Index [account.ache.org]account.ache.org/eweb/upload/Black2e_Index-f467d9a7.pdf · Accelerating Health Care Transforma-tion with Lean and Innovation: The Virginia Mason Experience

487

Index

Note: Italicized page locators refer to figures or tables in exhibits or to photos.

Abelson, David, 432, 435Abercrombie, Richard, 459Accelerating Health Care Transforma-

tion with Lean and Innovation: The Virginia Mason Experience (Plsek), 424

Accountability, 201, 429Adashynski, Beth, 458Adjacency, 300Adverse Events Management System

(AEMS), Saskatchewan, 344Adverse healthcare events, 28–29Affordable Care Act, 6, 11; Lean

improvement and, 439; signed into law, 5

Airbus, 60Alcoa, 21Anchor draggers, 96, 385Anderson, Julian, 20Anderson, Mark, 379Andon, 90, 200; avoiding overproduc-

tion and, 81; definition of, 44, 46; Lean House, 75; patient flow use, 262; purpose, 80–81

Antosh, Susan, 375, 457Ash, John, 338, 365, 412Athabasca Health Authority, 285A3 report, 35Autoliv plant (Utah), 352, 358Autonomous maintenance, 267Ayers, Craig, 297

BAC. See Boeing Aerospace Company

Baker-Norton study (Canada), 92, 199, 218, 236, 247, 286

Bancescu, Shelda, 349Barnett, Mark, 166Bartlett, Donald L., 31“Battle fatigue,” Lean transformation

and, 407–9Battlefords Union Hospital: kanban

system, 367BCAC. See Boeing Commercial Air-

plane CompanyBetter (Gawande), 322Between-process time: productive use

of, 146Beyond Budgeting: How Managers

Can Break Free from the Annual Performance Trap (Hope and Fraser), 97

Bingham, Tom, 20Biopsy reports, 266Bjorndahl, Sterling, 378Blanton, Kent, 20Blue, Jim, 19Boeing Aerospace Company (BAC),

442; audit system, 413; Boeing 737 moving production line, 315; challenges, 59; kanban system, 368; performance metrics, 61; production line, 62; quality effort, 60, 61; redeployment policy, 329; sensei introduction, 61–62; zero defects philosophy, 313–14

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488 Index

Boeing Commercial Airplane Company (BCAC): Lean transformation at, 17–22

Boeing Commercial Airplane Group, 59; Strategy Council, 61

Boeing Production System, 55, 62, 385Boeing Production Systems Specialists

(BPSS), 326Borman, Frank, 18Breakthroughs: cross-functional man-

agement and, 112–13Brenia, Alan, 181Brossart, Bonnie, 312, 316, 317, 332,

384, 390, 420, 451, 452, 454, 457Broten, Cam, 386, 387Brown, Ngaire Woodroffe, 348, 349,

406, 413Brownfield, 103Bryan, Charlie, 18Bryden, Candice, 296, 454, 458Buffer stock, 175Burke, Claudia, 458“Burning platform,” large-scale trans-

formational change and, 295Burnout, 289, 433Byrne, Art, 291, 291

Cahill, Tom, 436, 437, 438, 439, 440, 441

Cairns, Myles, 458Campbell, Vivian, 458Canada. See also Saskatchewan;

Saskatchewan healthcare system: communication style prevalent in, 286; healthcare costs in, 11

Caplan, Robert, 314Carlson, Sam, 124, 125, 240, 245, 248,

250Cascade scheduling, 214– 215, 261Case cart standardization, 268–70Cashway, Lynn, 360Catch-ball process, 111, 113, 304Caterpillar, 21Cell: definition of, 41Center for Health Services Research, 430Center for Hyperbaric Medicine

(VMMC), 220, 221–34, 236;

cabana, 228, 229; Everyday Lean Idea System, 235, 236; 5S workplace organization, 233; five whys process, 225–27, 236; Lean results, 233–34; new clinic, 223–24; new hyperbaric chambers, 228; patient environment, 227–28; patient kanban cards, 231–32, 232, 237; prehistory, 222; previous one- and four-patient hyperbaric chambers, 222; 3P, 224–25, 225; treatments, 221; work standard-ization, 229, 230, 231, 237

Centers for Disease Control and Pre-vention, 258

Certification: leadership, 126, 127–29, 140, 202, 204, 244, 246, 288, 314, 318, 320, 321, 396, 396, 437, 442

Chain of command, 117Challenge upward, 286Change: bad-mouthing Lean and,

384–85; organic, 417Change agents: KOT leaders as, 337Chapple, Alan, 458Chartrand, Genevieve, 407Checklist Manifesto, The (Gawande),

322Chen, Jean, 20Children’s Hospital of Saskatchewan

(CHS), 294, 447; identifying effi-ciencies, 300–301; patient room mock-up, 300; pediatric oncol-ogy unit, 373; saving millions of dollars, 301–3; 7 Ways approach, 299; table-top mock-up, 297, 297; 3P applied to, 296–98; 3P Lean facility design, 295–98

Christiaens, Erin, 296CHS. See Children’s Hospital of

SaskatchewanClinician flow. See Provider flowCoaching, 420Commitment: leadership, 122, 312,

314–15, 340, 420, 427–28, 430, 442

Complacency: avoiding, 169Complications (Gawande), 322


489Index

Condit, Phil, 18Conley, Jennifer, 457Connelly, Steven M., 117, 268, 272, 435Constancy of purpose, 431, 435Continuous-flow production, 15, 96.

