Healthcare Quality – you’re doing it wrong. Focus on adaptation not trendy QI methods.

I attended the recent NAHQ conference in Nashville. Although the conference theme was “Quality in Harmony” it may have been better titled Quality in Lean Six Sigma. The concepts of Lean permeated the meeting. One presenter remarked, “If you’re not moving towards LEAN you’re missing out.”

Quite a misguided statement.

I believe that LEAN is extremely misunderstood and its complexity downplayed by industry insiders; many of whom stand to benefit from endless promotion of LEAN application in healthcare (e.g. book authors, consultants and speakers). There is a curious tendency to correlate LEAN with superior data management, but that view is woefully incomplete. It’s a lot more complex than that.

LEAN is fundamentally an interpretation of the Toyota Production system (TPS). It is about creating an environment in which the abnormal can be accurately distinguished from the normal. It’s about developing a workforce that knows what the right thing is to do when they encounter the abnormal. It’s about motivating every employee to be involved in the process.
That’s all well and good except for one thing, in an industry focused on patient-centered care distinguishing between normal and abnormal is tricky business. Who gets to define these differences? How will industry changes and external threats be acknowledged and integrated into the normal/abnormal paradigm? In my view they won’t.

I predict that a maniacal focus on LEAN will obscure and delay the more important work of adaptation. Success and failure will ultimately be determined by one thing: how well organizations adapt in the face of industry disruption. Determining how to identify and eliminate waste from a process is not enough. We have to step back and ask ourselves why the process still exists to begin with.

Are you asking the right questions? When it comes to LEAN Six Sigma where do you see things heading?


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I blog about the intersection of quality management systems, evidence-based clinical practices, and implementation science within hospitals and healthcare organizations.