I agree with Michael Porter’s statement in a recent New England Journal of Medicine article when he says “Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system.” The article goes on to say “This goal is what matters for patients and unites the interests of all actors in the system.” Which is exactly why Lean can deliver amazing results in improving health care.
Lean Integration complements Michael Porter’s view on value in health care by putting the patient at the center of “waste elimination” and “continuous improvement” focus and stressing outcome-based measures and not process or activity metrics. It is relatively straightforward to come up with health outcome-based metrics, but it is hard to adjust the rewards for all players throughout the health-care system since it is fraught with special interest groups and political land-mines. Furthermore, while a common “goal” is a necessary ingredient to unite actors, the goal by itself is insufficient. This is where Lean Integration comes in.
Lean Integration is a management system for driving improvements in a customer value stream that involves multiple independent organizations or individuals. Until such time that the U.S. health system rewards are restructured (which could take a very long time), the Lean Value Stream Mapping method is a way to:
- Keep everyone in the value chain focused on the perspective of the patient
- Explicitly identify value-added and non value-added activities as defined from the patient perspective
- Model both the flow of materials (activities that contribute to the health outcomes) and flow of information (activities related to governance, coordination, control, compliance, etc.) in the end-to-end process
- Document facts about the end-to-end process so that all players have a common understanding
- Identify the root-causes of waste and not just the symptoms
- Facilitate fact-based improvement events across a collection of independent actors that need to work together as inter-dependent teams
In short, while Porter lays out a clear picture of what is needed to improve value in health care, Lean Integration shows how to drive the improvements. In an upcoming article, I’ll walk through a specific example of how Lean Integration can help drive value in health care.
 Michael E. Porter, Ph.D., What Is Value in Health Care?, The New England Journal of Medicine, December 23, 2010