Lean Leadership for Healthcare: Approaches to Lean Transformation, 1st Edition (Paperback) book cover

Lean Leadership for Healthcare

Approaches to Lean Transformation, 1st Edition

By Ronald Bercaw

Productivity Press

254 pages | 51 B/W Illus.

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Paperback: 9781466515543
pub: 2013-04-23
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pub: 2017-07-27
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Healthcare organizations that have already applied Lean thinking to their processes, with the diligence of effective management and strong leadership support, are now realizing the benefits of their efforts. And, many of those benefits surpass what was thought possible just a few years ago. To be successful, these organizations had to provide the leadership to arrive at their future state.

Written by a Shingo Prize-winning author and Lean sensei, Lean Leadership for Healthcare: Approaches to Lean Transformation explains how to apply Lean improvement to both clinical and non-clinical processes. It presents valuable lessons learned by the author over the years of leading improvements in this complex industry and lays out a clear roadmap for initiating your Lean improvements.

Illustrating the leadership behaviors required to achieve sustainable success, the book is ideal for leaders in the healthcare industry looking to initiate Lean improvements to clinical and non-clinical processes. It reviews the fundamentals of Lean and explains how to link a strategy of continuous improvement to corporate strategy to achieve operational excellence. It also describes how to mitigate the risk of failure when undergoing large-scale corporate change—including what can go wrong and how to prevent these failures.

The book includes case studies that share the time-tested insights of healthcare team members and leaders. It outlines a management system for sustaining your Lean improvements and provides the Lean leadership approaches, thoughts, and visual tools you’ll need to guide your organization along the path toward world-class healthcare performance.

Table of Contents

Lean at a Glance

What Is Lean Healthcare?


Non Value-Added

First Theme of Lean Improvement: Continuous Improvement

Second Theme of Lean Improvement: Respect for All People

Seven Wastes








Two Additional Wastes

Unused Human Capital

Waste of Organizational Design

Principles of Improvement




Visual Management


Lean Healthcare Defined

Summary: Key Points from Chapter 1

Creating and Deploying a Lean Strategy

Creating a Culture of Improvement

Seven-Phase Policy Deployment Process

Step 1: Establish the Organizational Vision

Step 2: Develop Three- to Five-Year Breakthrough Objectives

True North Measures

Step 3: Develop the Annual Breakthrough Objectives and Improvement Priorities

Identify Top-Level Improvement Priorities

Selecting the Top-Level Improvement Priorities

Step 4: Deploy the Improvement Priorities

Step 5: Implement the Improvement Priorities

Use a Value Stream Approach to Improvement

Lean Tools


Step 6: Monthly Review

Step 7: Annual Review

Enablers of Hoshin Kanri

World-Class Targets for Improvement

Summary: Key Points from Chapter 2

Leading Change—The Transformation Roadmap—Phase 1:"Get Ready"

Beginning the Journey

Phase I: Preparing to Transform (Get Ready)—Building the Infrastructure

Selecting Your Change Agent

Get Informed

Get Help

Establish a Steering Committee

Train Your Internal Experts

Develop and Deploy a Communication Campaign

Summary: Key Points from Chapter 3

The Transformation Roadmap—Phase 2—The Acceleration Phase (Improve, Sustain, and Spread)

Delivering on Preparation Efforts

Step 1: Ensure You Have Selected the Right Value Streams on Which to Focus

Step 2: Establish Value Stream Governance and Set Up Your Value Stream Performance System

Step 3: Utilize A-3 Thinking to Realize Improvement

Step 4: Sustain the Improvements and Manage Visually

5S: A Beginning Place for Visual Management of Process

Using Visual Management for Process Control

Using Visual Management for Improving Results: Managing for Daily Improvement

Control Systems for Visual Management

Peer Task Audits (Kamishibai)

Step 5: Capture the Savings

Step 6: Support Your Change with Ongoing Training and Coaching

Lean Coaching

Step 7: Spread Lean Thinking across the Organization

Replication of Artifacts, Products, Solutions, and Process

Adding Additional Value Streams

Summary: Key Points from Chapter 4

The Transformation Road Map—Phase 3: Make Organizational Improvement the "New" Culture

Changing to the New Organizational Structure

Lean Capacity Building

Lean Information Technology

Lean Finance

Lean Human Resources

Lean Supply Chain

Lean Project Management, Lean Construction, and Lean New Service Introduction

Lean Leadership Processes

Medical Leadership Processes

Taking Lean beyond Your Four Walls

Summary: Key Points from Chapter 5

Leadership Behaviors and Actions for Success

Leading by Example


Learn the Tools

Rotate Teaching of the Core Lean Tools

Book of the Month Club

Become a Lean Facilitator

Walk the Value Streams

Commit the Resources to Be Successful


Team Resources

Middle Management Expectations


External Resources

Hold People Accountable

Address Antibodies

Redeployment versus Unemployment

Monitor and Demand Results


Summary: Key Points from Chapter 6

Mitigating Transformation Risk and Avoiding Common Mistakes

Being Successful and Avoiding Failure

Don’t Waste the First Six to Nine Months

Managing the Breadth and Depth of the Change

Leadership, Management, Support Staff, and Medical Staff Engagement

Inability to Operate Two Systems

Common Errors to Organizational Change Efforts

Summary: Key Points from Chapter 7

Closing Thoughts

Glossary of Lean Terms

About the Author

Ronald Bercaw is the president of Breakthrough Horizons, LTD, a management consulting company specializing in world-class improvement through the application of the Toyota Production System, more commonly known as "Lean." With over twenty years of experience in operations, his Lean management experience was gained through multiple enterprise transformations in different industries including custom packaging, power reliability electronic assembly, and test and measurement products.

Educated at Purdue University, Bercaw learned the details and disciplined applications of Lean principles, habits, and tools from both the Shingijutsu Sensei and their first generation disciples. Working in both shop floor and above-the-shop-floor areas, He has vigorously strived to remove waste from businesses through the involvement and ideas of the people doing the work.

Bercaw has consulting experience in the healthcare sector (U.S. and Canadian health systems including primary care, acute care, and community applications of both clinical and back shop improvement), the commercial sector (administrations, manufacturing, distribution, supply chain, and engineering), and the public sector (U.S. Army, U.S. Navy, U.S. Air Force including Maintenance, Repair, and Overhaul (MRO) assignments, Pentagon, and Surgeon General Assignments). He is also the author of Taking Improvement from the Assembly Line to Healthcare: The Application of Lean within the Healthcare Industry, published by CRC Press (2012), which won the Shingo Research & Professional Publication Award.

The November 2011 release of his book, Taking Improvement from the Assembly Line to Healthcare, detailed the application of the Toyota Production System within the healthcare industry. The book has been awarded a Shingo Research Award and has been recognized for advancing improvement knowledge.

Bercaw resides in Chardon, Ohio, with his wife, Tami, his five children, two horses, a dog, and a cat.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Manufacturing Industries
MEDICAL / Administration