See also FlowContinuous improvement cycle: syn-

ergy in, 84–85Continuous incremental improvement

(kaizen), 9, 220, 442Continuous quality improvement

(CQI), 18; “Partnership with People” (Principle 3), 328–29

Conway, Bill, 13, 20, 21Cooke, David, 98, 99Corvi, Carolyn, 427, 428, 431, 435Cost of poor quality, 8CQI. See Continuous quality

improvementCraig, Cheryl, 319, 332, 343, 414, 457Crash cart, 152Creative Healthcare, 386Creel, Bill, 459Critical Condition: How Health Care in

America Became Big Business—and Bad Medicine (Bartlett and Steele), 31

Cross-functional management, 97, 112–14, 431

Cross-training, 150–51Cryderman, Keri, 458Cugnet, Marga, 458Cultural constraints: smaller regions,

Saskatchewan healthcare system, 371

Cummings, Greg, 457Cycle time: cutting to meet takt time,

104, 119; definition of, 104; Lean formula, 475; provider time and, 151; reducing, 96

Cypress Health Region, Saskatchewan, 359–60, 452

Daily management, 97, 110–11, 429D’Amore, Bob, 291Data visibility, Saskatchewan health-

care system, 338–39, 340

Davidson, Jody, 458Davies, Maura, 278, 279, 295, 296, 302,

317, 318, 323, 331, 388, 410, 420, 452, 454, 458

da Vinci, Leonardo, 202Day-of-service lead time, 262Defects, 43–44, 45, 46, 52Deming, W. Edwards, 8, 20, 21, 58,

289, 431Desmeules, Jean-Marc, 457Dewar, Keith, 338, 339, 458Deyo, Richard, 32Diabetes registry usage, 257Distribution kaizen, 326Divers Alert Network, 167Dobson, Joy, 316Dollard, Deb, 304, 459Doubling up, patient services, 146Drucker, Peter, 135Dubuque, Denise, 212, 219Duncan, Dustin, 303, 364, 387, 390,

391, 397, 403, 407, 414, 457Dunn, Christine, 304, 459Dzus, Anne, 298, 316, 322, 452

Eastern Airlines, 18Efficiencies: identifying, 300–301eHealth Saskatchewan: electronic

health records, 375–79; executive visits to the gemba, 377–78; leader standard work, 379; reduced call-abandoned rate, 376, 378; Service Desk, 375–77, 377

Employees: crucial role, in continuous quality improvement, 328–29; redeployment, 328, 329; satisfac-tion, 10–11

Endoscopic facility (Park Nicollet Health Services), 240, 250, 261

Entropy, 438, 439Environmental Protection Agency, 167Equipment flow, 163–65, 170; improve-

ment methods, 163–65; PNHS, 164; questions, 165; VMMC, 163

Ergonomics, 151Errors: hospital, 29; medical, 310–11Eusek, John, 459


490 Index

Even flow, 182Event segment, 131Everyday Lean Idea System (Virginia

Mason Medical Center), 235, 236Executive development program,

136–37

Family flow, 147–49, 170; questions, 148; Royal University Hospital, Saskatoon, 148; Saskatoon City Hospital, Saskatchewan, 149

Fan, David, 457Federal Express, 21Feldman, Michael, 263, 267, 268Fenn, Ernie, 17, 18, 19Fields, Alenka, 459FIFO. See First-in, first-outFinancial crisis of 2008, 367, 432“First, do no harm” concept, jidoka

and, 14First-in, first-out (FIFO), 146First Nations people: Saskatchewan,

285Fishbone charts, 298Five Hills Health Region (FHHR),

Saskatchewan, 448; capital 3P Lean facility design event, 402–3; kanban efforts, 349, 350; Kanban Seminar, 366; Lean implementa-tion, 370; Moose Jaw hospital design, 402, 448, 449; process 3P Lean designs, 405; RPIW, 389, 450; transport waste, 48

5S workplace organization, 84, 85, 90, 158–59, 233, 263, 322, 348–49, 351

Five whys process, 226, 236Florida Hospital Zephyrhills, 5; kanban

system, 181–82, 368Florizone, Dan, 10, 280, 282, 283, 285,

286, 303, 310, 311, 312, 314, 317, 342, 353, 383, 384, 385, 388, 410, 411, 412, 420, 447, 454, 457, 458

Flow: definition of, 14; of equipment, 15, 142, 163–65, 170; even, 182; of family, 15, 141, 147–49, 170; in healthcare environment, 15; of information, 15, 142, 160–63, 170;

of medications, 15, 142, 154–57, 170; of patients, 15, 141, 144–47, 170; performance improvement with, 142–43; poor, 301; of pro-cess engineering, 165–69; of pro-viders, 15, 141, 149–54, 170; pull system, 220; summary thoughts on, 169–70; of supplies, 15, 142, 158–60, 170

Floyd & Delores Jones Cancer Institute (VMMC), 215; cascade sched-uling, 214–15; Lean improve-ments, 215–16; Lean results, 218; learnings, 219–20; opening, 214; patient and Lean operations, 216–17, 217, 218

Food tray line: eliminating defects in, 47, 48

Ford, Henry, 56, 57Ford Motor Company, 18, 21Forrester, Jill, 458Fox, Colin, 22Fox, Sherrell, 458Fraser, Robin, 97, 98Function Maturity Score Sheet, 329

Gachowski, Ted, 215–18Gawande, Atul, 322GDP. See Gross domestic productGemba, 116, 132, 169, 317, 323, 336,

