Guest Post: Lean Healthcare from a Family Member’s Perspective


Mark's note: Today's guest post is Tim Piotrowski from AME – the Association for Manufacturing Excellence. Their annual conference is being held in Dallas in October. I'll be attending on Thursday and will be teaching an optional workshop on “Kaizen: Continuous daily improvement for health care and services” on Friday morning. I hope to see you there. Use code HC2016″ to receive a $100 off your registration.

By Tim Piotrowski

untitled-designA few years ago, before I'd ever been aware of Lean healthcare, I spent a considerable amount of time at the hospital and in doctors' offices. I was not sick and I didn't work in healthcare. At the time, I was a freelance marketing professional who was primary caregiver for my mother, who spent two months in the hospital battling late stages of heart failure.

During those emotional, stressful moments, it was difficult to get much of my work done. However, I was endlessly fascinated by the activities of the doctors, nurses, administrators, and staffers. So, in the middle of my emotional journey, I spent considerable time listening and observing.

I knew that the doctors and the staff were doing their best to give my mother the best care possible.

But, there were moments when I saw opportunities for improvement and I witnessed many of the eight wastes of Lean healthcare, outlined by Dr. John Toussaint in his book, On the Mend:

  1. Defects: Making errors, correcting errors, inspecting work already done for error
  2. Waiting: For test results to be delivered, for an appointment or for a bed, for release paperwork
  3. Motion: Searching for supplies, fetching drugs from another room, looking for proper forms
  4. Transportation: taking patients through miles of corridors from one test to the next unnecessarily, transferring patients to new rooms or units
  5. Overproduction: excessive diagnostic testing, unnecessary treatment
  6. Overprocessing: a patient being asked the same question three times, unnecessary forms; nurses writing everything in a chart instead of noting exceptions
  7. Inventory (too much or too little): overstocked drugs expiring on the shelf, under-stocked surgical supplies delaying procedures while staff goes in search of the needed items
  8. Talent: failing to listen to employee ideas for improvement, failure to train technicians and doctors in new diagnostic techniques

Each trip to the doctor's office was an adventure. It wasn't unusual to spend an hour in the waiting room for her primary care physician to arrive, only to be whisked out quickly once she did get a chance to see him. In instances like these, I felt that my mother was getting cheated and her time was being wasted.

In the hospital, my mother spent time on different floors and different units, depending on the severity of her condition. Each time she transferred floors, I'd see nurses fumbling through a large file folder of information, yet they seemed clueless about what was happening with her in the moment. It wasn't unusual to see confused expressions from the nurses about the medication she was taking. I often repeated the latest story to the new team of nurses to provide some context.

I also found that her quality of care was very inconsistent overall. On certain floors, the nurses seemed on top of their game, on other floors they were barely visible.

I'll never forget the time she called me in tears from her hospital room asking me to stop by to help her…she had called for a nurse to help her get up to go to the bathroom and it had been nearly an hour — she was still waiting for help. During moments like these, it was obvious that the hospital had some serious flaws in its process and in the way it served its patients.

I've been fortunate to witness a healthcare organization that practiced Lean. What really stood out to me was how efficient it was and how much the employees loved their work environment. This employee happiness positively impacted the interaction with the patients.

At the 2016 AME International Conference in October, there are opportunities to learn from healthcare organizations applying Lean and continuous improvement principles at their workplace. One of these organizations is Intermountain Healthcare in Salt Lake City, which utilizes seven key systems to support continuous improvement at its hospitals. Another organization, Signature Healthcare in Brockton, MA, made the decision to put the needs of the patient first as they implemented Lean from a ground up management system across all departments within the hospital.

In Dallas, you'll have the opportunity further your organization's Lean journey by learning from healthcare organizations implementing Lean and continuous improvement through engaging presentations, tours and workshops. If you're a healthcare professional, be sure to use the code “HC2016” to receive a $100 off your registration.

As I learn about organizations applying Lean and continuous improvement principles, it comforts me in knowing that these principles are not only making operations more efficient, but also creating an environment where patients and their families are having a better overall experience.

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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. So sad that the hospital staff and care givers your mom had a relationship with experienced so much waste within their processes. All good people I’m sure, but flawed processes drives fractured interaction, frustration and ineffective care. Wasted effort and lost time. Bad enough in the manufacturing environment but in the world of Health and the caring for a mother the outcome is tragic. This was a great piece, it touched me because I saw the same things happening with my father-in-law. You should write learn more and write more about lean healthcare, your style of story telling is very strong. Thanks for sharing Tim. Your mom was blessed to have you during those troublesome times.

  2. What role does using Telehealth have in lean healthcare? It seems that a lot of the steps you outlined could have been avoided by using one of the emerging Telehealth services – like – or one of the others. We estimate that this year there will be at least 2million visits to Telehealth providers. No mention in your article of this trend?

    • Would you like to say more about that or did you just want to post a link to your website?

      There are many possible ways of solving those problems – improving the culture, improving processes, using technology intelligently…

      Please elaborate on how telehealth could help.

  3. I think it should be apparent. Less visits, more efficiency, greater access, less time spent – and thats just on the patient side. On the doctors side, less drive time, ability to live out of the metro area (but still serve patients within). I think the existing medical system is so stuck in their levels of bureaucracy that its hard for them to change their way of doing business.


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