The Power of Ideas to Transform Healthcare: Engaging Staff by Building Daily Lean Management Systems, 1st Edition (Paperback) book cover

The Power of Ideas to Transform Healthcare

Engaging Staff by Building Daily Lean Management Systems, 1st Edition

By Steve Hoeft, Robert W. Pryor, MD

Productivity Press

422 pages | 143 B/W Illus.

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Many companies conduct Lean training and projects, but few have tapped the wealth of ideas in the minds of their staff like Baylor Scott & White Health. This book documents the path Steve Hoeft and Robert Pryor created at Baylor Scott & White Health and shares what worked as well as what didn’t—illustrating over seven years of successes and failures in detail.

Providing easy-to-follow guidance for deploying Lean and TPS in healthcare, The Power of Ideas to Transform Healthcarefocuses on what needs to be done and who needs to do it. It explains that the new "currency" for 2015 and beyond will be ideas—ideas brought out in projects, problem solving, and especially in "Huddles." The most significant concept in this book is not huddles. Instead it’s who builds the systems around them and why.

  • Supplies the understanding required to build a Lean management system in any industry
  • Explains how to align staff around common goals and cascade and translate those goals using Hoshin Kanri
  • Demonstrates how daily Lean can reduce the cost of healthcare

The authors share hundreds of pictures, forms, tools, and tips. Describing how to engage all staff and draw out their ideas in daily huddles, the book offers ways that staff can try out their ideas without spending too much time away from their work.

Although the book focuses on healthcare, the management systems described, along with the lessons learned and best practices, will work in almost any industry.


The joint wisdom and experience of Hoeft/Pryor makes this book both fun to read and a great resource for organization leaders and internal consultants tasked with improving processes. While the fit for healthcare is obvious, the practices they have so succinctly described will benefit any workplace.

Cindy Jimmerson,Author and Founder of Lean Healthcare West

Lean healthcare has become a buzzword and as such often gets mired in the bureaucracy of ineffective programs. Steve and Bob give us deep insight into the philosophy and thinking essential to making Lean healthcare a way of putting innovative ideas to work to achieve breakthrough performance for patients, team members, and the institution.

—Jeffrey K. Liker, Ph.D., Shingo Prize-Winning Author of The Toyota Way

This book is built upon rock-solid foundations, bringing the daily Lean management system to life through their stories and examples. Hoeft and Pryor colorfully demonstrate how staff ideas and a broader Lean management system greatly benefit patients, staff, physicians, and the health system. Lean is not just a set of tools or a series of projects, and this book is full of inspiration and practical advice for everybody who needs to participate actively in a Lean transformation, starting with the CEO and other senior leaders. This is a must-read.

—Mark Graban, Shingo Prize-Winning Author of Lean Hospitals and Co-Author of Healthcare Kaizen

… The Scott & White system, at the time this book was written, counted 2,000 implemented ideas for improvement from employees per week from their 16,000 employees, this in an environment that included recent budget and staff cuts. That number is unheard of in my experience outside of a few high volume, low variety automotive manufacturers, mainly Toyota and some of its suppliers.

That level of employee engagement is for me the sine qua non of a successful Lean implementation supported by a robust Lean management system. … Steve Hoeft is a teacher and coach with firsthand experience in Toyota’s thinking and approach. Pryor knew the direction he wanted to go: sustained high levels of employee engagement in improving S&W’s performance. Together, they developed an approach to move in that direction. Either would tell you they’re far from done. But the distance they’ve traversed and the progress they’ve made stands as a significant achievement, chronicled in the pages that follow … This book documents the path the authors created at Scott & White … It’s a systematic approach, and it’s working…. It entails taking leaders through a process wherein they persuade themselves of the value of sharing, with front-line staffers, their managerial discretion to define problems worth working on. When that happens, it holds the promise to improve the entire organization’s performance in ways others will find difficult to duplicate. The goal is worthy, the journey is worth making.

David Mann, Ph.D., Shingo Prize-Winning Author of Creating a Lean Culture, Third Edition

The Power of Ideas to Transform Healthcare is an invaluable tool for any organization seeking to align their objectives from the system level to the front lineand that should be all organizations. In it, Hoeft and Pryor describe a practical approach to developing a culture of continuous improvement by engaging employees in problem-solving and developing a management system to support it at all levels.