337, 382, 437, 439; definition of, 9; eHealth’s success and executive visits to, 377–78; getting Sas-katchewan leaders to, 342–43

Gemba kaizen, 63–64, 133, 326Gemba Kaizen (Imai), 9General Dynamics, 21General Motors, 18Genie-Terex, 132, 197, 242, 368Gillis, Carol, 458Gissing, Bruce, 21, 59, 60, 61, 137Global enterprise value-stream net-

work, 105Global Production System (GPS),

294, 331–32; components of, 73, 75–85; concepts, 89–90; definition of, 70; foundation, 73, 89; graphic,


491Index

74; key principles, 78–79; under-standing, 72–73

GNP. See Gross national productGPS. See Global Production SystemGreenfield, 103Greuel, Cindy, 458Gross domestic product (GDP):

healthcare costs as percentage of, 11–12

Gross national product (GNP): US health-care costs as percentage of, 30

Hagan, Pat, 368, 369Hallberg, Tina, 288, 296, 298, 301, 344,

392, 459Hampson, Neil, 221, 222, 224, 225,

226, 229, 233, 234Handoffs: reducing, 10Hand-washing mandates, 343Harley Davidson, 21Harper, Rennie, 410Hartquist, Beth, 256, 257, 258, 259, 459Healthcare: dramatic improvements

in, 6–7; people most important resource in, 9–10, 25, 51

Health insurance: employer-spon-sored, annual premiums for, 30

HealthPartners: merger with Park Nicollet Health Services, 432

Health Quality Council (HQC), Sas-katchewan, 285, 312, 316, 332, 336, 390, 413

Health unit coordinator (HUC), 263Heartland Health Region: process 3P

Lean designs, 404Hebeler, Bud, 60Heeran, Sister Monica, 3, 290, 290, 292Heijunka, 89, 151, 214, 263, 442; defini-

tion of, 76; explanation of, 76; importance of, 95, 182; kanban and, 182; Lean House, 73, 78; model service line and, 86; sur-gery schedules, 272

Henderson, Mark, 323Hendricks, Max, 283, 284, 285–86, 303,

314, 317, 342, 343, 344, 383, 390, 451, 453, 454, 457

Herman, John, 240Hess, Jan, 288, 324, 372, 459Hetzel, Joe, 175, 180, 182, 183, 184,

187Hewlett-Packard, 21Hippocrates, 310Hitachi, 291, 326Hokushin Kogyo, 291, 326Honeywell, 21Hope, Jeremy, 97, 98Hoshin kanri (management by policy),

294, 303–4, 306, 307, 336, 344; definition of, 112; involving every-one in, 305; 3sHealth Saskatch-ewan, 382

Hoshins for patient flow: Five Hills and Saskatoon Health Region, 405

HQC. See Health Quality CouncilHUC. See Health unit coordinatorHunt, Cecile, 457Hunt, Jeremy, 5Hyperbaric clinics: functions of, 221

IBM, 21Imai, Masaaki, 8, 9Imre, John, 20Inelastic demand, 63Information flow, 160–63, 170;

improvement methods, 161–62; PNHS, 162; questions, 162–63; VMMC, 160

Infrastructure, definition of, 70. See also Lean infrastructure

Injuries, healthcare workers, 311Institute for Healthcare Improvement,

4Internal leaders, 96Inventory, 38–39, 40, 52, 263, 266“Invisible supply chain,” 366Iwata, Takeshi, 459Iwata, Yoshiki, 15, 61, 72, 132, 172,

175, 186, 292, 443

Jacobs, Andrew, 212, 214, 216, 219Japan study trips, 22, 60–61, 88–89,

133–34, 140, 197–98, 291, 313–14, 319, 326, 327, 368, 427


492 Index

Japan Super Flow, 198Jefferson, Thomas, 56Jidoka, 57, 199, 201; continuous

improvement cycle of, 84–85; defi-nition of, 14, 89; equipment flow application, 163; Lean House, 73, 75, 77, 78; Lean production and, 14; patient flow and, 145

JIT. See Just-in-time (JIT) productionJohnson, Julie, 375, 458Johnson, Todd, 180, 183, 184Joint Commission, The, 162, 258Jones, Daniel T., 4, 129Jones, Rob, 20Journal of Patient Safety, 29Juran, Joseph, 8, 20, 58, 60, 139Just-in-time delivery, 158Just-in-time (JIT) production: defini-

tion of, 14, 89; jidoka and, 73, 75, 77; kanban and, 57, 172, 173, 187; Lean and, 14; Lean House component, 77, 78; supply flow, 157, 158–60

Just-in-time supply chain, 348, 366

Kaikaku, 211; definition of, 95; example, 104–5; kaizen and, 101–3, 118; Lean implementation through Kaizen events and, 101–3, 118

Kaizen, 24, 169, 211, 309, 419, 442; activity reports, 429; career ladder, Park Nicollet Health Services, 246; definition of, 8, 9; kaikaku and, 101–3, 118; masters, building, 136–37; path, 107, 108, 109

Kaizen event (Rapid Process Improve-ment Workshop), 442; certifi-cation program, 131–32, 197; definition of, 36; Lean implemen-tation, 101–3; PNHS, 266–67, 268, 269, 270; Premera Blue Cross, 436, 437; reducing waste from defects, 45; reducing waste in processing, 50; reducing waste in transportation, 47; reducing waste of movement, 42; reducing

waste of overproduction, 35; reducing waste of time on hand, 37; VMMC, 194, 195, 201, 206–7, 219, 229, 231

