Original ResearchExamining the Relationship Between the Lean Management System and Quality Improvement Care Management ProcessesTierney, Aaron A. BA; Shortell, Stephen M. PhD, MPH, MBA; Rundall, Thomas G. PhD; Blodgett, Janet C. MSc; Reponen, Elina MD, PhD Author Information Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley (Mr Tierney, Drs Shortell, Rundall, and Reponen, and Ms Blodgett); and Department of Perioperative, Intensive Care, and Pain Medicine and Central Lean Improvement Office, HUS Helsinki University Hospital, Helsinki, Finland (Dr Reponen). Correspondence: Aaron A. Tierney, BA, Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, University Hall, 2018 Oxford St, Berkeley, CA 94704 ([email protected]). Aaron A. Tierney is funded via a T32 grant project 2T32HS022241-06. This work was supported in part by the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative under grant 1U19HS024075, which studies how health care delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. The work of Elina Reponen was supported by personal grants from the Foundation for Economic Education, Finland; the Finnish Medical Association, Finland; the Finnish Society of Anesthesiologists, Finland; and the Pulsus Foundation, Finland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from IQVIA information services (OneKey subscription information services 2010-18, IQVIA Inc, all rights reserved). The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Inc or any of its affiliated or subsidiary entities. The American Medical Association (AMA) was the source for the raw physician data; statistics, tables, and tabulations were prepared by the authors using data from the AMA Physician Masterfile. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.qmhcjournal.com). Quality Management in Health Care: January/March 2022 - Volume 31 - Issue 1 - p 1-6 doi: 10.1097/QMH.0000000000000318 Buy SDC Metrics Abstract Background and Objectives: The United States has an underperforming health care system on both cost and quality criteria in comparison with other developed countries. One approach to improving system performance on both cost and quality is to use the Lean Management System based on the Shingo principles originally developed by Toyota in Japan. Our objective was to examine the association between hospital use of the Lean Management System and evidence-based or recommended quality improvement care management processes. Methods: A cross-sectional analysis of data from 223 hospitals that responded to both the 2017 National Survey of Healthcare Organizations and Systems and the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals was conducted. Results: Controlling for hospital organizational and market characteristics, the number of years using Lean was positively associated with use of electronic health record–based decision support, use of quality-focused information management, use of evidence-based guidelines, and support for care transitions at the P < .05 level. The degree of education and training in Lean methods and processes was also positively associated (P < .05) with greater support for care transitions. The number of years using Lean was marginally associated with screening for clinical conditions at the P < .10 level. There was an unexpected negative association between education and training scores and screening for clinical conditions. Conclusions: Greater experience in using the Lean Management System is positively associated with several evidence-based and/or recommended quality improvement care management processes. © 2021 Wolters Kluwer Health, Inc. All rights reserved.