Do Toyota's "Lean" Management Methods Work for Healthcare?  New Study Says Yes

The Takeaway

1. Health economist K. John McConnel at Oregon Health and Science University led a study recently published in JAMA-Internal Medicine that found it is not only possible to apply Toyota-type quality improvement methods to health care, it leads to better outcomes.

2.  The study looked at 597 hospital cardiac units in the US that operated catheterization laboratories.

3.  Nurse managers were interviewed about 18 key performance practices in their organizations. They were asked to rate their units as poor, average or higher performers on each indicator. The researchers then gave each response a number from 1 to 5, with 5 being considered a "best practice."

4. Performance scores were divided into categories representing management goals: standardizing care/Lean operations, tracking key performance indicators, setting targets, and incentivizing employees.

5. Units with higher ratings had lower 30-day mortality ratings but they did not have lower 30-day readmission rates.

6. Because of its large sample size and the ability to rate different organizations in a consistent way, this study  showed that Lean Management Methods can be used effectively in health care settings, not just in manufacturing.

The One Minute Summary

Back in the 1990s, Toyota's quality improvement program was being widely hailed by management gurus as the way to regain America's competitive advantage.  It features worker/management teams, incentivized goals, and a focus on process and communication. Today, process-oriented quality improvement methods  have become routine in American business but their adoption by health care organizations has been difficult to measure and evaluate. Now economists have come to the rescue.  They have created a management practices evaluation tool that can compare quality improvement efforts at different organizations in a standardized way. The tool has been validated and shown to work in the health care setting. This particular study used the measurement tool to compare how different organizations were putting quality control practices to work in their cardiac catheterization units in 2010. They found a correlation between those that were rated as using the best management practices and lower 30-day risk adjusted mortality rates.

This study provides a good example of the way the social sciences and medical sciences can work together. Economists have learned how to measure and compare management practices.  Their work provides a significant tool that health care planners can use to evaluate their own management practices. It should be applicable to all types of health delivery settings.

There is a lot of focus on reducing 30-day hospital readmission rates at the moment and, interestingly, this study did not find a correlation between the use of best management practices and lowered readmission rates. That finding does not look especially compelling given that there is no evidence that the hospitals being studied were actively engaged in targeted efforts to prevent readmissions.  Had they done so, the results of this study may well have been more encouraging on that front.


Read the study: Management Practices and the Quality of Care in Cardiac Units
K. John McConnell, PhD; Richard C. Lindrooth, PhD; Douglas R. Wholey, PhD; Thomas M. Maddox, MD; Nick Bloom, PhD