Lessons Learned from Large Scale Lean – Healthcare Market Overview

An article by Menachemi et al. entitled “Implementation of Lean in a Health System: Lessons Learned from a Meta-Analysis of Rapid Improvement Events, 2013–2017” which was published in Journal of Health Management (Menachemi, Tinsley, Johnston, & Schulhof, 2020) explores the results of large-scale implementation of Lean in a healthcare system that includes 16 hospitals, health plans, and dozens of outpatient clinics. The article states that, over a 5 year period, 45% of the 1,144 rapid escalation events (RIEs) introduced to Indiana University Health resulted in significant cost and time savings, improved workflow with simplified process steps, and 56,100 prevention clinical disease. and 49,900 nonclinical defects. The authors further suggest that the impact of RIEs imposed in emergency departments is more significant, especially for cost savings. Adequate analysis and review of this article requires a summary of its contents and personal analysis with correct predictions.

The main aim of this article is to present a more comprehensive analysis of the application of Lean thinking on a larger scale in healthcare settings, particularly at Indiana University Health, Indiana’s largest health care system. To date, a large body of literature on Lean process improvement in healthcare describes the theoretical benefits of Lean, Lean techniques and implementation barriers, organizational readiness, and best practices and presents case studies of limited small-scale Lean implementations with limited results reports. . This article focuses on using RIE, the most common Lean approach to efficiently assess and redesign inefficient processes. The key question the authors are trying to answer is “What new lessons can be learned from implementing Lean on a large scale in healthcare?” The authors found that, over a 5-year period, the most common benefit from implementing 1,144 RIEs at Indiana University Health was significant dollar savings across multiple sites. The main conclusions and conclusions are that Lean thinking, in and of itself, inherently leads organizations to identify opportunities that result in real dollar savings and that the relative ease of calculating real dollar savings makes these results the most logical initial target. Over time, time savings became the predominant benefit of lean activities, and a more diverse mix of benefits began to develop. The main concept that readers should understand from reading this article is that Lean process improvement can offer healthcare organizations substantial yearly institutional benefits and the use of RIE is a valuable tool for implementing Lean activities in institutions. The main assumptions underlying the author’s thinking are: (1) cost reduction and quality improvement are goals that are beneficial to all health institutions; (2) Improvement of lean processes in healthcare must expand beyond the theoretical realm to include more evidence-based conclusions from large-scale institutions; (3) the use of RIE, value stream analysis, and other Lean methods is a viable way to add value opportunities to organizations; and (4) Lean principles, even at the lowest level of the organization, have the potential to change inefficient work practices (Menachemi et al., 2020).

The authors recommend that healthcare managers, decision makers, and organizations interested in quality improvement consider how they can align RIE with specific service objectives, how Lean activities can be used to grow, develop, and retain low-level employees, and how to adopt institutional-wide commitments. for Lean process improvement can be beneficial to the organization. The implication of the author’s reasoning is that health care organizations, clinics, or other healthcare providers can always benefit from reduced costs and increased quality. If readers do not accept the author’s line of reasoning, I believe that his healthcare organization will have tremendous difficulty achieving economies of scale. The main viewpoint presented in this article is that substantial benefits are likely to follow from implementing Lean activities across institutions, such as RIE. Through Lean RIE, healthcare institutions, including large healthcare systems, have great potential to experience increased cost-effectiveness, better staff efficiency, optimized workflows, and reduced clinical errors or adverse events (Menachemi et al., 2020).


Menachemi, N., Tinsley, T., Johnston, A., & Schulhof, A. (2020). Lean Implementation in Health Systems: Lessons Learned From the Rapid Improvement Events Meta-Analysis, 2013–2017. Journal of Health Management, 65(6), 407-417. doi:10.1097/jhm-d-19-00097