Lean is a performance improvement strategy that emphasizes reducing waste, with waste defined as activity that adds less value than it costs. Examples of waste include patients’ waiting time (which adds no value from their perspective), staff looking for supplies, staff who are not using all their skills, and unnecessary paperwork.

The Lean approach stresses increasing efficiency and redesigning products so that they meet customers’ goals better. Does Lean reduce costs in primary care? Does it improve customer satisfaction? Does it improve staff satisfaction? Does it improve clinical quality? California’s Palo Alto Medical Foundation for Health Care, Research and Education (which has more than 1,400 physicians and more than 5,000 other employees) systematically evaluated its systemwide Lean initiative to find out (Hung et al. 2017).

This initiative standardized the equipment, supplies, and education materials in exam rooms; set up shared work spaces for physicians and staff; and redesigned multiple workflows. For example, teams started daily morning huddles to review schedules, expanded the roles of medical assistants, and established metrics to track clinical quality, costs, patient satisfaction, staff satisfaction, and physician satisfaction. Most measures of clinical quality did not change, although diabetes care improved. Costs dropped, patient satisfaction increased, staff satisfaction increased, and physician satisfaction did not change (Hung et al. 2017).

Discussion Questions

• What are other examples of waste?

• How would standardizing equipment, supplies, and education materials increase efficiency?

• Why would expanding the roles of medical assistants increase efficiency?

• Cost per visit fell by 12.5 percent. How would this affect profits?

• How might huddles reduce costs? Increase quality?

• Would the changes described in this case reduce costs from a patient’s perspective?