Standardization, Lean Processes, and the Question We Aren’t Asking in Healthcare

Over the past several years, healthcare systems have increasingly embraced standardization and lean operational models. And in many ways, that’s a good thing.
Standardization can:
✅ Reduce errors
✅ Improve safety
✅ Lower costs
✅ Eliminate true operational waste

But from the perspective of someone working inside a surgical specialty like spine care, I’ve begun to wonder:
❓ Are we pushing standardization and lean processes too far ❓

Healthcare is not manufacturing.
Patients do not arrive in predictable patterns. Their pathology varies widely. Their recovery trajectories vary even more.

Ive learned that one of the fundamental truths is that variability is unavoidable in service systems. When demand and service times fluctuate, systems must maintain some degree of slack capacity or redundancy to function well.
In other words:
💡 Not all “waste” is actually waste.
💡 Some redundancy is strategic.

A system designed to operate at near-perfect efficiency may look great on a spreadsheet, but in reality it may become:
1️⃣ More fragile
2️⃣ Less responsive
3️⃣ More prone to delays and errors
4️⃣ More exhausting for the teams working inside it

The uncomfortable reality is that many operational changes today are driven by short-term efficiency targets rather than long-term system resilience and sustainability.
Lean initiatives often focus on reducing personnel, rather than improving processes.
And when incentives become misaligned, the consequences can appear downstream:
✅ Longer patient wait times, more difficult access
✅ Reduced adaptability to complex cases
✅ Increased clinician burnout
✅ Lack of innovation

A more important question might be:
❓ What variation actually matters ⁉️
Not all variation is bad. The key question is whether variability affects patient outcomes or the cost of care.
➡️ If it doesn’t, it may be harmless (or even necessary).
➡️ If it does, that is where standardization should focus.

So perhaps the real goal is not maximum efficiency, but something harder to achieve:
⭐ Operational systems that are efficient in the short term, but resilient over the long term. ⭐

Healthcare systems today face a difficult challenge:
How do we design organizations that are simultaneously
✅ standardized
✅ adaptable
✅ innovative
✅ sustainable
✅ and centered on patient outcomes?

That question may ultimately determine which health systems truly succeed over the next decade.

I (and many of my wonderful colleagues) are on the front lines facing the consequences of all the decisions being made on our behalf.

Thank you to Christian Terwiesch and Gad Allon --- who have laid down the important principles to keep my brain racing in this space. The Wharton School

And also RIP Aaron Rosenberg, who always encouraged me to keep stretching and writing!