Chris Van Gorder, FACHE, President and Chief Executive Officer, Scripps Health

The pursuit of Lean thinking is not a top down process, it is a way of allowing everyone to do what is best for the patient in the most effective and efficient manner. Bob and Steve’s book gives great insight on how this is done in healthcare.

C. Courtland Huber, Ph.D., Past Director of the Executive M.B.A. Program at the McCombs School of Business, University of Texas at Austin

Table of Contents


What Can Lean Do for My Organization?

Bob’s Background

Steve’s Background

Why Lean? Why Now?

The Healthcare Desert Oasis

Healthcare Challenges Nationwide

New Challengers: Non-Traditional Healthcare Providers

A Process for Dealing with Change

S&W’s Particular Challenges

S&W’s Growth Era

S&W’s Financial Model

S&W’s Secret to Low Costs—Integrated Health Delivery

How S&W’s "Secret Sauce" Helps Improve Population Health

Rapid Growth and Pride

Confusing Leaders—Management Systems and Gurus Everywhere

Systems Thinking: Big and Small

Lots of Operating Systems: Which One?

A System that Ties Together Other Good Micro-Systems

Bob’s Bold Statement

Toyota Changed the Value Equation (aka Only One Way to Thrive)

The Promise

What Percentage of Your Creative Brainpower?

Countering the Two Biggest Excuses


Toyota’s Philosophy

Patient Centered

The Improvement Philosophy for Healthcare

Bob Finds His People-Based Lean Philosophy

Go, No-Go #1: CEO-Driven

Go, No-Go #2: No Layoff Policy

It’s All About People

The Goal: Building a Culture of Continuous Improvement

Investing in People


The Toyota House

The Toyota Way Principles

Toyota’s Patience—San Antonio

All Staff Need to Develop "Eyes for Waste" (Downtime)

Lead Time and Value Added Time

The Customer Determines Value

Types of Work

Scientific Method

Lean Thinking Penetrates Every Part of the Organization: Baldrige Framework

Tensions are Natural in Every Transformation

Standardize vs. Improve: Defending Standardized Work

(Forced) Standard Improvements vs. Team-Based Improvements

Detailed Standard Work or General

Do It This One Best Way vs. Figure Out Best for You (Rigid vs. Flexible)

SMART vs. Stretch Goals

Problem Solver vs. Problem Finder

No Layoff Policy vs. Layoffs in the Face of Volume Imbalance or Major Cost Pressure

Not Big Enough vs. Too Big

How S&W Did It—Applying TPS to Healthcare

Step 1. Lean Training and Tools

Orientation and Two Hats

Continuous Improvement Training

Common Core Training and Applications for All Staff

Advanced Development Tracks for Select Staff

Lean Steering Council

Sausage Diagram and Project Identification—System-Wide Value Stream Mapping

Project Prioritization and Selection Matrix

Maintaining the Matrix: How Detailed?

Step 2. Major Lean Projects: Self-Sufficiency Plan

Leader Roles

Self-Sufficiency Philosophy

Many, Many Projects

Setup Checklists

Tracking Return-on-Investment (ROI)

Lean Project Example—Chemo Infusion (VSM Workshop)

Re-Casting a VSM Vision

Spreading Ideas from One Area to Another

Why Doing Lean Projects Only Will Not Work

Step 3. Align all Staff through Hoshin Kanri

All 13,000?

Catchball and Contribution to the Leaders’ Goals— Different for Everyone

S&W’s Hoshin Forms

Linking Human Resource-Led Backward-Looking Annual Reviews with Forward-Looking Hoshin


Advanced Practice Professionals (APPs)

S&W Strategy Development

Population Health

Step 4. Daily Lean: Lean Management System-Building (LMS)

Unleashing Ideas—the Iceberg

"Ultimate Arrogance"

Three Parts of Lean Management System (LMS)

Part 1: Leader Standard Work

Part 2: Visual Controls

What Do You Put on a Huddle Board?

