Leveraging Lean in Healthcare ─ Transforming Your Enterprise into a High Quality Patient Care Delivery System

This practical guide for healthcare executives, managers, and frontline workers, provides the means to transform your enterprise into a High-Quality Patient Care Business Delivery System. Designed for continuous reference, its self-contained chapters are divided into three primary sections:



Defines what Lean is and includes some interesting history about Lean not found elsewhere.
Describes and explains the application of each Lean tool and concept organized in their typical order of use.
Explains how to implement Lean in various healthcare processes—providing examples, case studies, and valuable lessons learned


This book will help to take you out of your comfort zone and provide you with new ways to extend value to your customers. It drives home the importance of the Lean Six Sigma journey. The pursuit of continuous improvement is a journey with no end. Consequently, the opportunities are endless as to what you and your organization can accomplish.

Forty percent of the authors’ profits from this book will be donated to help the homeless through two Baltimore charities.
Praise for the book:
… well-timed and highly informative for those committed to creating deep levels of sustainable change in healthcare.— Peter B. Angood, MD, FACS, FCCM, Senior Advisor – Patient Safety, in National Quality Forum
… the most practical and healthcare applicable book I have ever read on LEAN thinking and concepts. — Gary Shorb, CEO, Methodist Le Bonheur Healthcare
… well written … an essential reference in the library of all healthcare leaders interested in performance improvement.— Lee M. Adler, DO, VP, Quality and Safety Innovation & Research, Florida Hospital, Orlando; Associate Professor, University of Central Florida College of Medicine
… a must read for all Leadership involved in healthcare. … I can see reading this book over and over.— Brigit Zamora, BSN, RN, CPAN, CAPA, Administrative Nurse Manager, Florida Hospital, Orlando

The Four Critical Issues in Healthcare Occurrence of Errors or Mistakes in the Delivery of TreatmentThe Recognition of the UninsuredCost of Delivery of HealthcareDoctor’s FeeInsurance Fee Medication (Prescription Drugs) Technology Hospital Costs Efficiency Directions of Improvement in Healthcare IntroductionPrimary CareHospital Care Managed CareThe Mechanics of Change Typical Participants in a Healthcare Team Boundary Conditions Sample Roles and Responsibilities of Team Members Implementation of the TeamDecision Making Decision-Making Tools D When to Use DThe Whys IS/IS NOTMeasuring Effectiveness of a TeamRelationships between Internal and External Teams The Transition of Groups to Teams Internal Development of the Team Stage 1: Forming Stage 2: Storming Stage 3: Norming Stage 4: Performing Stage 5: Ending Logistical Issues of Teams To Meet or Not to MeetSetting Objectives Selecting Participants Creating an Agenda Establishing Meeting Roles and Ground RulesThe Meeting Leader The Facilitator The Participants The RecorderGround RulesRoom SetupRoomOther ConsiderationsSuppliesFacility ConsiderationsStarting a MeetingEstablishing Team Strategies and ObjectivesInvolving all Team Members and Building Team Consensus Applying Active Listening SkillsLeading a Brainstorming Session Handling Difficult SituationsKeeping the Meeting on TrackMeeting MinutesThe Effects of Change in HealthcareWhat Are We Trying to Accomplish? How Do We Know Whether the Change Is Indeed an Improvement?What Are the Changes That Will Result in Expected Improvement?Testing Changes Customer Satisfaction Introduction The Customer Service AttributesApproach for Healthcare Service Quality ImprovementDevelop Feedback Systems for Customer Service QualityImplementation Measurement The Six Ps and S Model Considerations in Defining the Customer (Patient) for Healthcare Developing a Patient Satisfaction Instrument Preliminary Steps to an Effective Survey Healthcare Concerns about Customer Satisfaction (CSat) Insubstantial Theory Haphazard Execution Measurement Confiscation Inappropriate Application Understanding the Process Failure Mode and Effect Analysis (FMEA) Systems Thinking Poka-yoke (Mistake Proofing/Error Proofing) Advance Practice Quality Planning (APQP) Measurement Project Management The Process of Project Management Key Integrative Processes Project Management and Quality A Generic Seven-Step Approach to Project Management Phase 1. Define the Project Phase 2. Plan the Project Phase 3. Implement the Plan Phase 4. Track Progress and Complete the Project Process Flowchart Value Process Mapping Using Six Sigma Methodology for Improvement Define Measure Analyze Improve Control Design for Six Sigma DefineCharacterizeOptimizeVerifySpecial NoteSynthesis of Lean Thinking and Six Sigma Lean Six Sigma Healthcare Conclusions Using Lean Methodology for Improvement Lean Enterprise versus Lean OrganizationApplying the Hoshin MethodLean Is Not a Toolbox It Is a Way of Thinking about WorkTools Used in Lean5SValue Stream MappingConstruction of a VSM The Seven VSM Tools Quick Changeover—SMED Setup Reduction SMED Example Theory of Constraints Kanban Kaizen Some Additional Items Concerning LeanPush versus PullA Final Note for the Lean DiscussionUnderstanding Measurement Introduction Level I (System or Hospital)Level II (Departments)Level III (Operational Issues) Monitoring Measurements Investigative Measurements Understanding Variation Primary CareUnderstanding the ProcessPractice Redesign Step 1: Select a RegistryStep 2: Identify a TemplateStep 3: Protocols (Standardize the System of Care)Step 4: Self-Management Support (Using Diabetes as a Model)Patient-Centered Medical Home (PCMH) Lean Strategy for Primary Care Facilitate the Project Using Leadership Skills "Lean" the Practice Using Lean Six Sigma Special Note on Measurement Note 1: Understanding the Customer and the Process Note 2: Chronic Model Note 3: Medical Home Primary Care Example Concerns and Comments Secondary Concerns Immediate Applications for Computer Technology (IT) in Healthcare Billing and Administration Electronic Documentation Patient Care Health IT Focused on Improving Patient Care Population (Proactive) Care Whole-Patient (Planned) Care Measurement Change ConceptsUse of Models, Including Models of the Desired Care System and Models of ImprovementFocus on a Practical, Patient-Oriented View of Functionalityand What It Should Be Able to AccomplishUse of Learning Strategies to Accelerate Progress in Testing and Applying Change IdeasSpecific Change Ideas Implications for Spread Data Structures to Support ImprovementDense Display of DataTransferability of DataCustomizationOptimal Design of Alerts and Reminders Designs That Are Patient-Centric (Patient-Controlled)Personal Health Records (PHRs), Communications,Home as Hub Project Selection The Link between Quality Function Needs and OverallStrategic Plan The Link between Strategic Plan and Quality Plan The Theory of Variation (Common and Special Causes) The Quality Function Mission Is Very Important in Strategic Planning Metrics and Goals that Drive Organizational Performance Resource Requirements to Manage the Quality Function How Is Robustness Incorporated into Six Sigma and Lean Methodologies? What Is the Significance of the Project? What Is the Cost of Poor Quality?What Is Customer and CTQ Identification? What Is the Significance of a Data Collection Plan? Measurement for Projects What Are Some of the Common Formulas Used in Six Sigma?Specific Project Expectations of the DMAIC Model for Each PhaseUnderstanding and Utilizing ISO Standards Third Accreditation Option for Hospitals: National IntegratedAccreditation for Healthcare Organizations (NIAHO) Medical Devices The Certification Process Understanding and Utilizing the Malcolm Baldrige National Quality Program Epilogue Index
Each chapter begins with an Introduction and concludes with a Summary, References, & Selected Bibliography