"If You're Not Keeping Score, You're Just Practising"*
Vince Lombardi, former head coach of the Green Bay Packers
Lean methods originated with the Toyota Production System developed shortly after World War II (Ohno 1988). Recently, they are finding widespread usage in healthcare. In industry, the primary objective of Lean is to enhance corporate earnings; but in healthcare, Lean seeks to improve patient-centred care and system efficiency (Institute of Medicine 2001). Lean evaluations have tended to be ad hoc, usually focusing on before and after pictures, graphical displays or vignettes. With Lean's widespread adoption in healthcare, a broad and rigorous framework for its evaluation is needed.
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