Taking Improvement from the Assembly Line to Healthcare: The Application of Lean within the Healthcare Industry, 1st Edition (Paperback) book cover

Taking Improvement from the Assembly Line to Healthcare

The Application of Lean within the Healthcare Industry, 1st Edition

By Ronald G. Bercaw

Productivity Press

180 pages | 44 B/W Illus.

Shingo Award Winner
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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 car accidents, breast cancer, or AIDS. With the healthcare system in such critical condition, Lean is the best possible treatment.

Winner of a 2013 Shingo Research and Professional Publication Award!

Taking Improvement from the Assembly Line to Healthcare: The Application of Lean within the Healthcare Industry supplies step-by-step guidance on how to implement Lean methods to achieve world-class improvement within the healthcare industry. Specific examples of this approach are provided 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. It presents client interviews and case studies from the U.S. and Canada to provide readers with the real-world understanding needed to embark and sustain a successful improvement journey.

With two decades of experience in industrial operations management, Ronald Bercaw details a proven approach for discovering waste and delivering improvement in healthcare organizations. He presents powerful insights gained through successful Lean implementations in private industry, U.S. and Canadian healthcare systems, U.S. Pentagon business systems, U.S. Surgeon General assignments, and U.S. Navy, Army, and Air Force maintenance applications.

Providing a comprehensive view of improvement within and outside the walls of the hospital and clinic, the book reveals valuable lessons learned and mitigation strategies to increase your chances of success. It identifies and addresses the leadership challenges that are likely to emerge and includes a detailed roadmap to provide you with the tools needed to achieve sustainable improvements in quality, patient safety, productivity, and staff development and engagement.

Watch Ronald Bercaw discuss how to apply the Toyota Production System to the healthcare industry.

Part I: http://www.youtube.com/watch?v=XTnKWHZ82vM&feature=youtu.be

Part II: http://www.youtube.com/watch?v=tBsoRcKDOaM&feature=youtu.be


Ron Bercaw has made an important contribution to the Lean healthcare movement by starting with the ABCs of Lean and showing through detailed healthcare case studies how they can be used to greatly improve healthcare. He then goes on to give a rich description of the leadership role, the single most important success factor in creating a culture of improvement. Anyone in healthcare doubting that Lean can apply to them should be convinced of the power of Lean by this book.

—Professor Jeffrey K. Liker, University of Michigan and Shingo Prize-Winning Author of The Toyota Way

Table of Contents

Critical Condition: Why Change Is Needed Now

Introduction: The Perfect Storm

Quality of Care

Access to Services

Affordability of Healthcare Services

Shortage of Resources

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


Tools for Improvement


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

A-3 Thinking

Value Stream Mapping and Analysis



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


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

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


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 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).

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration