The How Not the Who!

I recently read an article from Modern Medicine Network in their Medical Economics section that talked about how a manufacturing process can transform healthcare delivery. What surprises me is that the article is five years old and yet most healthcare organizations have not heard of this concept: lean healthcare. The Toyota Production System is a transferable lean methodology designed to remove waste from any system. Yes, people are not widgets and yes, everything a practice does is for the patient. However, it is not the who but the how that has waste. How things are done, the processes, and the way in which work is viewed as a system rather than an individual task. And my favorite part: the value of the people doing the work. Healthcare, after all, is a service for people and provided by people.

If you'd like to read the entire article: click here

If you'd like to contact the Transformation Team for a free quote on a practice assessment: click here

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Transition from Individual Change Efforts to a System-wide Improvement Movement

When the Infinitum Team goes into a healthcare organization the first thing we ask is, "Where's your pain?" Everyone knows where they hurt, and when the hurt goes on for any length of time it begins to wear down a person's enthusiasm, work relationships, and the mission of the organization. Many individuals seek to make changes within their own work and soon discover it is not enough and become discouraged.

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It is the Infinitum Team's practice to take that hurt and discouragement and turn it into an aim. The aim is the goal post or shared mission for a system-wide change by learning and implementing system thinking. This improvement science is data based. Measures are created to support the aim and evaluate countermeasures on a regular basis. These measures are like a measuring stick in that they not only show whether the implemented changes are the desired improvement, but also if they are sustainable.

Every clinician knows how to provide care and has some basic improvement skills. The key is to expand that skill from the patient to the system that serves the patient. Awareness and methodology needs to be learned to create system thinking and system problem solving across the healthcare system. The Infinitum Team enjoys seeing the faces of the people we work with light up when that awareness hits them. At that point system thinking cannot be unseen. When system thinking and system problem solving become shared knowledge as people speaking the same language a culture change takes place and patient safety, patient satisfaction, and optimal health outcomes are met with returned enthusiasm for the work that clinicians are passionate about.

System-wide improvement takes dedication and energy that not everyone has when they first start on the system thinking journey. The Infinitum Team can perform an assessment to address this very normal starting point and prepare people by helping them understand through education and implementation. The Infinitum Team has observed three key elements:

Everyone must be included; a multi-disciplinary team that has at least one person from every area of the system is essential to system thinking from the patient's view. Everyone knows something about the system and they have working knowledge of their area within the system.

Gather, analyze, and understand the system data to measure the desired changes and standardize those changes into sustainable improvements. Data from the EMR, safety data, patient satisfaction data, employee data, and quality data are all pieces in the data picture.

Not every employee has "quality" or "system thinker" or in their title, but everyone should have "quality" and "system thinker" in their job description. It should be a mindset that is shared by all through education, training, and transferable knowledge for system thinking to be cultural.

The Infinitum Healthcare Transformation System teaches people how to view their work from the lens of the patient within the whole system by showing them how their work affects patient safety, patient satisfaction, optimal health outcomes, and how their work is interconnected as a system of care. Consideration of the patient from the time they enter the system to the time they leave is a new cultural mindset. This mindset is transferable knowledge between individuals, teams, and the healthcare organization as a whole. If you're interested in a system-wide improvement movement and want to talk about an assessment to determine your starting point on this journey, contact the Infinitum Team.

Fostering Dignity

I learned about John Perry Barlow's "The 25 Principles of Adult Behavior" while attending the 2018 School for Change Agents through Horizons National Health Services in the United Kingdom. (If you haven't taken their classes, I highly recommend them. They are online and it was free!) We've all heard the term "lead by example," right? Well, "Change Starts with Me" was the School for Change Agents' first class. I wanted to share the 12 principles that the School for Change Agents shared because I couldn't help but think about how beneficial these principles are for creating and sustaining change initiatives:

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The Infinitum Healthcare Transformation System would add Barlow's #22, foster dignity, to the School for Change Agents list for "Change Starts with Me." If you look up the definition for dignity, you'll read that it is a sense of pride in oneself or self-respect, and knowing that you are worthy of honor or respect. One of the two pillars of lean is respect for people. Respect fosters dignity and creates intrinsic motivation to sustain the other pillar of lean: continuous improvement.


Note:  Here's the entire list of Barlow's "The 25 Principles Of Adult Behavior," if you're curious:

 1. Be patient. No matter what.

2. Don’t bad-mouth: Assign responsibility, not blame. Say nothing of another you wouldn’t say to him.

3. Never assume the motives of others are, to them, less noble than yours are to you.

4. Expand your sense of the possible.

5. Don’t trouble yourself with matters you truly cannot change.

6. Expect no more of anyone than you can deliver yourself.

7. Tolerate ambiguity.

8. Laugh at yourself frequently.

9. Concern yourself with what is right rather than who is right.

10. Never forget that, no matter how certain, you might be wrong.

11. Give up blood sports.

12. Remember that your life belongs to others as well. Don’t risk it frivolously.

13. Never lie to anyone for any reason. (Lies of omission are sometimes exempt.)

14. Learn the needs of those around you and respect them.

15. Avoid the pursuit of happiness. Seek to define your mission and pursue that.

16. Reduce your use of the first personal pronoun.

17. Praise at least as often as you disparage.

18. Admit your errors freely and soon.

19. Become less suspicious of joy.

20. Understand humility.

21. Remember that love forgives everything.

22. Foster dignity.

23. Live memorably.

24. Love yourself.

25. Endure.

Seize the morning, seize the day!

"The difference between ordinary and extraordinary is that little extra."

-Jimmy Johnson

Jimmy Johnson is one of the greatest football coaches in American football. He understood that giving a little extra, in the beginning, made all the difference in the end. Morning team huddles are like that. Initially, you might even think there isn't time, but in time you will realize that they make all the difference.

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Morning Huddle Tips:

The morning huddle should be quick and lively with a bit of fun.

  • Timing is everything! Start and end on time. Be brief and concise in the sharing of information. Bigger issues that need brainstorming and planning should be scheduled for another time.

  • Although a quick stand-up meeting it is a time for everyone to connect just like a football huddle before each play.

  • Start and end the meeting the same way to create a shared ritual.

  • The team huddle will set the tone for the day, so be positive. Start with good news or something positive from the previous day.

  • Be prepared with an agenda that will relay information; don't wing it:

    • Game strategy: share figures of how you are doing against our target, status update.

