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Why Lean doesn't work for everyone
  1. Gary S Kaplan1,
  2. Sarah H Patterson2,
  3. Joan M Ching2,
  4. C Craig Blackmore3
  1. 1Virginia Mason Health System, Seattle, Washington, USA
  2. 2Virginia Mason Medical Center, Seattle, Washington, USA
  3. 3Center for Health Services Research, Virginia Mason Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr C Craig Blackmore, Center for Health Services Research, Virginia Mason Medical Center, Mailstop: R3–324, 1202 Terry Avenue, Room 324, Seattle, WA 98101, USA; craig.blackmore{at}


Popularisation of Lean in healthcare has led to emphasis on Lean quality improvement tools in isolation, with inconsistent results. We argue that delivery of safer, more efficient, and higher quality-patient focused care requires organisational transformation of which the Lean toolkit is only one component. To successfully facilitate system transformation toward higher quality care at lower cost, Lean tools must be part of a comprehensive management system, within a supportive institutional culture, and with committed leadership.

  • Lean management
  • Healthcare quality improvement
  • Organizational theory

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