About Us

Welcome to CLEAR!

In recent years the pace of change in health care has accelerated. Some of these important changes include the growing adoption of value-based payment arrangements that require health care providers to accept more financial risk for the care they provide patients, increasing requirements for reporting on the safety and quality of care provided, and greater transparency regarding providers’ performance with respect to efficiency, processes of care, patient outcomes, and patient and staff safety. In response, many health care organizations have implemented the cultural beliefs and values, tools, and processes of Lean management. Lean is an approach to managing organizations that evolved from the Toyota Production System first developed in the 1950s to eliminate waste and improve quality in the manufacture of automobiles.  More specifically, we define Lean as:

The development of a culture that enables an overall management system to create value for customers by eliminating waste and solves problems through the daily application of the scientific method in creating standard work.

Lean has been implemented in many manufacturing and service industries in numerous countries. As hospitals and other healthcare providers have adopted Lean management, the organizations’ leaders, managers, and frontline patient care staff have tried to transform the way they identify and solve problems in care processes using new ideas (such as focusing on value from the patient’s perspective), tools (such as value stream process mapping), and problem solving routines (such as A3 thinking and the plan, do, study, act (PDSA) cycle of improvement).

But does research on Lean management in healthcare show that it makes a difference in key outcomes such as efficiency, quality of care, patients’ satisfaction with their care, or employees’ satisfaction with their working conditions? Unfortunately, we do not yet have a clear answer to that question. Many case studies using interviews or other qualitative techniques report positive perceptions of Lean’s effects among managers and frontline care staff. However, analyses of quantitative data on quality, efficiency, and other performance metrics report mixed results. Unfortunately, the vast majority of the reported studies used weak research designs and methods. We agree with the conclusion drawn in a recent systematic review of the published quantitative research on Lean in healthcare:

“While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, high quality and better conducted research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.”1

To meet this need, CLEAR is committed to conducting and fostering better research on Lean in healthcare organizations. Our goals are to (1) conduct in-house leading edge research on Lean in healthcare, beginning with the first national survey of Lean in hospitals; (2) collaborate with specific healthcare organizations and other health services researchers on focused studies of the effects of Lean in particular organizations and departments; and (3) facilitate research among other researchers and healthcare delivery organizations through resources and information available on our website.

CLEAR’s administrative home is the University of California, Berkeley School of Public Health. Our initial partners in this effort include Catalysis (formerly the ThedaCare Center for Healthcare Value), the Lean Enterprise Institute, and Rona Consulting Group. We welcome you to join in our effort to study Lean in healthcare. Working together, we can provide a more robust evidence base and actionable knowledge to help healthcare organizations meet the transformational challenges they face.

If you have questions regarding CLEAR’s activities, please contact one of the center’s co-directors: Stephen Shortell, Ph.D., M.B.A., M.P.H., Blue Cross of California Distinguished Professor of Health Policy and Management (shortell@berkeley.edu) or Thomas Rundall, Henry J. Kaiser Professor of Organized Health Systems Emeritus (trundall@berkeley.edu).


1Moraros, J., Lemstra, M., and Nwanko, C. (2016). ‘Lean interventions in healthcare: do they actually work? A systematic literature review’, International Journal for Quality in Health Care, 28 (2), pp. 150-165.