Why It Matters
IHI Senior Scientist Gareth Parry, MSc, PhD, leads IHI’s Results and Evaluation work. In this interview, he helps to address some common misunderstandings about Lean and IHI-QI.
Why did IHI publish the white paper, Comparing Lean and Quality Improvement?
With more focus than ever on changing from volume-based systems to value-based care, quality leaders are making choices about how to make changes in their health care organizations. Especially in the US — as the Affordable Care Act plays out — organizations are making choices about which approach to use to guide those changes.
With that in mind, it’s a good time to compare two of the most prominent options: Lean and IHI’s quality improvement methods.
If you talk to enough people working in health care quality improvement, you sometimes get the impression there is a lot of confusion and misunderstanding about Lean and what we refer to in the white paper as “IHI-QI,” or IHI’s approach to improvement.
Traditionally, IHI has focused much attention on the Model for Improvement, developed by Associates in Process Improvement (API). IHI has worked closely with API for the last 25 years.
People working on quality improvement also hear about approaches like the Toyota Production System, or Lean. They hear about how Virginia Mason Medical Center in Seattle and ThedaCare in Wisconsin successfully apply Lean.
How do these approaches differ, and what do they have in common? How, if at all, can we use these approaches together? IHI’s white paper attempts to answer these questions, to try to make sense of this landscape for health care improvers.
What are some of the common misunderstandings about Lean and the IHI approach?
Many assume Lean is only about cutting costs or reducing waste, or that it’s basically just a set of tools. With IHI-QI, people sometimes think it only means the application of PDSA cycles or the Model for Improvement.
People sometimes see both Lean and IHI-QI as using dogmatic checklists that spell out every step, or as if you can magically fix a problem as long as you use the right tool from the toolbox.
These simplistic views ignore that — whichever approach you use — you need an organizational and leadership strategy that guides how to introduce these methods and apply them in practice.
How can Lean and the IHI approach work together?
There are many similarities between the approaches and their underlying philosophies. They complement each other. Lean has strong and well-defined approaches that can help identify system-level issues for improvement. IHI-QI often uses similar tools as those used in Lean to understand the local system. Both approaches concentrate on the patients as the focus of the outcomes to be improved. Lean has PDCA (Plan-Do-Check-Act) and the Model for Improvement has PDSA (Plan-Do-Study-Act). They both rely on the scientific method: develop a hypothesis, make a change, collect data, and use the data to decide what to do next.
Both methods also recognize that all change is local. Improvement works best when people at the point of care, those engaged directly in the work, are empowered to test changes and use local feedback data to make improvements. You shouldn’t assume that what works well in one place is going to work everywhere — improvements might need additional adaptation and testing in a different location.
Do organizations need to choose between Lean or IHI-QI?
Again and again we’ve seen out in the field that it’s not as important to choose one or the other. It’s more important to develop a clear philosophy and a well-defined organizational structure for improvement, and empower people at the point of care to make changes. Whichever method or methods leaders choose, they need to be consistent and communicate this throughout their organization.
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