A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, “Virginia Mason Health System … has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota.”

The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value.

Attempts to incorporate lean into health care have met with varying degrees of success. I blogged about this six years ago and pointed out that a literature review done back then found “significant gaps in the [lean and six sigma] health care quality improvement literature and very weak evidence that [lean and six sigma] improve health care quality.”

Randomized prospective trials of lean in medicine are lacking. A recent paper from the Journal of the American College of Radiology found only seven studies on the use of lean in radiology and they showed “high rates of systematic bias and imprecision.” The authors concluded there was “a pressing need to conduct high-quality studies in order to realize the true potential of these quality improvement methodologies [lean and six sigma] in health care and radiology.”

In addition to the debatable evidence that lean actually works and the cost and time to develop and implement lean measures, the use of Toyota as a model for quality is also highly questionable.

In 2010, Toyota had recalled more than 9 million vehicles for various defects. Nothing has improved. So far this year Toyota has recalled over 11,654,000 vehicles. The problems included exploding airbags, brake failure, fuel tank defects, and minivan doors opening while cars were in motion.

Having adopted lean methodology in 2002, Virginia Mason is not really a new story. How is it doing?

About as well as Toyota.

In May of this year, the Joint Commission paid a surprise visit to Virginia Mason Medical Center and found 29 instances where the hospital was out of compliance with standards. The Seattle Times wrote that among the problems were not having an adequate infection prevention and control plan, failure to store medication safely, and failure to provide a “care, treatment, services and an environment that pose[d] no risk of an immediate threat to health or safety.”

On September 17, Virginia Mason regained full Joint Commission accreditation status, and 6 weeks later the hospital announced that it received an “A” grade for patient safety from the Leapfrog Group.

A hospital that failed a Joint Commission site visit because of multiple safety issues gets an “A” for patient safety in the same year? I discussed problems with the Leapfrog patient safety rankings in the past.

And if lean works so well in health care, can anyone tell me how does a hospital that has been practicing lean methodology for 14 years achieve 29 Joint Commission citations?

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  

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