Why It Matters
The following is adapted from an excerpt of the IHI Comparing Lean and Quality Improvement white paper.
The upsurge in adoption of Lean methods in health care settings, following on the wide dissemination of the “IHI approach” to quality improvement (referred to as “IHI-QI” hereafter) over the past 25 years, has led some people to ask, “Which is better, the IHI approach or Lean?”
Certainly, the choice of methodology can be challenging for organizational leaders with limited knowledge of both approaches. They may look to the literature, the testimony of colleagues, or current fashion to decide how to build their organization's improvement capacity. Some may see the choice of Lean or IHI-QI as a big decision, with serious risks and expensive consequences. The decision is made no easier by the narrow interests and elaborate technical language of consultants and vendors promoting their own particular approaches and skill sets.
But the question is equally contrary to the spirit of both traditions. A critical comparison of the origins, core principles, methodological roadmaps, and tool sets of IHI-QI and Lean reveals them to be harmonious in conception and complementary in practice. Instead of an “either-or” choice, there is much for leaders to gain by considering both IHI-QI and Lean in light of the needs of the new health care marketplace, with a clear view of the complementary strengths and applications of each, appreciating the profound compatibility of their philosophies and approaches.
Furthermore, integrating perspectives and lessons from the two approaches has the potential to strengthen both IHI-QI and Lean. IHI-QI practitioners see specific Lean lessons worth adopting, like the Lean requirement to ground analysis and improvement in the workplace, with expectations for all levels of a management hierarchy to engage in standard work and continuous improvement. For practitioners of Lean, IHI-QI offers diverse conceptual frameworks for managing change, techniques for implementing changes in complex systems, program formats for spreading change, and learning models that have been developed and implemented in a broad array of health care settings.
To learn more about Lean and IHI-QI, download Comparing Lean and Quality Improvement. This IHI white paper begins with a brief overview and some key definitions, followed by more detailed descriptions of Lean and IHI-QI. For each approach, the authors discuss the key conceptual foundations, the principles that lead the way to improved system performance, the project roadmaps typically followed under each approach, and the tools that characterize them in practice. The authors also point out the key differences between the two approaches, while also outlining their fundamental congruence:
- Both approaches recognize the purpose of the system — defined from the customer’s perspective — as the starting point for improvement.
- Both approaches take the well-being, morale, and dignity of people working in organizations as both ethical and instrumental objectives.
- Both approaches emphasize the design and continual refinement of processes as the way to reduce variation and increase value in outcomes.
- Lean and IHI-QI both rely on general principles (in IHI-QI terminology, “change concepts”) to guide the identification of candidate changes and solutions. They share many improvement tools and methods.
- Both emphasize the use of error proofing and inspection (including probabilistic sampling) in process design in order to improve reliability and reduce the rate of defects.
- Both approaches provide a simplified heuristic for defining quality problems on small and large scales, identifying candidate changes, and testing them to arrive at workable solutions. For IHI-QI, the heuristic is the Model for Improvement; for Lean, the A3 approach to problem solving.
- For both, the daily application of experimental methods by line-level staff to recognize workplace problems and identify useful changes (kaizen, PDSA) is the driving mechanism of sustainable improvement.
- Both recognize that measured feedback is an essential component of successful improvement efforts.
- Both see the ultimate work of improvement as transforming the culture of the organization from one based primarily on personal accountability to one based on cooperative understanding of system purpose, dynamics, and operation.
Finally, the authors suggest ways that practitioners of both Lean and IHI-QI can use the principles and methods of the other to extend their capabilities.
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