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Applying the Lean management philosophy to NeuroInterventional radiology
  1. Max A Gomez II,
  2. Joshua A Hirsch,
  3. Preston Stingley,
  4. Ernest Byers,
  5. Robert M Sheridan
  1. Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Max A Gomez II, Massachusetts General Hospital, 175 Cambridge Street Suite 200, Boston, MA 02114, USA; mgomezii{at}partners.org

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Introduction

The national debate over healthcare reform has, at times, spotlighted an arguably false choice between specialization and the delivery of fundamental primary care. Even prior to the emergence of any new legislation hospitals throughout the country are experiencing financial challenges. Additionally, hospitals and the practices within them are faced with ever increasing scrutiny by regulators as well as by the public to continue to improve the quality and safety of the care we deliver. Interestingly, this nexus of financial challenges and quality will be intersecting as reimbursement gets tied to quality measures.

As a field that had its inception in technological innovation and represents an area of super-sub specialization there is natural concern by NeuroInterventional (NI) practitioners that ‘our brand’ of healthcare will be a target of attention in this era of reform. Akin to the broader challenges facing our nation's hospitals, NI groups face many challenges and opportunities. These challenges include, but are not limited to, encroachment by non-neuro-based specialties with larger practice footprint, potential diminishing reimbursement and hospital/organization-wide capital contraction. Opportunities in NI are generally and quite naturally imagined as clinical and/or technical advances. Often forgotten are operational improvements that can serve to strengthen our underlying practices.

Historically, challenge can be a springboard for change and thus represent an opportunity for improvement. In the aftermath of the Second World War, the Toyota Corporation faced seemingly insurmountable challenges to its continued existence. Using operational tools that came to bear its name, Toyota maximized its value proposition and ultimately became the global leader in its industry.

Fundamentally, improvements in operational efficiency should serve to foster long-term stability of NI practices and not short-term practice requirements. The following case highlights our team's experience in adopting and integrating the ‘Lean system’ with institutional and operational practices. We present Lean in its historical …

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