Kaizen Fellows program, 20, 294; evolu-tion of, 326–27; for Saskatchewan, 324–27, 325, 331, 452; trips, 294

Kaizen (Ky’zen) (Imai), 8Kaizen leaders. See LeadershipKaizen Operations Team (KOT), 287,

419; creating, 99–100; overcoming challenges in Saskatchewan, 337; PNHS, 246, 258–59, 272; purpose of, 95; Saskatchewan, 320, 332; Saskatchewan structure, 335; Sas-katoon Health Region, 332, 334

Kaizen Promotion Office (KPO), 61, 91, 93, 118, 121, 193, 283, 287, 320, 332, 354, 419; assessment, 204–5; eHealth Saskatchewan, 375; leaders, 122–23; overcom-ing challenges in Saskatchewan, 337; Premera Blue Cross, 436, 437; purpose of, 95; Saskatch-ewan structure, 335; Saskatoon Health Region, 332, 334; staffing constraints in smaller regions of Saskatchewan, 370–71; VMMC, 204, 205–6

Kaizen work: accomplished in Sas-katchewan healthcare system, 396, 397

Kallas, Kathy, 459Kanban, 90, 245, 317, 320, 322, 348,

349, 350, 371, 379; benefits of, 172–73, 178–80; cards, 172, 177, 178, 179, 181, 182–83, 231, 232, 232, 237; definition of, 39, 41, 57; examples, 171–72; extended, 185; Florida Hospital Zephyrhills, 181–82; full potential, 186–88; importance of, 182; Lean House, 75; location of storage and kit-ting, 182–83; medication flow, 155, 156; model service line and, 87; obstacles, 183; origins, 173; outside suppliers, 184, 185,


493Index

188; PNHS, 177–80, 183, 184, 188; Premera Blue Cross, 436; principal outputs, 80; reduced waste of stock on hand, 39, 40; Saskatchewan healthcare system and, 366–69; Seattle Children’s Hospital, 368–69; supply flow, 157, 159, 187; two-bin system, 173–75, 174, 188, 367; VMMC, 180, 183, 184, 188

Kano, Reiko, 459Kaplan, Gary, 4, 122, 124, 136, 192,

193, 194, 196., 197, 198, 199, 202, 203, 205, 209, 216, 226, 327, 426

Kaupa, Mike, 123, 239, 240, 245, 247, 248, 249, 250, 432, 433, 434, 435, 436

Keewatin Yatthé Health Region, Sas-katchewan, 359

Kelsey Trail Health Region (KTHR): Kelvington Hospital redesign, 451

Kenney, Bill, 256, 259Kenney, Charles, 322, 424Kimball, Donna, 285, 288, 370, 459Kits, 154, 155Kitted supplies, 183Koenigsaecker, George, III, 291Koide, Katsuya, 172, 175, 186KOT. See Kaizen Operations TeamKPO. See Kaizen Promotion OfficeKrafcik, John, 4

Lab letters, 255Lacey, Kevin, 458Lancet, 29Larson, Gary, 246, 248, 249Laurent, Suann, 312, 355, 372, 458Lawson, Bruce, 459LDS. See Lean depth studyLeaders: coaching, 420; internal,

96; key Lean, in Saskatchewan, 457–59; transformational, traits and behaviors of, 461

Leadership: certification program, 126, 127–29, 140, 202, 204, 244, 246, 288, 314, 318, 320, 321, 396, 396, 437, 442; as change management,

343; commitment, 122, 312, 314–15, 340, 420, 427–28, 430, 442; education, 125–34; executive development program, 136–37; focus, 125; Kaizen Promotion Office, 122–23; line managers, 123, 140; nonmanagerial physi-cians, 123–25; non-value-added activity identification, 140; obstacles, 137, 138–39, 140; requirements, 125; service, 431; successful Lean implementation and, 121–22

Leadership maturity model, 330Leading the Lean Healthcare Journey

(Wellman), 322Lead time, 16, 96; cutting to meet takt

time, 103–4, 119; definition of, 16; efficient flow and, 15; Lean formula, 475; Premera Blue Cross and reduction in, 438; Sas-katchewan Cancer Agency, 374; Saskatoon Provincial Scheduling System and reductions in, 406, 406; surgical, RPIWs and reduc-tion in, 359

Lean accounting, 97–99, 119Lean action plan, 91–119; budget-

ing process, 97–99; elements of, 94–97; fundamental require-ments, 91–92; gaining traction with, 116–18; goals of, 92; kaizen events, 101–3; Kaizen Promotion Office and Kaizen Operations Team, 99–101; preparatory steps, 92–94; reorganization, 104–5, 107, 109; stand-up meeting, 115–16, 116, 117; supporting functions, 109–10; takt time, 104; visibility room, 114–15, 115

Lean depth study (LDS), 97, 134–36, 327–31

Lean formulas, 475Lean healthcare: definition of, 6; global

awareness of, 5Lean House, 331. See also Global Pro-

duction System


494 Index

Lean infrastructure, 424; building, 442; components of, 70; definition of, 70; for healthcare, three key requirements, 71–73; importance of, 69–70

Lean leaders: management system development by, 424

Lean leader training (LLT), 317, 320Lean organization: prototype, 106Lean production. See also Lean: Boeing