    • Coverage: attendance and shared awareness of who needs help.

    • Goal: focus on the priorities of the day, organize the workload for the day, and plan for coverage for the day.

    • Heads up: where are the opportunities and issues. Intel: share the "ah-ha!" learning.

    • Touch down dance: celebrate the wins, give a compliment, ask team members to make an appreciation statement for another team member, or share a team cheer.

  • Consider a whiteboard as a Huddle Board to create Visual Management of metrics, issues, ideas, and wins that can be updated throughout the day.

  • Agree to talk about things that matter and unite the team, and not a place to chit-chat, whine, complain or have side conversations.

  • When bigger issues arise, schedule a meeting for just that issue.

  • Consider using a ball that is tossed from one person to the next so that each person has an opportunity to be heard.

  • The facilitator should communicate in a conversational style rather than a one-way conversation.

  • Eye contact is essential along with active listening.

  • Consider taking turns as the facilitator, if appropriate.

Morning Huddle Practice Benefits:

  • Improved communication between team members.

  • Better coverage of the practice.

  • Provides an opportunity to share concerns and receive feedback.

  • Improves workflow. When team members start the day together they have a common understanding of the priorities and plan to address any issues.

  • Teamwork mindset; morning huddles create awareness of what is going on in each other's work.

  • Creates a teamwork culture along with ownership and accountability that is proactive instead of reactive.

  • Supports organizational goals toward becoming a higher reliability organization in quality and safety.

  • Initiatives and safety concepts get distributed throughout the team for common understanding and reduced misconceptions.

  • In addition to reducing email traffic, it is more timely than an email as everyone receives the information together and has a chance to add any information they know.

Morning Huddle Patient Benefits:

  • Better care; with a review or "scrub" of the patient record there is less chance of a gap in care or awareness of specific needs of the patient.

  • Holistic care; the care team functions toward a specific patient goal together from all their areas of care.

  • Faster service; with preparedness the day runs smoother for the entire system.

  • Depending on the size of the practice, sometimes medical assistants and providers have a separate morning huddle to review the patient schedule it can look like this:

    • MA "scrubs the chart" looking for care gaps or high priority items such as preventative care, disease management, and identifying missing information.

    • Plan for continuity issues such as a special care tray in the exam room but avoid too many tasks as the point is to stay on schedule.

    • If there is a health team on staff such as dietitians, social workers, behavioral health; all who provide care attend. Avoid too many tasks - the point of the huddle is to provide the best care and to stay on schedule.

Team huddles can have a huge impact on patient care when the healthcare team functions with a team mindset and patient focus. The morning huddle provides a time and place for active listening, active communication with multiple participants, and shared knowing and learning. If you would be interested in a morning huddle workshop or online training, please contact us.

Standardization of Exam Rooms

In the last three weeks I've talked about cleaning out and organizing the practice storage room, implementing a 2-bin supply system for replenishing the supplies, and reorganizing the physical flow of the office. This week I'd like to talk about organizing the exam rooms. Most practices have multiple exam rooms which are in constant use as Patients are roomed, cared for and cleaned. Exam rooms can be a significant limiting constraint on Patient flow, as anyone who has waited excessively for a room to become available can tell you. Rooms are one of the main resources a Practice has, so maximizing their utilization is very important. When we look at the work flow in exam rooms, we tend to find themes:

  • Rooms are set up differently, with different equipment and layout. Sometimes this is personal preference for one provider, other times it is just how the layout has evolved. Many times the rooms are laid out in a legacy format, designed by people who have long since left the practice.

  • Signaling systems are missing or inadequate. One of the main contributing factors to delays while in the exam room is the inability of the provider to know exactly when the Nurse/MA has finished the rooming process and the Patient is available for the Provider Visit.

  • Equipment and Supplies are stored haphazardly with stock outs commonplace

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Unless a room has a very specific purpose (and should only be used for that purpose), then there is a case to be made for standardizing room layout as much as possible. Every exam room should have the same supplies in the same place so no matter who is on duty items can be found quickly. If the gloves are on the third shelf in one room, then it should be the same in every room. This cuts down on people searching for supplies. And the same goes for equipment. Every exam room should have a blood pressure cuff instead of a shared one that has to be found every time there is a new patient being roomed. This will allow for better patient care as time will not be wasted looking for supplies and equipment. This is the beauty of standardization! Reduction in variability, easier learning curve for new employees, reduction in waste, and a baseline for improvement are just some of the benefits. Additionally, it adds discipline to the culture, and supports audits, and creates inclusion as it involves all healthcare team members.

 Standardization has received a bad rap in healthcare. There is still a pervasive thought process that insists everything about Medicine is an art, and shouldn't be tampered with. To this we say - Art is appropriate in some circles, but having the platform from which to create art be consistent can allow you to create that art with fewer distractions and delays. This is the philosophy behind standardization in the medical practice. The removal of reasons to divert thought away from the Patient and how the Physician interacts with them. 

 Standardized work is a powerful lean tool in which the sequence of job elements have been efficiently organized and repeatedly followed by the healthcare team. Standardization can maximize quality, repeatability, safety, interoperability, and compatibility. The goal is not only consistency but continuous improvement as changes take place. Some say (wrongly) that standardization makes us all operate like robots. This is not the intent. Standardization provides the commonly agreed best practices to the entire team, and helps them all perform to that best practice consistently. From that platform of excellence, innovation is encouraged, ideas tested through PDSA cycles and deliberate changes made to continually improve the underlying processes.

 Standardization is a core principle of Infinitum. We have extensive experience in designing standardized systems in medical environments. If you would be interested in holding a Standardization Workshop, please contact the Infinitum Transformation Team.

The Spaghetti Map

I have to confess that I love rearranging the furniture in my home. It's part of my spring cleaning routine to consider reorganizing a room that will make the most sense for the changes that have taken place over the last year. For example, maybe I added a new piece of furniture or bought a new TV and the layout needs to change. Part of the cleaning and organizing process for a practice is to look at where everything and everyone "sits" and determine if those placements make the most sense for the workflow of the practice.

Have you ever stopped to consider how many times in a day you walk from here to there in the physical layout of the practice? Unnecessary movement or motion is one of the eight waste categories in lean healthcare. If you were to draw a line for every place you walk to and fro, what would it look like? Spaghetti? Would it reveal that the scale over in the corner of the office creates a lot of extra steps? Unnecessary steps that take time away from doing something with more value for the patient?

