What Does #Lean Flow Look Like in Healthcare? Check Out These Two Videos


It's easy for people to think that Lean is about cost-cutting. That would be wrong, but many people associate Lean with cost cutting.

Cost cutting is the old mindset. The old hack and slash approach, which focuses on layoffs or “everybody cut your budget by x%” mandates, dies hard.

It's easy for people to think that Lean is the new way of accomplishing old goals. But, again, that's not true.

If you look at the roots of the Toyota Production System, the two pillars are “just in time” (flow) and “jidoka” (quality at the source). Lean is very much a TIME-based methodology. Reducing waste often means reducing delays and interruptions. The process flows more smoothly, which often leads to better quality AND lower cost. But, cost is an end result, not a primary goal.

Lean healthcare focuses on improving flow – reducing waiting times and reducing delays in care. This, again, usually leads to better quality and lower cost.

Here are two videos that were shared by John Toussaint, MD in his keynote at the recent Lean Healthcare Transformation Summit (see my notes here). Both videos show “what good looks like,” as he says.

As Toussaint said in that keynote:

“Lean is NOT a cost reduction methodology.”

A “Model Cell” of Lean Surgery at Seattle Children's Hospital

I've seen this surgical center in Bellvue first hand and it's amazing. Built using “Lean design” principles, it rethinks the patient and family experience and designs the ideal space to support the ideal flow. Better flow means better patient care.

We see an example of “visual management” of the sign being turned when a patient and family are in the prep room:

visual management in room

It's a good example of real-time visual management that's used throughout the day. Visual management is not just charts and metrics on the wall. It's also any information that can be conveyed visually, to prevent miscommunications, to reduce the number of times somebody asks “is there a patient in that room?,” and to help people make decisions.

A red light in the prep room is a visual signal that the operating room is still being prepared:

visual O.R. still being prepared

Yes, the prep room, two prep rooms actually, is connected directly to the O.R. via a simple door)

Visuals, whether signs, lights, or electronic boards, are only useful when people are disciplined in their use.

A Lean ThedaCare Family Practice Appointment

John shared a more local and more personal video with the Summit attendees — a video showing the flow in primary care, as illustrated through HIS real appointment.

ThedaCare has lab equipment in the clinic so that his blood work is processed while he's talking to his physician. He gets the lab results DURING the appointment, instead of the usual routine of waiting a few days for results that the doctor's office may or may not call you about (my experience with my non-ThedaCare primary care physicians).

The value added time of most routine blood tests (hematology or chemistry) are just a few minutes. Most primary care offices can't afford lab equipment (which is especially true if it's a small practice), so tubes get batched up and sent to a centralized lab (often a third-party vendor) that processes them in big batches.

John also gets a clear plan of care that's printed out before he leaves. John arrived at 7:35 am ( “a few minutes early”) for his appointment and he was out of there by 8 am. That would easily be an hour-long visit for most of us and that's WITHOUT getting lab results.

That's flow. That's Lean healthcare.

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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. Thank goodness, we’ve never had surgery for either of our kids in Bellevue–(we did have a minor emergency surgery in the main hospital)–but follow-up care was in the Bellevue Clinic. There was a noticeable difference in how the facility worked. The visual controls, the layout, everything just worked so smoothly. From the customer perspective, it worked, and we noticed it was different.

  2. Nice videos and both organizations should be admired for the work they’ve done.

    The danger for the uninitiated is that they may think that they can implement a number of technical features and achieve just-in-time and quality at the source.

    The untold story is 1) all the details that aren’t shown in the videos and 2) the cultural and leadership changes needed to do something like this reliably.

    Good stuff and thanks for sharing.

    • Great point. Yeah, the video is meant to be more of an inspirational “what good looks like” as opposed to being some simple “how to” video.

      There’s certainly more to the Seattle Children’s story than a new layout and some visual management. Those are only some artifacts of the Lean thought process and methodology.

  3. EPIC patient flow clinic, and a great surgical cell model in bellevue.
    I’d try a small kaizen by eliminating the “short wait” for the nurse after checking in.


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