Production System, 20–23, 55, 58–62; continuous improvement, 57; definition of, 4; flow in, 15; focus, 13; implementation, 12–13, 21; jidoka, 57; kaizen system, 291; kanban, 57; as proven transfor-mational model, 16–22; Toyota Production System, 56–58

Lean Production: Implementing a World-Class System (Black), 436

Lean Thinking (Womack and Jones), 129

Lean (Toyota Production System), 3; basic elements in, 94–97, 442; early beginnings, 55–56; elements of success, 12–13; goals, 73; improvements gained, 10–12, 63; team spirit and morale building, 51; thinking, 6; waste-free, world-class, and, 14

Lean transformation: maintaining momentum in, 407–10, 421; objections to cost of, 420; replica-tion model for, 417, 418; require-ments, 23

Lean Transformation Conference (Washington), 440, 441

Leapfrog Group, 4, 426Learn/do approach, 324–25Leveled production (heijunka), 73, 76,

78, 86, 89Level loading, 376Line managers, 123, 140, 337Livingstone, Scott, 374, 458Livingstone, Trish, 280, 447, 458Llewellyn, Colleen, 304, 305, 459LLT. See Lean leader training

Load leveling, 435Logan, George, 240Low-hanging fruit, 139, 433Lynn, Mary, 400

Machine that Changed the World, The: The Story of Lean Production (Womack, Jones, and Roos), 4

Management by objectives (MBO): management by policy vs., 111

Management by policy (MBP), 97, 111–12; management by objec-tives vs., 111; three elements of, 113

Management-by-process philosophy, 434

Management system for Lean transfor-mation: establishing, 419

Management training, 130Mann, Jackie, 303Manthey, Steve, 296, 301, 459Massachusetts Institute of Technol-

ogy, 4Mayo Medical Labs: mistake-proofing,

454MBO. See Management by objectivesMBP. See Management by policyMcGrath, Petrina, 302, 324, 348, 354McKee, Chris, 458McLetchie, Andrew, 457McMorris, Don, 287, 314, 353, 447,

457MCMP. See Minnesota Community

Measurement ProjectMedical errors, 310–11Medical subspecialties: PNHS, 259–60,

273Medicare, Canada, 383, 421Medication flow, 154–57, 170;

improvement methods, 154–57; kits, 154; PNHS, 155–56; ques-tions, 157; VMMC, 154

Medication kanban: PNHS, 176, 177, 179

Medicine: seven flows of, 141–42, 202Merriman, Shane, 457Mihalick, Stephen, 304, 459


495Index

Miller, Diane, 430Mind-set, changing, 24Ministry of Health (MOH), Saskatch-

ewan, 278, 280, 294, 298, 302, 303, 304, 309, 310, 315, 329, 332, 349, 355, 379, 385, 390, 398, 400, 414, 447

Minnesota Community Measurement Project (MCMP), 239, 256, 258

Minnesota Medicine, 240Mistake-proofing, 86, 278, 314, 317,

348, 352, 353, 358, 371, 372, 396, 414, 435, 454; patient safety as first priority and, 434; Saskatch-ewan healthcare system projects, 463–74; Saskatchewan teams’ projects by category, 397, 398; summary, VMMC, 355, 356

Model line, 95, 107, 114, 118, 129, 212, 310, 417, 442

Model service line: attributes, 86; essential elements, 86–87; estab-lishing, importance of, 85–88, 90

Modern Healthcare, 426Module marathon, 131Monuments, 164Morrill, Mike, 458Movement: waste of, 41, 42, 43, 52Muda, 8, 73, 89, 96, 202, 220, 280Muri (unreasonableness): avoiding,

152

Nakao, Chihiro, 61, 72, 132, 291, 292, 326

Narita, Shigeru, 380, 459National Oceanic and Atmospheric

Administration, 167Neidig, Susan, 296, 304, 331, 375, 380,

459Nelson, Dwight, 458Nemawashi, 427New Democratic Party of Saskatch-

ewan, 386Next-visit setup, 257Niwa, Senji, 292Nonmanagerial physicians, 123–25Non-value-added: definition of, 11

Non-value-added activities: excessive time spent on, 69

Non-value-added time: patients and, 10

North Battleford’s Saskatchewan Hos-pital, Prairie North Health Region: 3P Lean design project, 403–4

Numata, Soichi, 459

Ohno, Taiichi, 4, 33, 55, 58, 61, 129, 132, 173, 186, 187, 226, 380, 443

One-piece flow, 435; definition of, 78, 79; equipment flow and, 164; patient flow improvement, 245

One-touch operations, 151Open-room arrangements, 162Operational availability, 75, 80–81Operator CT: Lean formula, 475Organization: viewing with “new set of

eyes,” 88–89, 90Otake, Kumi Iwata, 459Otero, Henry, 212, 219Outside suppliers: kanban extended to,

184, 185, 188Overproduction: reducing waste of,

33–34, 35, 36, 52

Paperwork-preparation cycle time: patient flow and, 263

Pareto charts, 298Park Nicollet Health Services (PNHS),

5, 211, 317, 326, 414, 431–36, 442; anticoagulation care model, 435; asset protection improvements, 267; biopsy reports, 266; bron-choscopy procedures, 267; bud-geting process, 97–98; capturing both minds and hearts at, 433–34; case example, 239–73; certifica-tion process, 127–29; constancy of purpose at, 435–36; endoscopic procedure center, 260; endos-copy suite, 240, 250; Frauenshuh Cancer Center, 432; GI clinic, 260, 264, 265; information flow, 162; Kaizen Promotion Office structure, 99–101, 100; kanban at, 177–80,


496 Index

Park Nicollet Health Services (continued) 183, 184, 188; lab results, 34;

Leadership Fellows, 136–37; Lean benefits, 245–46; Lean experience, 258–59; medical subspecialties, 259–68, 273; medication flow, 155–56; medication kanban, 176, 177, 179; merger with HealthPart-ners, 432; movement waste, 41; patient flow, 147, 260–64; patient rooming process, 254, 273; patient safety comes first at, 434–35; patient tracking system, 44; primary care service line, 253–59; processing waste, 49; recession of 2008 and layoffs at, 432; reduced waste of stock on hand, 38–39; RPIWs, 266–67, 268, 269, 270; seven flows and improved perfor-mance for, 142–43; standard work sheet, 82; stand-up meeting, 117; supply flow, 159; surgical services, 268–72, 270, 271, 271–72; trans-port waste, 46; type 2 diabetes patients, 256–58, 273; visibility room, 115, 115; wait time, 36

Park Nicollet Health Support System: commitment, 242; ex post facto, 250; future challenges, 249–50; infrastructure, 246–47; kanban system, 368; leader involve-ment, 241–42; leadership role, 248–49; Lean results, 243, 243–44; obstacles/resistance, 247–48; patient focus, 247; supporting concepts, 241

Par level, 175Patient: demand, 78; environment,

227–28; fully prepared, 256; “lifting the lid” in Saskatchewan, 400–401; at risk, 28–30; satisfac-tion, 7, 10, 256; self-rooming, 255; type 2 diabetes, 256–58, 273

Patient advisers: Saskatchewan, 400–401

Patient advocacy, above all special interests, 419

Patient-discharge planning, 157Patient falls, mistake-proofing and

reduction in, 355Patient-first philosophy, 13, 92, 199,

218, 236, 247, 286, 418Patient First Review, Saskatchewan,

287, 307, 357, 364, 398, 400Patient flow, 170; improvement meth-

ods, 145–46; PNHS, 147, 260–64; questions, 146–47; Saskatchewan healthcare system, 338; standard work sheet, 144–45; VMMC, 144

Patient/procedure quantity analysis (PQA), 358

Patient rooming process, 254, 255, 273

Patient safety alert (PSA), 43–44, 77, 145, 216, 428, 452

Patient tracking system (PTS), 44, 261Patterson, Sarah, 425, 427, 428, 429,

430, 431Pay: linking to value creation, 97PeaceHealth, 3, 290, 292, 317; RPIW

implementation schedule, 293Performance improvement, 142–43Persistence, 220Petit, Richard, 457Pharmaceutical samples, 156Physicians: nonmanagerial, 123–25PKPO. See Provincial Kaizen Promotion

OfficePlan-do-check-act (PDCA) cycles, 344,

353, 375, 376, 377, 378, 379, 417, 433

Plsek, Paul, 424PNHS. See Park Nicollet Health

ServicesPoggetti, Joanne, 3, 20, 63, 288, 289,

290, 290, 291, 291, 292, 294, 324, 389, 410, 454, 459

Poggetti and Associates, 3Point-of-use: medication flow and, 155Poka-yoke, 145, 146, 313PQA. See Patient/procedure quantity

analysisPrairie North Health Region

(PNHR), Saskatchewan: Lean


497Index

implementation, 370; mistake-proofing, 396–97; reduction in wait time, 36, 37, 38; 3P Lean facility design event, 450

Premera Blue Cross, 5, 436–41; Afford-able Care Act and, 439; challenges faced by, 438–39; educational efforts, 440; RPIWs, 436, 437, 440; senior value stream consultant at, 438; upstream processes focus, 438–39

Premera Way University, 437Premiums: employer-sponsored

healthcare plans, 30Primary care clinics, PNHS, 253–59Prince Albert Parkland Health Region

(PAPHR), Saskatchewan, 344; Lean implementation, 370; RPIW, 450

Prince Albert Victoria Hospital: kanban system, 367

Process, 62, 76Process engineering, 165–69; ques-

tions, 168–69; successful, 167–68; VMMC, 166–67

Process engineers, 165, 166, 167, 168Process flows: profitability and, 165Processing: sequential order of, 146;

waste in, 48–49, 50, 52Production boards, 220Production preparation process (3P),

224–25, 225, 264, 265, 294, 295–98, 400

Productivity: Lean formula, 475Productivity improvement, 10–11Providence Health and Services, 5Provider flow, 149–54, 170; improvement

methods, 150–52; PNHS, 153; questions, 152, 154; VMMC, 150

Provincial Kaizen Promotion Office (PKPO): Saskatchewan, 332

Provincial Kaizen Promotion Office (PKPO), Saskatchewan: over-coming challenges, 332, 336–37; transitioning roles and responsi-bilities of, 336

Provincial Surgical Kaizen Operation Team (PSKOT): Saskatchewan, 358

PSA. See Patient safety alertPSKOT. See Provincial Surgical Kaizen

Operation TeamPTS. See Patient tracking systemPublic Broadcasting Service, 424Pull production, 16, 220, 231; defini-

tion of, 17, 79; kanban and, 366; Lean House, 75, 79; model service line and, 87; “push” system vs., 79

Pull system: patient-centric care and, 419–20

Purpose: constancy of, 431, 435; patient and definition of, 27–28

“Push” system: pull production vs., 79

Quality, cost, delivery, safety, and morale (QCDSM), 115

Quality checks, 145–46Quality improvement: Lean vs., 432Quality improvement center (QIC):

organizational chart, 19, 19, 20Quality of Work Life Institute, 18“Quality revolution” (1980s), 17, 21Quick-check process, 255