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The Transformation Team was at the IHI San Francisco Conference last week discussing lean methodologies including the above spaghetti map which is one of many countermeasure projects to reduce waste in the patient pathway. In this particular project there was an 87% reduction in unnecessary movement. If you'd like to learn more about saving time to create time, please contact us.

Two-bin Systems are Better Than One!

When staff can't find the supplies that they need healthcare organizations end up with delayed patient care, frustrated staff, hording which can create over ordering of items which adds cost to the system, as well as interruptions to the workflow of the purchaser having to deal with a rush order. Most healthcare organizations usually use the par system whereby each item has a set par level based on historical usage. The purchaser or material handler would have to manually count how many of each item was in inventory, enter the amount into the system, and deliver the exact amount needed to bring the item up to par in the storage space. In addition to this process being inefficient, it has a lengthy learning curve for any new material handler.

A two-bin inventory control system is aimed at reducing inventory and optimizing the reordering process. The system monitors the quantity of how many items remain by a visual process. When the first bin is emptied the Kanban or visual card on the front of the bin is flipped to signal that it is time to reorder. The clinical team uses the items in the second bin until more items arrive. The person doing the reordering can quickly tell what needs to be reordered by the color of the visual card.

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The advantage of a two-bin inventory control system;

  • Items never run out for reduced waiting time (no stock-outs);

  • Items are always reordered when needed for minimized lead time ( no overstock);

  • Optimized inventory volume for the need of less storage.

The two-bin inventory control system has four factors that must be balanced:

  • C - the number of visual cards must equal the number of bins in use;

  • S - the size of the bin or how many items can fit in it;

  • L - the lead time to replenish the inventory or how long from sending the signal until the team receives new inventory;

  • D - the daily demand for the particular item.

The formula for the optimal two-bin system is (C-1)*S = L*D. Of course, this basic approach does not factor in fluctuating demand, minimum orders, or other variables as these are the customization calculations that would need to be included. This may not be an issue if you partner with a supplier that fills the bins as needed on a regularly scheduled delivery.

Check out this short training video!

The Infinitum Transformation Team can assist you in implementing a two-bin inventory control system. Contact us if you'd like to train your staff.

Spring into 5S!

Spring has sprung and the sun feels warm and the days are getting longer. Time to open the windows and let in all that sunshine and fresh air. I have the urge to spring clean and I'm ready to hoe out all the things I forgot I had and organize! I have a rule that if I haven't used it or worn it in a year, then it must find a new home. As I dig through my closets I am reminded of the lean 5S methodology that has been proven to be an effective way to identify and eliminate waste while organizing and standardizing the workplace. The list below describes the steps to organize a work space so that it functions with efficiency in mind and is effective at eliminating unnecessary motion, maintaining a clean and tidy area, making inventory easy to manage, and sustaining the new order.

You'll notice this 5S list is now 6S because the Transformation Team at Infinitum has added "safety:"

  • Sort -

    Goal: Reduce the number of items and reduce the amount of needed storage. If more people wear medium gloves than small then the amount of each size of glove should represent the office population. Everything has a "home." You do not waste time looking for items as you know exactly where items are stored so they are easily available and inventoried.

    Implementation: Evaluate whether or not an item should be stored in this space. Evaluate the number of each item. Remove unnecessary items, and "red tag" all the items you are not sure about and place in a "red tag" area until you know.

  • Set in order -

    Goal: Reduce inconvenience. Reduce unnecessary movement and over reaching.

    Implementation: Put the items that are used most in the most convenient or optimal place. Items should be in a logical order as to use or size. Make it easy to find items by using visual labels (color code, number, alphabetical order) Put tape on the floor to show where equipment "lives."

  • Shine -

    Goal: Keep area clean so it is pleasant to work in. Keep area picked up so it is safe. Keep equipment well maintained to prevent time loss during an equipment breakdown.

    Implementation: Sweep and dust regularly. Inspect area and equipment within the area regularly.

  • Standardize -

    Goal: Standardize the sort, set in order, and shine processes. Procedures and schedules are within the standardized 5S policy.

    Implementation: Make sure it is part of everyone's daily routine. Provide visual reminders such as photos and diagrams. Ensure that everyone knows their responsibility. Create an audit checklist.

  • Sustain -

    Goal: Sustain the developed and sometimes co-created processes. Staff will follow the processes without being told.

    Implementation: Organize training sessions. Audit the entire procedure regularly as things change. What made sense a year ago may not be true anymore. Staff feedback is valuable for ongoing improvements. When issues arrive, address them by identifying the cause to avoid them happening again.

  • Safety -

    Goal: Increase safety.

    Implementation: Eliminate hazards that can cause trips, slips, and falls on the floor. Eliminate falling object hazards. Eliminate injury by putting heavy and often reached for items closer to the person.


Feeling ready to do some spring cleaning in your work spaces? Contact the Infinitum Transformation Team and we'll be happy to help!

Becoming a Data-driven Healthcare Organization

Becoming a data-driven healthcare organization takes more than deciding to become one. It takes commitment and planning:

  • The commitment of leadership and an implementation plan with a shared mission.

  • The right technology architecture in place.

  • Selecting the best analytical tools to derive insights from data.

  • Realigning an organization’s culture to make sure that everyone is involved in understanding the value of the data, how to obtain good data, and how to translate data into decisions.

  • While the transformation takes commitment and planning the formula is simple : (Executive Commitment + Shared Mission) x (Data Analytics + Employee Involvement) = Data-driven Decision Making Culture

Transforming the culture of an organization from one of "this is how we've always done it" to "this is how we know we're doing it the best way" has to come from the top and be of constant support to the change leaders. The four steps to transforming culture:

  1. Executive Commitment -Executives need to be shown how analytics will bring value to the organization. Metrics must be clearly defined. Managing expectations with small changes, such as a pilot program, to prove the return on investment. Knowledge costs money, data is knowledge; what is its value to the organization and qualify it to the mission of the organization and quantify it to the cost of care.

  2. Shared Mission - It is essential that the Data-driven Culture Change Implementation Plan be connected to the mission, vision, and value statements of the organization. These three statements serve as a constant reminder of "who we are," "where we are going," and "how we will get there."

