Lean Book Review: Lean Hospitals by Mark Graban

Book Title - Lean Hospitals

Author - Mark Graban

Register now for the 2009 TWI Summit and hear Mark Graban speak on TWI in Lean Healthcare!
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Bottom Line

At first, I thought, "this is another Lean Simplified book with hospital words" - lean concept after concept with extensive commentary. This isn't criticism of author Mark Graban, it is what I have come to expect of these days with Lean books. It seems everyone re-publishes the same thing about Lean, except the authors use the "Lean ___insert your industry technical jargon here___," approach.

Here in Lean Hospitals, we have a truly unique experience. I had to read this twice, because I was gliding through this like it was another lexicon remix. This caused me to miss the deeper insight that the author, Mark Graban, artfully inserts in example after example. Once I slowed my pace, Graban very quickly takes you deep into thought provoking examples about the healthcare industry – pushing the reader beyond the common Lean definitions and into the real world. How refreshing! No made up stories in somebody’s garden or garage or a skip-hop-and-a-jump through imaginary utopias; NO – Lean Hospitals is the real world application of lean with all of its successes and many lessons learned.

Jammed full of knowledge, testimonials, how-to examples, pictures and illustrations for anyone wondering how Lean could possibly apply to a hospital environment, this book follows a similar pattern of other well written Lean related books where a concept is presented, explanation of the concept is offered and then a host of examples follow to cement the concept in practical application. The real strength of this book is in unique adaptations of kanban and lean concepts which should give some hospital administrators the confidence to take that first step in an otherwise uncertain Lean journey. Bottom line: order several copies and organize a book/work study group with your staff, working out real problems as you make your way through the book. Hint: take your time.

What’s New?

Mark Graban, who has extensive experience in Lean Healthcare implementations, diplomatically chips away on the mainstream approach to 5S - housekeeping - something I have blogged harshly on for over a year now. He stresses the importance of taking 5S out of the narrow crawlspace of housekeeping and into the infinite world of daily idea generation, involvement and continuous improvement. My only criticism here, if you could call it that, is that we only get a glimpse of this alternate 5S universe for a brief period. My neediness aside, this book is unique; non-Japanese AND goes beyond what we know as 5S conventional lean approaches. Mark shows us how hospitals are adopting lean and adapting to their unique environment, the ultimate lesson we should all learn. This is not only rare but refreshing for those of us that have struggled with the way 5S and Lean was interpreted over twenty five years ago and subsequently (and superficially) taught to thousands over the decades. Kudos Mark, for daring to go there, but on this matter - I was hoping you opted for a surgical grade bonesaw instead of a scalpel!

Mark touches briefly on TWI and in particular Job Instruction while you are knee deep in the Standard Work for Hospitals section. Here Mark draws a clear picture of the need for Job Instruction in order for Standard Work to be useful on a daily basis. I believe that this is the only book I have seen that explains the need in a non-manufacturing setting – again, illustrating how hospitals can and are adopting and adapting lean concepts to a real world environment. This may be a good opportunity for readers to point other Lean/TWI skeptics to a real world example of how JI is an elemental skill for Lean leaders. Even more so, TWI and Lean zealots alike will see how this book is substantial, should be taken seriously, and certainly not a Lean “___insert your industry here___“ book.

In a previous book review of Managing to Learn, I reveal how John Shook presents a new "pull based authority" concept. In Lean Hospitals, Graban shows us how pull based authority is applied across hospital departments – here we get clear insight on the kanban “how-to” and the reasons why we should consider this approach in administrative situations. It is very important and worth every penny for this chapter alone. This and many other sections of the book take complex Lean concepts and present them simply and clearly for anyone at any level in a hospital setting.

How many Gold Rivets, Rosie? 4.5/5

Lean Hospitals is a great book, loaded with how-to and sharp insight that predicts the future of healthcare; those organizations that run business as usual and those that are customer-oriented. The style is straightforward - concepts backed up with know-how, but may require another read to fully grasp the full context. This is because the examples tend to chop up the flow of the concepts and I found myself going back a couple of times to tie it all together. Regardless of my minor observations, keep this fantastic reference handy; I have pulled it off the bookshelf several times already and I work in consumer goods manufacturing, so it should be extremely useful to anyone in a hospital setting.