Frequently Highlighted Passages in “Lean Hospitals”


I love my Amazon Kindle (I have had a 2nd generation 3G Kindle for about two years). Amazon has recently made the device more “social,” where you can share highlights and notes that you take about a book via Twitter, Facebook, or the web. Here are my notes that I've made publicly available.

It's also  interesting to see, as an author, what the most popular highlighted passages are in your own book, in my case Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction.

You can see the most popular passages here via this link.

They are:

It is often said that Toyota gets outstanding results with average people working in brilliant systems, while most other companies get mediocre results by hiring brilliant people to fight their way through broken systems. Which statement sounds more like hospitals? Imagine the potential of combining brilliant people with brilliant systems?

Highlighted by 4 Kindle users

waste, which has a similar context and meaning in the Lean terminology, to mean any motion or effort that does not provide any value for the customer (or patient).

Highlighted by 4 Kindle users

Lean thinkers do not blame a lack of hard work for their hospital's problems. We have to improve the system, and sometimes that means that people expend less effort, because their work is easier and outcomes are improved for all.

Highlighted by 5 Kindle users

One study estimated that 13% of a hospital's costs are due to “inefficient practices within control of the hospital,”  while other estimates are closer to 20%.

Highlighted by 5 Kindle users

“People are much more likely to act their way into a new way of thinking, than think their way into a new way of acting.””

Highlighted by 6 Kindle users

Local improvements made in one area need to be shared with other departments or areas to prevent everyone from having to go through the same improvement cycles on their own.

Highlighted by 4 Kindle users

1. The customer must be willing to pay for the activity. 2. The activity must transform the product or service in some way. 3. The activity must be done correctly the first time.

Highlighted by 7 Kindle users

Womack and Jones defined the value stream as “the set of all the specific actions required to bring a specific product (whether a good, service, or increasingly a combination of the two) through the three critical management tasks of any business: the problem-solving task, the information management task, and the physical transformation task.”

Highlighted by 4 Kindle users

With Lean, our goal is not to be better than our peers, but rather to be as good as we can be, aiming for the goal of a perfect, waste-free process.

Highlighted by 5 Kindle users

Without a standard, you cannot have sustainable improvement. If employees do things in different ways, an improvement idea from one employee might either add to the variation in the current system or get lost because we do not have a standard method for transferring that new idea to other employees.

Highlighted by 4 Kindle users


Do any of the quotes resonate with you? Do you have comments on any of the quotes?

The 2nd edition, renamed “Lean Hospitals: Improving Quality, Patient Satisfaction, and Employee Engagement” should be out in October 2011.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Highlighting the text ‘completes the loop’ for the author – a great technological advance. Understanding what the readers value.

    • It’s good feedback, but there’s not (yet) a Kindle feature that allows the reader to highlight parts that are terrible! :-) Now *that* would be helpful feedback for a 2nd edition!

  2. ‘1. The customer must be willing to pay for the activity. 2. The activity must transform the product or service in some way. 3. The activity must be done correctly the first time.’

    Dr Tetrault talked about the dual role of lean in creating the perfect patient experience and a better work environment.

    If you think about the patient as the end customer of a series of supplier/customer relationships, as staff handoff one task to the next with each staff being the customer of the preceding step and becoming the supplier to the next step, then we are suggesting a singular role for the application of Lean principles and concepts, ie, to improve the system by better defining the customer/supplier relationships with the end customer providing the guide for the overall system.

    If we want to make it better for patients, we have to make it better for those taking care of patients.


    Read more: Frequently Highlighted Passages in “Lean Hospitals” – Lean Blog

    • Mark – thanks for the comment. Yes, I’m completely on board with the idea that Lean serves both the customers (patients/families) AND staff members and healthcare professionals.

      The idea of “internal customer” is an important one, but I also don’t think that translates to “value” from an end customer standpoint. A lot of the internal customer related work is more about “required waste” or “enabling waste”. For example, prepping and gathering instruments for a surgeon…. this needs to be done correctly and promptly for that internal customer, but I don’t think that prep activity translates directly into customer value.

      To some extent, this is an academic and semantic argument, I think.

      My book (I hope) makes the point clearly that making things better for staff allows them to make things better for patients. Patient focus shouldn’t mean ignoring everybody else.


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