  3. Data analytics - What, why, and how need to be planned out. What data will you collect to answer the "why" and how will you collect it? Employee training on how to collect and input data is vital to the success of clean data. It is often said that what comes out is only as good as what goes in.

  4. Include everyone - All those working within the culture need to be part of the change for the change to stick. Additionally, their work knowledge and ideas are important to the success of creating the best processes and innovations. As an organization begins applying those insights directly to the healthcare system, using them in the decision-making process will start to become embedded within the organization and the culture will change organically.

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Forging a stronger connection between analytics and healthcare outcomes is accomplished by combining executive commitment, shared mission, data analytics, and the people doing the work to become a data-driven making culture. Infinitum recognizes the need for culture change and can provide a cultural assessment of where a healthcare organization is currently at, where it needs to go, and co-create a plan with leadership on how to get there. If your healthcare organization is ready to make data-driven decisions through process change, please contact us and we'll show you how to implement a culture transformation.


Kralla, Preston. Providing the business value of big data. 10 December 2015. Web address:

Know your numbers, know your world!

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"All known things have number."

--Pythagoras, Greek mathematician and philosopher

If all the known world is a number, do you know your healthcare world; specifically your patient and operation numbers and how they correlate? Do you know the numbers of other healthcare organizations in comparison to your numbers?

As I write this post the has reached almost 7.7 billion people. Every one of those people needs healthcare. It blows my mind. What is the healthcare data on 7.7 billion people?

According to Our World in Data, Americans have a life expectancy of 79.2 years. They estimate that the last 11.6 of those 79.2 years are spent living with disability and disease. With the new value-based payment structure and the population aging, how will healthcare organizations manage these populations and keep healthcare organizations fiscally sound?

While we may never know the healthcare data of 7.7 billion people, a healthcare organization could and should know their healthcare world numbers by creating and monitoring its patient and operations data and correlating it to know with 98% accuracy it's demand and capacity at any given time. These collected numbers are called data analytics and are used to manage the world from which the numbers were collected. There are three type of data analytics:

Descriptive Analytics: Uses data aggregation and data mining to provide hind sight into the past to answer the question, “What has happened?”

Predictive Analytics: Uses statistical models and forecast techniques to provide foresight into the future to answer the question, “What could happen?”

Prescriptive Analytics: Uses optimization and simulation algorithms to provide insight into the present and answer the question, “What should we do?”

The Infinitum Healthcare Transformation System looks at a healthcare organization's numbers and applies data analytics to understand what has happened in the past, what could happen in the future, and what is the best practice for the present based on the patient and operations data. Would you like to know the numbers of your healthcare world? Contact Infinitum to learn more.


Our World in Data. 14 March 2019. Website address:

Pythagoras, Greek mathematician and philosopher. 11 March 2019. Website address: Searched: All Known Things have Number

Wikipedia. 14 March 2019. Website address: Searched: Descriptive, Predictive, Prescriptive Analytics

World Population. 13 March 2019. Website address:

Data Goes with the Flow!

In healthcare organizations, the data goes with the flow of the patient. Every step a patient takes creates a data footprint. Data literally follows the patient through the patient pathway within the healthcare organization like bread crumbs in the forest. When data is collected over a length of time, predictive data exists that can actually predict where the bread crumbs will fall with 98% accuracy within a given day, month, and season!

The first question is: are you collecting this data? It is important to collect this data in order to optimize patient flow throughout the healthcare organization as it is essential to ensuring safe, high-quality, patient-centered care.

The second question is: do you know what to do with the data? When this data is applied, for example, to a current state value stream map clinicians can see where waste exists by assessing the problem areas and identifying major areas of opportunity for change. Or maybe you'd like to balance demand and capacity through load leveling?

The Infinitum Healthcare Transformation System is based on the lean Toyota Production System that provides the right care at the right place and at the right time. Waste is removed from the patient pathway by the people doing the work as lean methodologies are learned such as visual management. Employees learn to work as a collaborative team and individual QI experts resulting in innovative problem-solving. When data is collected, monitored, and analyzed through the lens of system thinking the healthcare organization can ensure that capacity can meet the demands for services, prevent overcrowding, create predictable scheduling, and calculate the return on investment.

Last question: would you like to go with the flow of your patient data? Contact Infinitum! We will customize a learning package that fits your healthcare organization size and implement actionable strategies, transferable knowledge, and ensure a data-driven work culture.

Blog Index

You don't know what you don't know!

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It's true, you really don't know what you don't know until you become aware of it. This is more than an amusing adage as it speaks to the need for information. Information that reveals factual data to create awareness. According to Google, awareness is the "knowledge or perception of a situation or fact." Ever wonder if something is really true? Your mind tells you one thing and your gut tells you another. Somehow the human heart negotiates between the two to make a decision. But how do you know if it's the right decision until you have all the information?

When data is collected and analyzed, it reveals truth and provides knowledge. What is something you'd like know? How about the demand and capacity of your healthcare organization? Would you like to know how many people in the population you serve need to be seen and how often? Would you like to know if these patients are being scheduled correctly? Would you like to know if your demand and capacity line up? Even if your gut had a crystal ball you would never be able to guess that information. What do you need? Data! And lots of it. Preferably a year's worth, and it can be pulled from your EMR. A year's worth of data to show the fluctuations from day to day, month to month, and season to season. For example, in the fall you know you're going to have a lot of flu vaccine appointments and sport physicals before school starts. Or maybe your data will show that Mondays are consistently over scheduled.

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Now that you have the data, what are you going to do with it? Here are some basic steps:

  • Sort the patient data by provider and appointment to create upper and lower control limits. You quite literally can see the demand over time; days, weeks, months, and seasons. (There is so much you can do with this information including the takt time of the practice. We will discuss this more later, but for now, let's stay focused on demand and capacity.)

  • Pull your EMR procedure list and sort them by time to create service families.

  • Perform a patient time study on procedure time.

  • Compare the appointment times against the actual visit time.

  • Perform a root cause analysis to determine why the appointment times and actual visit time do not match.

  • Create a countermeasure plan to address the service family deltas.

  • Complete another patient time study to confirm that procedures are now correctly organized within the service family.

  • Analyze how many clinical hours and compare against demand.

  • Perform a root cause analysis to determine why the schedule does not accommodate the population.

  • Create a countermeasure plan to address the demand and capacity deltas to adjust the work load and alleviate burnout.