Rapid Process Improvement Work-shop (RPIW or kaizen event), 101, 132, 194, 195, 201, 206–7, 219, 229, 231, 254, 257, 261, 262, 263, 265, 266, 268, 269, 270, 278, 292, 293, 316, 320, 322, 342, 343, 344, 371, 400, 442; definition of, 36; Premera Blue Cross, 436, 437; reducing wait times, 359–60, 361, 363, 364; reducing waste from defects, 45; reducing waste in processing, 50; reducing waste in transportation, 47; reducing waste of movement, 42; reducing waste of overproduction, 35; reducing waste of time on hand, 37; replica-tion model, 417; Saskatchewan Cancer Agency, 374; Saskatch-ewan healthcare system results summary, 407, 408; Saskatoon Provincial Scheduling System, 405; 3sHealth, Saskatchewan, 381


498 Index

Reassignment, 97Redundancy, 33Regina General Hospital, Saskatch-

ewan: 5S success at, 349Regina Qu’Appelle Health Region

(RQHR), Saskatchewan, 316, 324, 330, 359, 360, 448; Allen Blair Cancer Centre in, 372; Lean implementation, 370; Lean patient improvements, 398; long-term-care Kaizen Operations Team, 348; over-capacity improvements, 365; process improvements in mental health and addiction services, 364; surgery wait-time reductions, 362; value-stream mapping, 406–7; Wascana Reha-bilitation Centre, 381

Regional Health Authorities (RHAs): in Saskatchewan, 285, 304

Reorganization: by service lines, 109; value stream network, 105, 105

Replication model: for Lean transfor-mation, 417, 418

Replication readiness checklist, 417Report-outs, 132Required daily output: Lean formula, 475Resistance, 433; to change, overcom-

ing, 5–6; fear of change and, 219; in smaller regions, Saskatchewan healthcare system, 371

Retirement, early, 97Rework, eliminating, 152RHAs. See Regional Health AuthoritiesRhode, Jim, 295, 306, 453Rona, Mike, 4, 136, 192, 193, 194, 196,

197, 198, 199, 202, 203, 205, 206, 209, 226, 327

Room changeover time, 255Rooming defect rate, 255Roos, Daniel, 4Root cause analysis, 377, 379Rounding, 428Rousseau, Pauline, 280, 286, 317, 447,

457Royal University Hospital, Saskatoon,

295, 298, 359, 360; hoshin teams,

411; job instruction at, 351; kan-ban system, 367

RPIW. See Rapid Process Improvement Workshop

RQHR. See Regina Qu’Appelle Health Region

Rupp, Steve, 314

Safety Alert System (SAS): Saskatoon, 345, 346, 347, 404

“Safety huddles,” 357Saint Martin, Christina, 206Sandstrom, Joan, 260, 263, 267SAS. See Safety Alert SystemSaskatchewan, 442; extending Lean fur-

ther in, 417; healthcare manage-ment system, patients as focus in, 401; health regions, 281; indirect communication style used in, 286; key Lean leaders in, 457–59; Lean adoption across the province, 382–83; Medicare pioneered in, 383, 421; number of healthcare workers employed in, 277; popula-tion growth in, 302–3; Regional Health Authorities, 285; size of, 305; surgery wait-time reductions, provincewide, 363; total financial impact of Lean in, as of March 2015, 409; what we learned in, 417–20

Saskatchewan Cancer Agency (SCA), 452; Lean implementation, 372–74; 3P Lean facility design team, 373

Saskatchewan healthcare system: Adverse Events Management System, 344; adverse events statistics, 286; bad-mouthing Lean, 384–85; budget process, 289; Cancer Agency, 285; capital 3P Lean design events, 402–4; CEO succession plan, 331; data, building the infrastructure, 330, 338–39; division into phases, 310; eHealth, 285, 375–79; erosion of support, 385; 5S organizational


499Index

process, 348–49, 351; getting leaders to the gemba, 342–43; Global Production System tailored to, 332; going it alone, 390–92; Guiding Coalition, 317; health-care landscape, 287; higher-quality care as real aim in, 283–84; importance of involving everyone, 305; infrastructure for provincial transformation, 309–40; instilling safety culture, 310–12; Kaizen Fel-lows program, 323–27, 325, 331, 452; kaizen work accomplished in, 396, 397; kanban as way of life for, 366–69; KPOs and KOTs, 331–32, 335, 340, 354; leadership commit-ment, 122, 312, 314–15, 340, 420; leadership “maturity model,” 320; Lean depth study, 327–31; Lean implementation, 294–306; Lean implementation in smaller regions and agencies, 370–83; Lean leader certification by January 2015, 396, 396; Lean scorecard after three years, 413–14, 415–16; Lean trans-formation of, 306; management system, 333; mistake-proofing projects, 397, 398, 463–74; need for publicizing Lean results, 389; North American mistake-proofing tours, 319–20, 325, 352–55, 353, 356, 448; obstacles and resis-tance, 383–92; organizational size and Lean transformation in, 279; overcoming PKPO/KPO/KOT challenges, 332, 336–37; Patient First initiative, 287, 307, 341; patient flow, 338; Phase 2 challenges in smaller regions, 370–72; physician involvement, 315–16; politics and, 386–88; procurement savings, 407; push-ing through challenges for early results, 395–407; questioning the public interest, 388–89; reduced wait times for inpatient surgery, 16; resource gathering, 287–89;

