Hospitalists: Lean leaders for hospitals

Unsustainable increases in health care costs mandate efforts at cost reduction. Such efforts necessitate enhanced productivity, especially given the specter of an aging population afflicted by a burgeoning chronic disease burden. Productivity is less a choice than an imperative forced upon hospitals and health systems as they attempt to address the competing requirements of diminished resources and increased demands. While the traditional mindset treats the goals of cost reduction and improving quality as tradeoffs, the methodology and philosophy known as ‘‘Lean’’ provides a proven approach for simultaneously improving both factors. Ideally, improved quality should lead to lower cost, and improved productivity should lead to better quality outcomes for patients. This issue of the Journal of Hospital Medicine (JHM) describes multiple efforts to assess the activities of hospitalists and other hospital-based physicians through use of time-flow measurement. Understanding how health care workers spend their time and on which tasks that time is spent are essential steps toward applying Lean methodology at the point of care, or ‘‘gemba’’—a Japanese word that means the place where the work is actually done. At many health care institutions this ‘‘gemba’’ focus has not been integral to healthcare management models, and likely is a contributing factor to the cost and quality levels that exist today. The studies directly observing care delivery published in this issue of JHM provide invaluable lessons on how we might both improve productivity and quality of care delivery in the hospital. In this editorial, we review essential components of Lean methodology and propose how hospitalists and hospitals can benefit from its application.