We've all heard the term "data-driven decision making." Why has this become so popular in system thinking? Because without data you do not have the information you need to become aware of the situation and make the most informed decision. Data will back up any decision reliably. The numbers don't lie, but your gut can. Would you like to know what you don't know using data? Contact Infinitum, the healthcare transformation system that relies on data!



Awareness, defined by Google. 26 February 2019. Web address:

Love my work!

Have you heard yourself tell other people those three little words? If you haven't, have you taken the time to ask yourself why? Obviously, you're passionate about your patients, the work that you do, and the people you affect or you wouldn't be where you are. Right? So what are the items that fall under the "con" column in your work life?

Lack of joy at work affects everyone in healthcare, but let's look at what a physician might have in their "con" column. According to Medscape's National Physicians Burnout, Depression & Suicide 2019 Report, 44% of the physicians surveyed in October 2018 reported that they felt burned out. And what were the top three biggest contributors? Too many bureaucratic tasks, spending too many hours at work, and "increasing computerization of practice." According to the Advisory Board's 2019 survey report, 21% of a physician's work hours are spent on non-clinical paperwork, and 54% stated they were emotionally exhausted. Sadly, this data confirms what you already know: we have a national crisis in American healthcare.

So, how is this crisis being addressed? Physicians were also asked how they cope with burnout and the top three answers were: exercise, talk with family members and close friends, and "isolate myself from others." Can you see how the root cause of the problem is not being addressed and the coping tactics are just a bandage for the real problems? There are people working together across the healthcare industry to try and find a solution for the future, but what about right now?

Infinitum can offer you a "right now" solution: assessment, transference of lean knowledge, root cause analysis, countermeasure projects, and implementation. The Infinitum Healthcare Transformation System begins with an assessment by an Infinitum Consultant, a lean healthcare expert, who will evaluate the healthcare organization for:

  • Current improvement methodology.

  • Strategic alignment of the board of directors, executives, management and frontline staff with respect to the organization's goals.

  • Alignment of overall priorities in the adoption of a lean management system.

  • Behaviors and policies that demonstrate implicit or explicit principles and expectations of leaders and staff that can accelerate or impede the adoption of a lean healthcare management system.

  • The consistency of the day-to-day approach of implementing process improvements that will provide sustainable growth and benefits to future growth strategies.

  • Enable a multidisciplinary group of stakeholders as participants to envision, simulate and co-create a future-state vision for implementation.

After the assessment, the Infinitum Consultant will customize a learning and training package for the healthcare organization based on the desired level of implementation. Infinitum offers lean healthcare methodology through the Infinitum University online education modules; on-site or virtual workshops, training, and certification for your quality improvement people or the organization as a whole; and consultant support at every level of the chosen learning and training package. Infinitum consultants are experienced multidisciplinary transformation experts who will assist a healthcare organization to design and promote a consistent day-to-day approach to implementing process improvement across the healthcare organization; achieving a sustainable culture of change and collaboration, and operations fine-tuned to deliver value to your patients while improving work relationships and reducing the mental load.

At Infinitum we help people address their "con" column by addressing the root causes within a given healthcare organization. Would you like to hear yourself say, "Love my work?!" What are you doing "right now" to improve your joy at work? Contact Infinitum!

Graphs provided by Medscape's National Physicians Burnout, Depression & Suicide 2019 Report:

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Hasan, Hamza Hasan. Research Division Practice Manager of The Advisory Board Company. 18 January 2019. Web address:

Kane, Leslie. "Lifestyle Burnout and Depression. Medscape. 16 January 2019. Web address:

Love My Work

For the love of Lean!

Organizations love lean because it works when properly implemented. This implementation requires that the whole team be willing to look at healthcare through the lens of data and become reliant on data-driven decisions. Yes, this process improvement methodology came from car manufacturing, however, it is transferable when it comes to reducing inefficiencies and improving patient value with their healthcare being the end product. Lean has three key goals:

  1. Eliminate waste

  2. Value employees

  3. Continually improve

What is interesting about the three goals is that they work synergistically. You cannot meet one goal without meeting the other goals. Through the inclusive process of eliminating waste by focusing on non-value added activity; keeping inventory low by only storing what is needed when it is needed; embracing technology to provide data and reduce manual labor, valuing employees by developing people, and continuously improving by focusing on the root causes the synergy happens. Healthcare organizations across the country are learning to love lean as their awareness of the transformation in the way they look at the patient flow via data grows.

Recently the Infinitum Transformation Team was conducting a Value Stream Map Workshop, also known as the Transformation Acceleration Program or TAP Workshop. At the table was a representative from each work area discussing delay area 2 on their current state value stream map. One of the delays was that the "providers were running late." Through the 5-why root cause analysis it came down to the providers being late because the previous appointment took longer than expected. This happens, but upon further investigation, it was discovered that this happens frequently as in more than 50% of the time. The Infinitum Transformation Team walked them through the data mining process of figuring out their demand and capacity so that they are now scheduling patients within the appropriate time slots by creating service families; processes were reconfigured to meet the time limitations; and they learned how to create a demand chart from their data showing upper and lower control limits to address the patient demand variations with 98% accuracy.

Lean on lean; it's reliable! Contact us to learn how your organization can transform for the love of lean.


Dunn, Lindsey. "5 Key Principles for Hospitals from Toyota's Lean Production System." Becker's Hospital Review. 17 Sept, 2009. Web address:

The Heart of the Matter!

The heart of lean healthcare is to create value by eliminating waste. It's hard to imagine that there is any waste when all efforts are for the patient. After all, where would the human race be without medicine and the professionals that care for us? So let's define waste within the framework of patient flow. Waste is the non-value added activities or the inefficiencies within a given process or workflow of a system; in this case, healthcare. Gain or value-added services are what the patient is willing to pay for. Every step in a process is either value added or it non-value added. Non-value added activities fall within these eight categories:

  • Defects: Poor labeling of tests, incomplete referral instructions or missing information in patient charts.

  • Excess Inventory: The cost to store, manage, and maintain (e.g., monitor expiration dates) is greater than the savings of buying in bulk (e.g., latex gloves).

  • Excess Transportation: Moving patients back and forth, moving information, and moving lab tests.

  • Excess Motion or Movement: Lifting, bending, and reaching more than is necessary. Not having the things that are used most often closest to your work; this includes equipment.

