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An interesting piece that has some truth in it but also misrepresents what quality improvement processes (wherever they originate) are about.

Virginia Mason doesn't represent the whole of the U.S. healthcare. It does represent an organisation that has made very impressive and sustained improvements. They have had staff battles along the way - see their work on the staff 'compact' as an example.

Lillrank & Liukko talk about a 'quality broom' with standardisation as a long, narrow handle, and flexibility and responsiveness as the bristles. Both are needed for an effective system. Improvements in safety, quality and efficiency of healthcare will come from both, not one at the expense of the other. As a clinician I disagree with a previous poster that standardisation is not helpful in safety and efficiency. Standard processes - handwashing, protocols for invasive lines, major trauma protocols - these save lives and cut costs. They are not a panacea but we are safer for them.

There are risks in simply taking the outwards signs of high quality systems (lean, run charts etc.) without understanding the fundamental role of excellent leadership and culture. Perhaps this is where the NHS has failed before, and also where VMMC or any other world leading organisations can give the NHS a helping hand.