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Lean Management of Crisis Response and Post-Pandemic Outcomes in US Primary Care Practices

The COVID-19 pandemic tested the resilience of primary care practices across the country — and a new study from the Center for Lean Engagement and Research (CLEAR) finds that those equipped with lean management systems were significantly better prepared to respond. Published in BMC Health Services Research, the study led by CLEAR Director Dorothy Hung draws on a nationally representative sample of 1,245 U.S. physician practices to examine how lean management shaped practices' ability to navigate the pandemic, manage workforce shortages, and sustain financial performance in its...

Addressing Social and Cultural Needs with Lean Management in a National Sample of US Physician Practices

Addressing patients' social and cultural needs is increasingly recognized as essential to high-quality primary care but integrating these interventions into everyday clinical workflows remains a persistent challenge. A new study from the Center for Lean Engagement and Research (CLEAR), published in The Milbank Quarterly, finds that lean management may offer a practical path forward. Led by CLEAR Director Dorothy Hung, the study draws on a nationally representative sample of 1,245 U.S. physician practices to examine how lean implementation relates to practices' capacity to screen...

The Quality of Healthcare in the UK and the USA: Looking Back, Moving  Forward

Twenty-five years ago, CLEAR Co-Founder Stephen Shortell and colleague Ewan Ferlie of King's College London proposed a framework for improving healthcare quality in the United Kingdom and the United States that was built on distributed leadership, learning-oriented culture, team-based care, and information technology. In a new paper published in BMJ Innovations, the authors return to that framework to assess what has changed, what has been accomplished, and what remains undone. Their assessment is somewhat sobering and posits that while both countries have made incremental...

Lean Healthcare Research Symposium 2026

Thank you to everyone who attended the 10th annual Lean Healthcare Research Symposium on March 11th, 2025 in Houston, Texas!

Celebrating Lean Implementation in the U.S. and Around the World

2026 Lean Research Symposium...

Lean Management of Crisis Response and Post-Pandemic Outcomes in US Primary Care Practices

June 1, 2026

The COVID-19 pandemic tested the resilience of primary care practices across the country — and a new study from the Center for Lean Engagement and Research (CLEAR) finds that those equipped with lean management systems were significantly better prepared to respond. Published in BMC Health Services Research, the study led by CLEAR Director Dorothy Hung and CLEAR Co-Founder Stephen Shortell draws on a nationally representative sample of 1,245 U.S. physician practices to examine how lean management shaped practices' ability to navigate the pandemic, manage workforce shortages, and...

Advancing Equity: Lean Leader Practices and A Path Forward

A new study from the Center for Lean Engagement and Research highlights how health care leaders are using lean management practices to advance health equity and scale initiatives that ensure high-quality care for all patients. Drawing on in-depth interviews with 67 leaders across five U.S. hospital systems, the research reveals that leadership plays a critical role in embedding equity and workforce diversity goals into everyday operations through lean approaches to process improvement. The authors call for the development of new measurement systems with clearly defined performance metrics...

Associations Between Lean IT Management and Financial Performance in US Hospitals

Justin Lee, BA; Dorothy Y. Hung, PhD, MA, MPH; Elina Reponen, MD, PhD; Thomas G. Rundall, PhD; Aaron A. Tierney, BA; Pierre-Luc Fournier, PhD, MS; Stephen M. Shortell, PhD, MBA, MPH

This study used primary data sourced from 1222 hospitals that responded to the National Survey of Lean(NSL)/Transformational Performance Improvement to understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.

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Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals

Tyler Roey, Dorothy Hung, Thomas Rundall, Pierre-Luc Fournier, Athena Zhong, Stephen Shortell

This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals...

Improving the US Healthcare System: The Case for Practical Wisdom

A new publication first-authored by CLEAR founder and Professor Emeritus, Stephen Shortell highlights the critical need for a renewed focus on “practical wisdom” in U.S. health care reform.

Despite spending nearly 17 percent of its GDP—totaling $4.9 trillion annually—on health care, the United States continues to rank among the lowest-performing countries in the OECD on key health outcomes. Stark disparities in infant and maternal mortality, hospital safety, and overall care quality persist, especially among minority populations.

The study argues that while numerous reform...

Lean Practices for Resource Use, Timeliness, and Coordination of Care in Breast Cancer Navigation

Dorothy Y. Hung, Paul Kim, Martina Li, Qiwen Huang, Cynthia Cantril, Natalia Colocci, and Ellis C. Dillon,

Researchers at Sutter Health completed a study on making cancer care more efficient and patient centered. Using Lean methods, a BCN program focused on women receiving a breast biopsy was developed at a pilot site and later implemented throughout the healthcare system. After implementing the BCN program, more timely biopsy results were delivered to patients. Patients were more likely to complete an initial consultation within two weeks of biopsy and made fewer outpatient...