  • Overproduction: By producing in excess, faster, or earlier than needed (e.g., producing “just in case” IV solutions, or batching lab samples).

  • Over Processing: Re-testing, extra labels on charts, multiple insurance claim forms.

  • Unused Talent or Creativity: Sharing of knowledge and ideas, working to the top of a license or skill level, and a safe culture that respects creativity.

  • Waiting or Reoccurring Delays: Waiting to be roomed, waiting to see the provider, or waiting for an x-ray are a few examples.

According to Maureen Bisognano, President Emerita of the Institute for Healthcare Improvement and a Senior Fellow, the top reason to improve patient flow is to reduce patient that feels disrespectful to patients and families. This stress on the patient is also stressful on the clinicians and staff because it negatively affects them and creates burn out. Lean provides a way to create a more effectively designed and managed process that supports clinicians and staff morale resulting in increased joy at work, reduced stress, and increased productivity and job satisfaction.

There are opportunities to remove non-value added activities within the interconnected processes in any and all healthcare systems. Lean is a multi-faceted methodology that requires a simultaneous application within a healthcare organization in the micro, meso, and macro work levels. The Infinitum Healthcare Transformation System is designed to work with and integrate all three levels:

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Some lessons from the field have taught the Infinitum Transformation Team:

  • It starts with leadership. Employees look to leadership for permission to be innovative, autonomous, and collaborative within a team.

  • Purpose (sets the direction), Process (how people do it), and People (organizational values that drive action). A shared vision is a co-created story that everyone plays a part in. Sustainable change happens when everyone moves in the same direction while aligning their actions to a shared vision.

  • The vital few must be identified. A system-wide transformation requires representation from each work area. It was Italian economist Vilfredo Pareto that reported in 1906 that 80% of the land was held by 20% of the people. He also noticed that 20% of the pea pods in his garden produced 80% of the peas. This principle of factor sparsity or the law of the vital few is known as the Pareto Principle. This statistical distribution of data states that 80% of a specific event can be explained by 20% of the total observation, or 20 percent of an activity will account for 80 percent of the results. Therefore, the 80-20 rule is a very helpful concept for life, time management, and work. A modern day example, Microsoft observed that 80% of the operating system crashes were eliminated by fixing 20% of the most reported bugs.

  • Identify issues through learning rather than blame. Learning is a curiosity rather than an assumption. The Infinitum Transformation Team asks "why" rather than "who."

  • Customer satisfaction through patient flow is the patient's perspective on how they move through a healthcare system.

  • Methods matter as much as results.

  • Back to the data; always back to the data. Not only the average, minimum, and maximum, but how often and within what control limits?

Healthcare organizations are businesses providing a service, and like all businesses, they need to focus on achieving a positive ROI (return on investment) to stay in business. The lean process can give you between 20%-60% cost savings and more work capacity which equals more profit. Lean methodology provides evidence that quality improvements are sustainable in the long term and are culture changing. The Infinitum Healthcare Transformation Team can help you get at the heart of the matter!


Bisognano, Maureen. "Flow Failures are Disrespectful to Patients." Institute for Healthcare Improvement. 25 Aug, 2016. Web Address:

Teich, Sorin T and Fady F Faddoul. “Lean Management-the Journey from Toyota to Healthcare” Rambam Maimonides medical journal vol. 4,2 e0007. 30 Apr. 2013, doi:10.5041/RMMJ.10107. Web Address:

Tracy, Brian. "The 80-20 Rule Explained." No date. Web Address:

Kenton, Will. Reviewed 80-20 Rule. 29 May, 2018. Web Address:

The Heart of Experience!

The Infinitum Transformation Team is passionate about their work. They have witnessed firsthand how lean methodologies such as value stream mapping works to increase capacity at healthcare organizations. In addition to removing waste, creating efficient processes, boosting staff morale, and addressing provider burnout, lean methodology also helps people to see how their work in interconnected to the work of others within the system of care. This self-awareness is a catalyst for change not only in the work they do, but in the relationships between the team members.

Within the Infinitum Healthcare Transformation System we have a value stream mapping workshop that we call TAP (Transformation Acceleration Program). The TAP workshop is one of many lean methodologies used by the Infinitum Transformation Team. The Infinitum Transformation Team has observed that the TAP Workshop has an effect on relationships in many ways:

  • TAP looks at processes and not people. TAP is a non-judgmental workshop that creates a safe space for people to think about how their work fits into the value stream without feeling judged. (Depending on the number of people the workshop can usually be done in 4 hours with additional pre-work and post-work hours with one designated contact.)

  • TAP creates a shared view of the patient pathway which puts the team members on the same mission to find waste and improve the patient experience by problem solving together.

  • TAP instills a shared knowledge of a quality improvement lean technique that the team members can continue to use long after the Transformation Team is gone.

In addition to the improved team member relationships and employee satisfaction, the patient relationships are improved also as they will move more efficiently through the practice system of care by having better scheduling management and less waiting.

Recently the Infinitum Transformation Team was contracted to deliver a TAP Workshop to a primary care practice. There was tension between two of the providers because one provider consistently saw more patients each day. The cause was that the other provider talked longer with each of her patients. The provider seeing more patients considered this a problem because the other provider wasn't staying within the allotted appointment time which then cascaded through the patient pathway making each consecutive patient wait longer for their appointment. The provider seeing less patients believed that taking more time with the patient meant giving them more care. They wondered how to fix the problem, and didn't know how to avoid a conflict. Does any of this sound familiar?

It was a beautiful thing to witness the two providers become aware of each other's view, and the provider who saw less patients shared how she now saw how she was holding up the patient flow in the name of care. This new shared awareness created the non-judgmental space to talk about the situation and brainstorm about how to keep the system moving on time and provide the best possible care. This is part of the IDEAL state we teach in the TAP Workshop.

We spend more time with the people we work with than our family and friends. Work relationships matter that much. We all want healthy relationships where we are respected and can work collaboratively within a non-judgmental or safe space. The TAP Workshop provides the awareness and process to support that goal. Additionally, the patient relationship has as much importance. They trust the people within a healthcare organization to provide them with the care they need. A healthcare system is complex because of the different relationships interconnected processes. Every person within that system touches the patient from the front desk that makes the appointment to the checkout desk that might schedule a test or a follow up appointment.

