Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

Document Type : Commentary


Canadian Foundation for Healthcare Improvement, Ottawa, ON, Canada


Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.


Main Subjects

  1. Sampalli T, Desy M, Dhir M, Edwards L, Dickson R, Blackmore G. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping. Int J Health Policy Manag. 2015;4(7):459-466. Doi:10.15171/ijhpm.2015.76   
  2. The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease. Canadian Foundation for Healthcare Improvement (CFHI) Web Site. 2012. Updated January 5, 2015. Accessed June 16, 2015. 
  3. GOLD: My Care My Voice: Integrated Chronic Care Service (ICCS) initiative to reduce wait times to care for complex patients by providing a “Voice to the Patient”. Nova Scotia Health Authority Web Site. Updated January 5, 2015. Accessed June 15, 2015.
  4. The Commonwealth Fund.  “2014 Commonwealth Fund International Health Policy Survey of Older Adults in 11 Countries”.
  5. Public Health Agency of Canada (PHAC). Preventing chronic disease strategic plan 2013-2016. Published February 18, 2013. 
  6. Canadian Institute for Health Information (CIHI). Healthcare in Canada, 2011: A focus on Seniors and Aging. Ottawa: CIHI; 2011.
  7. Canadian Institute for Health Information (CIHI). Seniors and the Healthcare System: What Is the Impact of Multiple Chronic Conditions? Ottawa: CIHI; 2011.
  8. Lummus RR, Vokurka J, Rodeghiero B. Improving quality through Value Stream Mapping: a case study of a physician’s clinic. Total Quality Management. 2006;17:1063-1075. Doi:10.1080/14783360600748091
  9. Porter ME, Teisberg EO. Redefining Health Care. Boston, MA: Harvard Business School Press; 2006.
  10. Shimokawa K, Fujimoto T, eds. The Birth of Lean: Conversations With Taiichi Ohno, Eiji Toyoda, and Others. Cambridge, MA: The Lean Enterprise Institute; 2009.
  11. Toussaint JS, Berry LL. The promise of lean in health care. Mayo Clinic Proc. 2013;88(1):74-82. Doi:10.1016/j.mayocp.2012.07.025
  12. Kenny C. Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience. New York: Taylor & Francis Group; 2011.
  13. Toussaint JS, Gerard R. On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry. Cambridge: Lean Enterprise Institute; 2010.
  14. Continuous Improvement: Lean. Health Quality Council web site. Updated January 5, 2015. Accessed May 21, 2015.
  15. Transformation. St-Boniface Hospital Web Site. Updated January 5, 2015. Accessed May 21, 2015.
  16. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. Doi:10.1377/hlthaff.27.3.759   
  17. Labinjoh C, Mate K, Maher L. What matters to me? From concept to reality. April 21, 2015, Institute for Healthcare Improvement – British Medical Journal Forum 2015.
  18. Verma, Kontz, Farmanova
  19. Whittington JW, Nolan K, Lewis N, Torres T. Pursuing the triple aim: the first 7 years. Milbank Q. 93(2):263-300. Doi:10.1111/1468-0009.12122
  20. Bate P, Robert, G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Quality Saf Health Care. 2006;15:307-310. Doi:10.1136/qshc.2005.016527
  21. Carman KL, Dardess P, Maurer M, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood). 2013;32(2):223-31. Doi:10.1377/hlthaff.2012.1133
  22. Schoen C, Osborn R, How SK, Doty MM, Peugh J. In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff (Millwood). 2008;28(1):w1-16. Doi:10.1377/hlthaff.28.1.w1
  23. Schoen C, Osborn R, Squires D, Doty M, Pierson R,  Applebaum S. New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Aff (Millwood). 2011;30(12):2437-2448. doi: 10.1377/hlthaff.2011.0923
  24. Toyota Production System. Toyota Motor Corporation Web Site. Updated January 5, 2015. Accessed May 21, 2015.