What are the Differences (and Similarities) Between Lean and Quality Improvement?

Kevin Little, PhD; Principal, Informing Ecological Design, LLC; IHI Faculty

Today, I’m going to talk a little bit about Lean and what we’re calling the IHI approach to quality improvement. There’s been a lot of interest in Lean applications in health care in the last, I’d say, probably 10 years — and rightly so. In addition, the IHI, of course, has been working on quality improvement for about 25 years. And there are common themes, but these two approaches are not identical. So I wanted to talk a little bit about the differences and similarities.

First of all, [among] the similarities are both Lean and the IHI approach to quality improvement are very much rooted in reality: They’re data-based, and they are interested in continuous improvement over time applied to any particular system. We’re talking health care obviously, but for those of you who have learned or heard about Lean, you probably know that it originated with Toyota back starting in the late 1940s, and then evolved over 25 years in Japan, and then has been translated and expanded into this idea of Lean.

The interesting piece for me is when we think about quality improvement at the IHI, many times we’re focused on projects. So we’ve developed a set of tools and experiences that talk about knowing what your aim is, getting some measures, thinking about things you could change, and then doing a scientific test cycle. We call it Plan-Do-Study-Act, and that’s a universal approach to improving just about any kind of system.

What’s interesting as we look at the wonderful accomplishments of our colleagues in Lean is that they have a very particular focus on what they call production systems. So, originally Toyota called it the Toyota Production System, and now there are different health care organizations that may have their own version, but what’s key is thinking about the management method.

You may have learned about some things or seen or heard these rapid improvement events and kaizens and other things. Those are important. Certainly they are tools that map over to what we do in IHI project improvement, but what is really interesting to me is this idea of integrating into daily work and standard practice by physicians and by nurses — point of care. So what happens every day? What’s the rules by which we are going to practice?

We think that there’s a tremendous overlap between the two sets of approaches and two sets of tools. But we also believe that practitioners in both schools can learn from each other. For the folks who have been grounded in the IHI quality improvement world, we think that to study and apply Lean’s emphasis on building and management systems that integrates continuous improvement and standardized work is really key.

For the folks over in the Lean world, we think that being able to understand what we’ve learned in the past 25 years about complex projects and program planning, there are some specific tools that we’ve developed and think about, which could very useful to folks who are deploying and implementing Lean across different settings. In the end, these two approaches are highly compatible.