The Infinitum Transformation Team, like the healthcare industry we serve, are passionate about our work because we see how lean methodologies like the TAP Workshop affect relationships and the processes within a healthcare system. It is from the heart of our experience that the Infinitum Transformation Team wants to support your relationship goals and quality improvement programs. Contact us and tell us about the relationships that matter to you.

Leading by Example

"Quality is everyone's responsibility."

—Dr. W. Edwards Deming

Dr. W. Edwards Deming is one of the Infinitum Transformation Team's favorite lean leaders. He was a business consultant, statistician, engineer, author, and professor. As a leading management thinker in the field of quality, he played a major role in the post-war WWII recovery in Japan and worked closely with leaders of Japanese industry. Dr. Deming is credited for launching the Total Quality Management movement.

In his book "Out of Crisis" Dr. Deming writes about his "System of Profound Knowledge" which contained four points of views: appreciating a system, understanding variation, psychology, and the theory of profound knowledge. The theory of profound knowledge is a management philosophy grounded in systems theory. It is based on the principle that each organization is composed of interrelated people and processes that are the components of a system. His 14 point Total Quality Management Principles are:

  1. With the aim to be competitive and to stay in business, create jobs and consistency of purpose toward improvement of product and/or service.

  2. Adopt the new management philosophy because the times have changed and America needs to wake up to the challenge, learn their responsibilities, and take on leadership for change.

  3. Stop dependence on inspection to achieve quality. Eliminate the need for inspection and build quality into the product/service.

  4. Cease the practice of awarding business on the basis of the purchase price of a product/service, and instead minimize total cost. Business relationships are long-term and are built on loyalty and trust.

  5. Constantly improve the system of production and service and drive down cost.

  6. Institute training on the job is a must.

  7. Leadership should aim to help people and machines and gadgets to do a better job.

  8. So that everyone may work effectively for the company, drive out fear.

  9. Break down barriers between departments to create cross-functional teams to foresee problems of production/service.

  10. Eliminate slogans and targets for the work force asking for zero defects and new levels of productivity as they create adversarial relationships because the main cause of low quality and low productivity belong to the system and beyond the control of the workforce.

  11. Remove barriers that rob hourly people of their right to have pride in their work. It is the responsibility of leaders to provide focus on quality first.

  12. Remove barriers that rob salaried people of their right to have pride in their work. This means the termination of annual or merit rating and of management by objective.

  13. Institute a robust education and self-improvement program.

  14. Everyone should be working on accomplishing transformation as it is everybody’s job.

In addition to the above philosophy and management principles, Deming is the creator of the Deming Cycle, also known as a PDCA (Plan-Do-Check-Act) or PDSA (Plan-Do-Study-Act). This lean methodology is a continuous quality improvement tool consisting of four repetitive steps in a logical sequence for continuous improvement and learning. This lean tool is best used for small rather than complex problems.

Dr. Deming was certainly a leader in the quality management field. He led by example over a lifetime of teaching others that there is a better way to lead. We believe that part of his success was that he understood people and how they worked. We recommend watching the Red Bead Experiment. The Infinitum Transformation Team understands people and how they connect to the complexities of a healthcare system and their required involvement in quality.

"All anyone asks for is a chance to work with pride."

—Dr. W. Edwards Deming


  • Brainy Quote. W. Edward Deming, "Quality is everyone's responsibility." Web Address:

  • Brainy Quote. W. Edward Deming, "All anyone asks for is a chance to work with pride." Web Address:

  • Dr. Barbara Berry. 2011. Web Address:

  • Mind Tools. 14 point Total Quality Management Principles. Web address:

  • Wikipedia. Last updated January 18, 2019. Web address:

Fact: System Changes Need Collective Heroes!

Heroes are not born, they are developed by collective leaders. But what exactly is a collective leader? Sebastian Salicru, business psychologist, leadership development expert, executive coach, facilitator, researcher and author for The Professional Training Services (PTS) defines collective leadership as:

"Collective leadership is a social process aimed at accomplishing collective rather than individual goals and it requires collective and coordinated action. Terms such as 'collective', 'shared', 'distributive' or 'emergent' leadership are often used to describe very similar concepts."

Collective leadership sounds a lot like lean leadership. Like lean leadership, collective leadership breaks down silos; increases knowledge sharing across organizations; power structures change direction; team identification with team responsibility and accountability; greater utilization of talent, higher levels of engagement and commitment; improved inclusion and acceptance of multiple voices; rapid acceptance of change and implementation of innovation; and greater coordination of action and performance outcomes which all lead to better business results. The difference between the two is that lean leadership originated from the business world while collective leadership originated from the social world.

Cassandra O'Neill and Monica Brinkerhoff of The Nonprofit Quarterly (NPQ) wrote that collective leadership looks at an organization as part of a system instead of a machine. While Western leadership functions from hierarchy, the lean and collective leadership functions as a connected network. Decision making is shared as there is an assumption that people are inherently capable and can be trusted to do the right thing. The focus moves from the individual super hero to the team of super heroes and the belief that success comes from the diverse perspectives and skills of the many. Furthermore, collective leaders empower people to work with multi-steak-holders by collaborating with cross-sectors within community initiatives that have a shared vision. These transformed heroes on the ground, according to the NPQ article, benefit from collective leadership by:

  • Better decision and increased effectiveness can be accomplished with multiple perspectives provide better decisions.

  • Increased self-direction and internal motivation is the best way to eliminate resistance to change.

  • Removing barriers to internal motivation is needed for growth and development through forming a partnership toward a shared goal.

  • Shared responsibility makes the workload lighter and feels more successful.

  • Realizing potential is important for people as it leads to job satisfaction and better job performance.

  • Increased engagement and investment happens when leadership is shared and it energizes people to create.

  • Sustainability is maintained in the knowledge of the many, and change is supported by the knowledge.

Whether within the organization's system or without as part of a larger system of organizations, according to Reem Rahman, et all, of the Social Innovation Journal, collective approaches to system changes can be seen as having five major motivations:

  1. "an effective way to tackle the nature of complex social problems. Certain social problems have the qualities of being large-scale, multi-sector, interconnected, and constantly changing, so they require solutions that have those same qualities as well;

  2. designed to remain accountable to having impact that reaches the entire community served;

  3. a more efficient way to optimize resources to overcome fragmented, "service delivery chaos11" by leveraging resources outside of just a single organization;

  4. an essential way to keep up with the hyper-pace of innovation and change and ensure sustainable value chains; and

  5. a more realistic way to ensure sustained impact because they pay deliberate attention to diversifying the stakeholders as co-owners."

