Perfecting Patient Journeys and PDCA


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Perfecting Patient JourneysMy friends at LEI have a new book out by Judy Worth, Tom Shuker, and Beau Keyte: “Perfecting Patient Journeys.”  The book appears to focus on Lean problem solving processes, including value stream management… really important stuff.

Chapter 1 (PDF) has a good illustration of the PDCA cycle (although I, like Karen Martin, prefer to use the PDSA acronym). But, it's the same thought process, as this diagram shows very well:

Screen Shot 2013-01-30 at 11.26.26 AM


As I've learned and taught, “Plan” doesn't mean just coming up with the future state. What's shown above as the “Grasp the Situation” steps are what I'd normally include in Plan, including understanding customer value and the current state. “GTS” is part of the classic Toyota problem solving as taught by Pascal Dennis, and others I have learned from. I do like how the diagram shows this flowing into Plan.

Brian Joiner, in his outstanding book Fourth Generation Management, said we should “start with Check” — meaning looking at the current state. But, I think good PDSA already does that… whether you say “start with Check” or “start with Grasp the Situation.”

From page 49 of the Joiner book, he calls it CAP-Dp (Check-Act-Plan-Do):


I also love how the “Do” in the above diagram shows little PDCA cycles. “Do” isn't a simple “implement” step. It's more about TESTING ideas as small tests of change rather than just plowing ahead with a “solution.” Then we Check/Study the results and Adjust accordingly.

I'm looking forward to reading the whole book. I'd encourage you to check it out (as well as Joiner).

Update: LEI is doing a webinar about the book on February 14.

Disclosure: I am a former employee of LEI and currently serve as a faculty member.  

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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.


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