The Lean Debate – A “Wicked Disease”

John Seddon, a British occupational psychologist, has been a lightning rod for Lean promoters (which he refers to as “tool-heads) over his criticism of Lean.

Seddon bases his own work on Taiichi Ohno, the father of the Toyota Production System that Lean is also based on.

Seddon argues that industrial processes don’t adapt well to the service sector, where standardization often gets in the way of meeting the need for a variety of approaches, calling Lean a “wicked disease.”

“Lean as ‘tools and projects’ appeals to managers,” writes Seddon in one of his newsletters. ”Managers think they know what their problems are and they think tools training and projects will be useful. Managers like the idea (promoted by the lean tool-heads) that services should be standardized (big mistake). If they do get improvement it is marginal, often they end up worse but they don’t know because they are still measuring the wrong things (lean tool-heads don’t question targets or activity measures for example, indeed they don’t question management philosophy).”

Seddon instead promotes what he calls the Vanguard Method, which he says is more about intervention theory and system design. On the Vanguard website, he specifically recommends “service organizations avoid the ‘tools’ developed for ‘lean manufacturing’ as they don’t apply well in service organizations.”

Lean believers have been apoplectic about Seddon, writing lengthy articles about whether or not Ohno believed in standardization as part of the TPS.

In fact, it is this production line mentality that has been publicly blamed for the dramatic rise in hospital readmissions in the UK by that country’s health minister. Despite the widespread adoption of Lean in UK hospitals, readmission rates have gone up 78 per cent in the 2000s. The Telegraph reports that in 2009-10 UK hospitals had readmitted 620,054 patients who had been discharged less than 28 days earlier.

Finding quality evidence that Lean is truly making a difference is difficult to find, many suggesting that accomplishments are more about process and less about outcome.

One 2009 Texas A&M meta-analysis noted that while many studies existed that showed improvement in processes and outcomes, “the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.”

We previously noted that the Saskatchewan health system has signed contracts worth $38.5 million with a Seattle-based consulting company to bring Lean to their 43,000 health care managers and workers. That includes Lean certification for 880 senior managers in the health system.

It’s clear from government statements that cost savings are a big part of the reasoning behind the initiative. Some are suggesting it might have been more prudent to pilot such a project in a single region before rolling it out on this scale. The Saskatchewan government says that this is a 50-year project.

As part of the cost-savings rational, the Saskatchewan government points to design of the province’s new Children’s Hospital as an example of how Lean management saved $30 million from the projected costs.

Saskatoon Star-Phoenix columnist Mark Lemstra (who blows both hot and cold on Lean) writes:

“Let’s be more factual. In April 2007 the cost estimate was $100 million to $200 million. In March 2009 the proposed budget was $200 million. In November 2010 the Saskatoon Health Region initiated its lean management program for this project. In August 2011, the budget was expanded to $259 million.
In April 2012, the final budget was $230 million, which is $29 million lower than $259 million of August 2011, but it’s $30 million more than was originally budgeted. Only in the health-care sector can this process be considered lean.”

Of course, for the true believers every success story is the result of Lean, every failure is the misapplication of Lean. More on this next week.

What the heck is Lean? See our previous post, The Trouble with Lean, by clicking here.

One response to “The Lean Debate – A “Wicked Disease”

  1. Thanks for this interesting blog. We are applying the Vanguard Method in the English NHS. Our experiences are being captured on our blog should you want to find out more http://vanguardinhealth.blogspot.co.uk/2012/05/does-going-lean-going-wrong.html

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