Rahman and his co-authors of the Social Innovation Journal further believe there needs to be two major mindset shifts in order for collective leadership to be fully accepted:

  1. Top-down or hierarchical leadership is no longer effective; and acceptance that a few people making key decisions is now spread to many different people and organizations to lead a collective approach to leadership is a better way.

  2. The methodology of change from strategic planning to emergence. By tackling the root cause of problems through the knowledge that many factors affect every problem within a system. This wider thinking for problem solving looks at the problem as a symptom that is created by interactions within many system loops. Beyond strategic plans is asking the right questions, listening for what matters, and involving all that are involved so that the direction to move emerges from the chaos.

Imagine what would happen if collective and lean leaders were ubiquitous? What if every organization embraced collective and lean leadership? What would it be like if people from all areas of an organization functioned collectively with the organizations they interact with? What would it look like if we empowered all people to be collective heroes? If the healthcare system were to change over to a collective and lean leadership style, how many heroes would be made? This is, after all, the next evolution in healthcare: create the greatest value possible for the patient while connecting the community resources to the patient for the best health outcome.

Let Infinitum show you how to make heroes in your organization. Contact us to find out how!

Work Cited

Rahman, Reem, and Michela Fenech, Nadine Freeman, Kris Herbst, Dani Matielo. Social Innovations Journal: "Let's Bust the Lone Hero Myth: The Role of Collective Leadership in Systems Change." November 30, 2018. Web Address:

Salicru, Sebastian. The Professional Training Services (TPS): "Collective Leadership: What, How, and Why." August 18, 2015. Web Address:

O'Neill, Cassandra and Monica Brinkerhoff. Nonprofit Quarterly: "Five Elements of Collective Leadership." February 1, 2018. Web Address:

Lean Leaders Wanted!

'Go to the people. Live with them. Learn from them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say "We have done this ourselves." ' —Lao-Tsu, founder of Daoism

There are leaders and then there are lean leaders. What's the difference and why are they better?

Lean leaders create a culture where change is embraced as an opportunity for improvement and innovation. People are natural problem-solvers and the lean leader increases this skill with lean management. Lean leaders use their authority to manage people in the following methods:

  • Create a shared vision: By creating a shared vision the lean leader is able to align goals so that both the work and the people grow together. This shared purpose creates momentum while empowering the team to problem solve their issues together and form a healthy social bond.

  • Bottom-up management: A major difference in this management style from that of the atypical Western leadership style of top-down is that the lean leader believes the people doing the work are the best at figuring out how to do the work. A lean leader does not seek to convince or demand others to do things their way; instead they provide a safe space for inquiry and experimentation to challenge the team to find out what works best.

  • Guiding by challenge: The lean leader challenges the team by asking questions to evoke problem solving skills and idea sharing within the nurturing environment of the team where processes not people are judged. These challenges are meant to be part of their development and growth in themselves and their work. The work is a moving target and the lean leader ensures the work environment is non-judgmental to allow for innovation toward ultimate efficiency.

The effect of lean leadership is that there is one organization and one vision to continuously improve the processes within the organization while improving themselves. Are you willing to be a lean leader? If yes, you're wanted! Please contact us to learn more of this management style and how the Infinitum healthcare transformation system can improve your organization!

Work Cited

Lao-Tsu Opening Quote:

How do the Toyota Production System and Healthcare Connect?

Patients are not widgets and healing is not a production line. So how do the Toyota Production System and Healthcare connect? Read on to find out how!

Lean Management History

The history of the lean concept grew out of the Toyota Motor Company established by Sakichi Toyoda in 1935. In 1950 Eiji Toyoda and Taiichi Ohno studied Western car production because the Japanese output was far less than the US output. Ohno observed two major flaws: large batches that created large inventory, and manufacturing methods that preferred large production over customer preferences. Through observation and small incremental changes the Toyota Production System (TPS) was created to make Toyota a world class auto manufacturer. How did they do it? They utilized the lean principles to manage production, employees, and even suppliers.

Lean Management Connection to All Industries

In 1990 the book The Machine that Changed the World coined the term "lean" production. The authors, Womack, Jones, and Roos, did a 5-million dollar 5-year study and postulated that the manufacturing and technology problems are universal to all of business management. This "transference" of issues meant that by "extension" the same lean principles that were successful for Toyota could help other organizations outside of the non-Japanese enterprises. According to Womack, et al, Western manufacturing companies quickly incorporated five lean principles into their processes:

  • Identification of customer value - the customer, or patient, determines: what is value and what is waste? For example, a patient may think it a waste of time to be sitting in the waiting room for more than 15 minutes. (There are eight defined wastes: motion, unused talent, inventory, over production, transportation, defects, over processing, and unused creatity.)

  • Management of "value stream" - there are four value streams (demand management, care delivery, financial viability, new service development & quality improvement) to be managed in balance of each other.

  • Developing capabilities of flow production - a lean environment is a learning environment where front-line employees are innovators and creators of change.

  • Use of "pull" mechanisms to support flow of materials at constrained operations - the lean mindset looks to find opportunities to keep the patient moving through the system.

  • Pursuit of perfection through reducing to zero all forms of "waste" - this is a continuous quality improvement process that is accomplished through the knowledge and utilization of lean methodologies.


Lean Management for Healthcare

To answer the question: how do the Toyota Production System and healthcare connect? They connect because every industry, including healthcare, is producing something that needs to be managed as efficiently as possible. And that something can be made more efficient by the lean principles and methodologies of lean management that will create a new paradigm around a bottom-up problem solving mindset where waste is removed to create more patient value and practice harmony along with increased demand capacity. What are the people at your healthcare organization producing?

Works Cited

Teich, Sorin T. and Fady F. Faddoul. “Lean management-the journey from Toyota to healthcare” Rambam Maimonides medical journal vol. 4,2 e0007. 30 Apr. 2013, doi:10.5041/RMMJ.10107 Web address:

Womack, James P, Daniel T. Jones, and Daniel Roos. The Machine That Changed the World: Based on the Massachusetts Institute of Technology 5-Million Dollar 5-Year Study on the Future of the Automobile. New York: Rawson Associates, 1990. Print.