2nd Edition

Taking Improvement from the Assembly Line to Healthcare
The Application of Lean within the Healthcare Industry

  • Available for pre-order. Item will ship after July 23, 2021
ISBN 9780367471545
July 23, 2021 Forthcoming by Productivity Press
208 Pages 52 B/W Illustrations


USD $49.95

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Book Description

Quality healthcare is a cornerstone of any healthy society. In the U.S., we have access to sophisticated medical technology, world renowned physicians, highly trained nurses and hospital personnel, advanced pharmaceuticals, and innovations in diagnosis and treatment. But for all of our sophistication, serious problems afflict healthcare systems across the U.S. today – problems that cause severe hardship for families in communities large and small. Considering its impact on society, healthcare is arguably our most important industry. Good health is a key aspect of a productive and fulfilling life no matter what a person’s age, cultural background, social status or career. To live well and provide for ourselves and others, we all depend on a strong healthcare system that can help us prevent illness and access effective treatment when we need it. Needless to say, building and maintaining that robust healthcare system is no easy task. According to a report by the Institute of Medicine, up to 98,000 deaths per year occur in U.S. hospitals as a result of adverse events. In other words, errors in hospitals cause more annual deaths than acceptable and are totally preventable. With the healthcare system in such critical condition, Lean is the best possible treatment as it moves to eliminate waste and improve processes. The revised edition of Taking Improvement from the Assembly Line to Healthcare supplies step-by-step guidance on how to implement Lean methods to achieve world-class improvement with the healthcare industry. The updated edition of this Shingo award winner book provides specific examples of Lean implementation in emergency medicine, diagnostic imaging, orthopedic clinics, general internal medicine, administration, and community care. Highlighting quality, safety, and financial evidence as to why immediate change is both possible and essential, the book provides a firm foundation in Lean improvement and the tools used to deliver sustainable solutions. This revised edition presents new and updated client interviews and how the process has changed or been enhanced, what worked and what didn’t work. New case studies from U.S. and Canada provide readers with the real-world understanding needed to embark and sustain a successful improvement journey.

Table of Contents




1      Critical Condition: Why Change Is Needed

Introduction: The Perfect Storm

Quality of Care

Access to Services

Affordability of Healthcare Services

Shortage of Resources

2      Fundamentals of Improvement

What Is Lean?

Value-Added Activities

Non-Value-Added Activities

Themes of Lean Improvement: Continuous Improvement

Themes of Lean Improvement: Respect for All People

Seven Wastes








Principles of Improvement: Lean DNA

Flow Concept

Pull System

Defect-Free Work

Visual Management


3      Tools for Improvement

Introduction to Tools

Takt Time

Clinic Example

Direct (Time) Observation

Loading Diagram

Spaghetti Mapping and Circle Diagrams

Circle Diagram

Flow Diagram with Value-Added/Non-Value-Added Analyses

Value-Added and Non-Value-Added Analyses

Standard Work

Process Control


Putting Tools Together

A3 Thinking

Value Stream Mapping and Analysis



4      Case Studies

Revolutionizing Emergency Services: Enhanced Quality and Access

Accelerating Productivity and Access in Diagnostic Imaging

Creating the Ultimate Patient Experience: A Visit to an Orthopedic Clinic

World Class Care at Inpatient Medical Unit

Beyond the Hospital: Continuing Care in the Community

Creating More Time for Quality Care: Streamlining Administration

Enhancing Clinic Flow: A Trip to a Dermatology Office…………………………………..


5      Getting Started

Define Measurable Outcomes

Select and Map Value Streams

Begin Improvement

Sustain Improvement and Manage Visually


Process Control

Results Management

Support Improvement with Lean Training and Coaching

Spread Improvement

Replication of Artifacts, Products, Solutions, and Process

Adding Additional Value Streams

6      Leadership Lessons Learned


Walk the Value Streams

Commit Resources to Ensure Success


Team Resources

Improvement Supplies

External Resources

Hold People Accountable

Engage Physicians

Establish Governance Structure

Address Antibodies

Develop and Deliver Communication Strategy

Redeployment versus Unemployment

Demand and Monitor Results

Expect Improvement!


Glossary of Lean Terms



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Ronald Bercaw is the President of Breakthrough Horizons, LTD, a management consulting company specializing in World Class Improvement through the application of the Toyota Business System, more commonly known as Lean. With more than 20 years of experience in operations, his Lean management experience was gained through multiple enterprise transformations in different industries including custom packaging, power reliability electronics assembly, and test and measurement products.

Educated at Purdue University, he 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, Ron has vigorously strived to remove waste from businesses through the involvement and ideas of the people doing the work.

Ron has consulting experience in the healthcare sector (US and Canada Health Systems, including primary care, acute care, and community applications of both clinical and back shop improvement), the commercial sector (administration, manufacturing, distribution, supply chain, and engineering), and the public sector (US Army, US Navy, US Air Force including MRO, Pentagon, and Surgeon General Assignments).