Workers Need Input or In-Process Measures to do Experiments



Close-Up of a Hand-Tracked Measure

Close-up of All Three Sections of Huddle Board

Part 3: Daily Accountable Process


Gemba Walks

More Gemba Walks, More Time

Daily Experiments

LMS Examples

Nursing—Labor and Delivery (L&D)

Temple Memorial—Overall Patient Satisfaction Effort Using Huddles

Quotes from Nursing Leaders

Monthly LMS Huddle Success Stories

Temple Environmental Services (EVS

Everyone at Every Level Huddles—A Tier-3 Leader Huddle

S&W’s Employee Engagement "Outlier"

The Huddle System (LMS)—In Detail

Keep it Simple: Two Guardrails to Guide all Daily Lean Ideas

Leadership, Gemba, and PDCA Cycles

Small "l" Leadership First

Faith not Feeling

Slow Data Feedback to Team Means Slow PDCA Experiments

Building LMS

Lean Leadership (LMS) Course

Required Courses?

More on Gemba Walks in the LMS Class

Idea Lists

Leader Standard Work

Visual Controls

Chaining all Huddle Boards Together—No Weak or Missing Links

Three Tiers

Keep it Simple


Daily Accountability Process (Huddles)

Part A: The Huddle

Huddle Tips

Part B: Leader Gemba Walks

Part C: Increased Floor Time for Leaders

Leaders Must Keep Teams Moving up the Stairs

Examples of Huddle Boards (Old and Newer)

Memorial ICUs

Medical Intensive Care Unit (MICU)

Surgical/Trauma Intensive Care Unit (STICU)

Cardiothoracic Intensive Care Unit (CTICU)

Temple HR Recruiting

Taylor POS Collections

Temple Orthopedic Clinic 2C

Temple GI Procedures

Taylor Lab

McLane Children’s Hospital Physical Therapy/Occupational Therapy (PT/OT)

McLane Children’s Hospital Imaging

McLane Children’s Hospital Lab

Llano Nutrition Services

Hillcrest Baptist Physical Therapy (Re-Evaluations)

Temple Pulmonary Lab

Entering a Huddle: Senior Executive Committee

Elevation System—the Strong Chain

Colored Card System to Track Elevated Ideas

Interventions to Accelerate Ideas



A3 Waves


Major Projects

Huddle Tracking System

Hand-Written Trackers

Managing Two-Deep



Tracking Huddles Two-Deep

Huddle Board Audit System; Layered Audits.1 Layered Audits

Lean Tools S&W Uses in Huddles.1 Tools

Rebalance and Workshare in Huddles


To the Huddle

Same Day Access (SDA) Effort—Using Huddles

Tips and Techniques

Tip 1: To All Leaders: Have Patience!

Tip 2: Make it Visual!

Tip 3: Be Flexible

Tear ‘em Down

Tip 4: Understand How Change Affects People

Tip 5: What You Measure is What You Get; So, Be Careful What You Measure

Tip 6: Put some "Teeth" into Hoshin Goals

Tip 7: Get Flow

Tip 8: Partner with a Lean Leader—Even in Another Industry

Tip 9: Steve’s Sensei Folder

Tip 10: Using Assessments or "Scores" to Grade One’s Progress

Overall Lean Maturity Score

Lean Assessment by Tool or Principle with Radar Chart

Baldrige (or Several Other) Framework

Tip 11: Tip of the Week Emails and Intranet Fresh Articles

Top Five Lists for Huddles

Top Five Reasons to Huddle

Top Five Things We Huddle About (Focus Topics)

Tip 12: Building the Internal Lean and LMS Toolkit

Tip 13: Using Videos to "Get the Message Out"

Tip 14: Have a Bias for Action

(Story 1) Must Cut Inventory in Half—a Bias for Action

(Story 2) Door Here!

Tip 15: Stop Lean during Epic or EMR Rollout?

Tip 16: Stop Lean during a Merger?

Tip 17: The ROI Trap and Role of Training

Tip 18: Kaizen or Kaikaku: Redirecting Labor

Flexing Staff to Other Sites


Appendix: Acronyms and Some Terms

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
BUSINESS & ECONOMICS / Workplace Culture
MEDICAL / Administration