7.01.2009

Report: Medical Schools Should Teach Doctors About Lean

I’ve taken some liberties with the headline on this posting. The report to which I refer is a new document from the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare. And the report did not actually say lean should be on the curriculum of medical schools.

What it did say is that medical schools need to change their curriculums. And part of that change involves focusing on what sound to me like lean principles.


Reforms in payment policies need to be accompanied by reforms in medical education. This pairing is important to ensure that students and residents learn the skills they need to provide care and leadership in new delivery models under restructured payment and incentives.

These skills include quality measurement and practice improvement, care coordination, multidisciplinary teamwork, cost awareness, and interpersonal skills. Research on internal medicine residency programs found several gaps in formal instruction on many of these skills.


Coordination, teamwork and measurement of cost are all central to a lean strategy, just as interpersonal skills are part of the fundamental lean principle of respect for people.

And let’s not forget about the central goal of lean, process improvement.


A Commission-sponsored study, conducted by RAND researchers, found that, although most internal medicine residency programs provide at least some instruction and experience in topics associated with quality and efficiency improvements, their curricula fall short of recommendations from the Institute of Medicine (IOM) and other experts…

The IOM states that physicians must be able to assess the quality of care they provide and implement changes in their practice for improvement…

The RAND researchers found that, while many residency programs provide some exposure to quality assurance and system change, only a small share require residents to complete their own systematic data collection, analysis, and resulting system change. Fewer than half the programs (11 of 26 programs) have lectures or computer-based training on quality assurance, but more (18 programs) require that residents work on quality assessment at the hospital. Fewer than a third (seven programs) have established curricula in which residents collect and analyze data on their own patients. The same share of programs introduces residents to chronic disease registries and provides lectures or computer-based training on implementing system change. Fewer still (four programs) have residents work directly on projects to implement system changes.


The section on medical education is actually only one part of the wide-ranging, 299-page MedPAC report, which is entitled “Improving Incentives in the Medicare Program.” For those interested in healthcare reform, it makes for interesting reading.

And I’m glad to see that lean principles are part of it, even if the word lean is not mentioned.

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