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Table 1 Key similarities and differences between QI and Lean (inspired by [30])

From: Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement

Aspect Lean QI
Definition in health care Continual improvement of processes by increasing value-adding activities and reducing non-value adding activities, variation, and bad work conditions [23]. Everyone’s continuous effort to create changes, that lead to better patient health, better care, and professional development [8].
Origins Toyota’s production system and approach to quality improvement can be traced back to the company’s development of an automatic stopping device for looms in 1896. Among important contributors to this development have been the quality improvement thinking of Shewhart, Deming, and Juran in the 1950s [22, 30, 4244]. Roots lie in physics, engineering, and manufacturing and the development of statistical methods and scientific approaches to understand and measure variation and thereby identify and eliminate sources of poor quality. By continually monitoring for and improving quality, a distinction was made in 1924 between quality assurance and quality improvement with the help of control charts. Key figures include Shewhart, Deming, and Juran, among others [30].
Applications in health care The first empirical applications of lean in health care began in the mid-1990s, but it was not until 2002 that applications began to spread [20]. Since the late 1980s, health care has experimented with series of different quality improvement approaches [4, 45, 46].
Key principles Jidoka (“automation with a human touch”, i.e. quality is built into the process) and Just-in-time (“only what is needed, when it is needed, and in the amount needed”) [44]. The “model of improvement” which links the Plan-Do-Study-Act (PDSA) cycle of iterative learning with three questions related to goal, measurement, and what to change [11].
Results Factors related to lean success: comprehensive project organization, employee and safety-staff representation, and top management attendance [35]. Factors related to QI success: leadership from top management, QI experience, organizational culture, and data infrastructure/information systems [10].