean Hospitals.I had been communicating back and forth with Mark over Twitter about healthcare and process issues that interested us both and so I decided to give “Lean” a serious look.I should make clear, that Lean Hospitals is very much a human healthcare book. For those in the veterinary profession, a significant amount of translation and out right rejection will need to take place. However, for those with large facilities to run and with hopefully a mandate to improve, there is a lot to learn from Lean and the Lean Hospitals volume that I am imperfectly reviewing here.Lean is about reducing waste. Not just physical waste, but the waste of your employees and your patients / clients time and resources. The general principle is that by harnessing the knowledge of your employees about what they do, and by actually looking at and standardizing how your employees work you can create internal systems that not only save time and money but that are safer for patients and employees. Coupled with this is the idea of a culture of continuous improvement and error proofing of the workplace.A lot of these ideas will be familiar to anyone who has attended a management seminar in recent years. What seems to make lean and Lean Hospitals different is how it is all held together and that is has real processes and tools for implementation and analysis.As a book, Lean hospitals takes the form of a workbook, with each chapter giving not only a formal conclusion and lesson points but also a list of questions for group discussion. Although, Mark primarily works in the human healthcare world now, Lean Hospitals is written almost from a lay persons perspective and so the use of human medical terminology or assumption of knowledge of those processes is kept to the bare minimum.On the downside, Lean as a process, is replete with jargon which mostly takes the form of Japanese words or phrases originally inherited from the Toyota Production method. Although there seems to be no real reason to have to use these terms, other than that some of the ideas need a name of some type, they can be a little off putting and require a certain amount of referring to the glossary (which is excellent!)Lean Hospitals is also a little expensive for a business book, although cheap by text book standards, but makes up for this by being an excellent read throughout.The most insightful passage in the book relates that healthcare is full of brilliant dedicated people that daily have to battle with broken systems and goes on to quote Fujio Cho, the Chairman of Toyota Motors: “We get brilliant results from average people managing brilliant systems. Our competitors get average results from brilliant people working around broken systems.”For those looking for an introduction to the world of Lean, or even just a set of interesting ideas from progressive human healthcare to cherry pick, Lean Hospitals is an excellent starting point.

I was behind the times not fully appreciating how Toyota's LEAN processes are impacting healthcare. As such I needed a quick primer on the subject. "LEAN Hospitals" is an excellent resource for learning how to implement useful, cost effective, and powerful change elements into a medical enterprise. Easy to read, well illustrated, and full of practical examples "LEAN Hospitals" is an excellent book that I keep close at hand on my resource shelf.A patient died because three syringes all had the same color of fluid: an anesthetic, a disinfectant, and a contrast agent. This was an accident ready to happen. Standard solution: fire the nurse, insist people read each label = result that doesn't really work. LEAN solution: have each solution be a different color. Zero cost, clearly visible = result that worked and prevented deaths, pain, and lawsuits.Many such examples with solutions are used throughout "LEAN Hospitals". The concepts, forms, and principles of LEAN are fleshed out. However to really effectively use LEAN and the Toyota system, you will need additional materials that deep dive LEAN. However for a primer on LEAN within healthcare this is simply the best resource available.

This was a very interesting book and gave me a heads up on what is needed to move toward lean in a hospital. For someone new to the healthcare system, it is scary to learn all the mistakes that happen in healthcare.

This is the single most comprehensive and helpful book applying lean management practices to the hospital setting. It is obvious that Mark Graban has done a great deal or work in hospitals and this book clearly demonstrates his practical knowledge. It should be required reading for everyone managing in healthcare. If you are in healthcare, get it, read it, and apply it.

[...] Toyota's system is actually designed to support the development of people, not to provide a quick fix set of technical solutions, and this takes time and patience. Many health care consultants have rebadged themselves as Lean consultants and do not understand the real thinking behind the Toyota Production System. Mark Graban is an exception[...]. His book is a welcome translation of the Toyota Production System into language any health care professional can understand[...].

This book is a bit too heavy on philosophy and lacking a bit of how-to-do-it content. It's not bad as a beginner's book, but it won't tell you exactly what you need to do and how to do it. I bought it for that, and was disappointed.

I found it very useful for my work in health care because it transforms the principles from automobile industry into service industry like health care where due to third party payment concept of customers and ineffectiveness and number of other things is "little bit" different

A clear, concise guide book with solid common sense that are easily understood.

Book is illustrative and easy to understand

Mark has a great grasp on how to apply Lean thinking in the Healthcare sector. His straightforward writing style and great use of examples combine to illustrate the use of Lean in hospitals. He thoroughly discusses both the opportunities and challenges in implementing Lean. This book is certainly a great introduction for anyone wanting to learn how Lean is applied in Healthcare, but it also contains many valuable insights for your Lean journey no matter what sector you come from.

The book covers in depth all aspects of lean in hospitals, with many good practice examples. Excellent explanation of the "two pillars" of lean : waste elimination and respect for people.

Very basic and only limited use