RPIW results summary, 407, 408; safety culture, 344–48, 346, 347; sampling of Lean improve-ments in, 399; standard work and job instruction, 351; summary of results, Phase 1 and Phase 2 regions, 392–93; summary timeline of Lean transformation, 447–55; Surgical Initiative, 284, 307, 357–60, 361, 362, 363, 364, 453; surgical waiting list, 357; task assessment, 282–83; 3sHealth, 285, 330, 331, 366, 379–82, 448; training leaders, 317, 318, 319–20, 321, 322–23; two new certification tracks, 322; vocabulary and cus-tomization, 383–84; zero-defects philosophy, 311–12, 313–14

Saskatchewan Party, 386Saskatchewan Surgical Initiative, 357Saskatchewan Union of Nurses (SUN),

323, 387, 388Saskatoon Cancer Centre, 372; 3P Lean

design project, 403Saskatoon Children’s Hospital: 3P

Lean facility design events, 396, 402

Saskatoon Health Region (SHR), 310, 323, 324, 325, 329, 330, 344, 360, 395, 447; “Better Every Day 14-Day Challenge” in, 411–12; KPO/KOT structure for, 332, 334; Lean achievements, 278; Lean and improved patient service in, 397–401; Lean implementation, 294; new leadership principles, 330–31; patient discharge process, 34, 35, 36; patient safety alert system, 452; safety hotline, 355, 357

Saskatoon Provincial Scheduling System: lead-time reductions, 406, 406; process 3P Lean design event, 404–5; staff scheduling improvements, 405–6, 406

Satellite pharmacies, 152, 155, 157Sausser, Gail, 296, 304, 459SCA. See Saskatchewan Cancer Agency


500 Index

Scale constraints: smaller regions, Sas-katchewan healthcare system, 371

Schmidt, Thomas, 304, 459Schulz, Cole, 453, 454Seattle Children’s Hospital, 5, 314;

Ambulatory and Surgery Center, 352; kanban system, 368–69; Sas-katchewan leaders at, 353

Selby, Bill, 18, 59, 60Self-discipline: in 5S workplace organi-

zation, 84, 85, 348Sensei, 288; assistance of, 12, 25, 443;

Boeing, 61–62; contract, 118; cre-dentials, 93; definition of, 13

Sequential order of processing, 146Service leadership, 431Service line leader (SLL), 100, 109Service lines, 96, 109, 328, 4177-7 rule, 1357 Ways approach, 299Shaw, Susan, 316Shingijutsu Company Ltd., 15, 61, 62,

63, 72, 132, 326, 443Shingo, Shigeo, 313, 314, 322Showa Tekko, 326SHR. See Saskatoon Health RegionShrontz, Frank, 22Shuno, Kenji, 459Simonar, Patti, 324, 325, 452Simplify: in 5S workplace organization,

84, 85, 348Simulation, 212, 214, 216, 219Six Sigma, 239, 240, 244, 250; zero-

defects philosophy vs., 313Sketching, 202–3Sleeping inventory, 178SLL. See Service line leaderSOD. See Strategic operational

directionSort: in 5S workplace organization, 84,

85, 348Spaghetti charts, 298St. Paul’s Hospital, Saskatoon: hoshin

teams, 411; Safety Alert System, 345, 346, 347, 453

Staff engagement: Lean and, 431

Staffing constraints: smaller regions, Saskatchewan healthcare system, 371

Stamper, Malcolm, 18Standardization of work, importance

of, 110Standardize: in 5S workplace organiza-

tion, 84, 85, 348Standard operations, 204–5, 442; defi-

nition of, 205; three-legged stool of, 83, 83

Standard work, 16, 340, 345, 381, 405, 424, 428, 435; blood pressure measurement, 82; definition of, 17, 80, 81, 90; job instruction and, 351; methods, 83; patient setup, 262; purpose of, 83; takt time and, 80

Standard work-in-process (SWIP), 80, 86, 90; Lean formula, 475

Standard work sheet: blood pressure measurement, 82

Stand-up meeting, 115–16, 116, 117, 428

Stationary pieces, eliminating, 151–52Steele, James B., 31Stock on hand (inventory): examples

of waste, 39; kanban results for reducing waste of, 39, 40

Stop the line, 75, 77, 286, 348Storage supply: patient flow and, 263Strategic operational direction (SOD),

303Stretch targets, 92Stuart, Pat, 458Succession planning, 23, 292SUN. See Saskatchewan Union of

NursesSun Country Health Region, Saskatch-

ewan, 360Sunrise Health Region, Saskatchewan,

312, 355, 359; improved mental health services, 364; wall walk, 372

Super flow, 133Supply-chain kanban, 326


501Index

Supply flow, 157–60, 170; improve-ment methods, 158–59; PNHS, 159; questions, 160; VMMC, 157

Surgical services, 268–72, 270, 271Sweep: in 5S workplace organization,

84, 85, 348SWIP. See Standard work-in-processSylvester, Julie, 212Synergy: creating, 84–85System performance: data visibility

and, 338

Taiho, 326Takenaka, Akira, 292Takt time, 78, 90, 96, 101, 102, 119,

204, 214, 442; definition, 75, 76, 104; importance of, 182; Lean formula, 475; model service line and, 86; process engineering and, 167; provider flow and, 151; seven flows and, 146, 169; standard work and, 80

Takt-time-paced production, 78Takt-time production, 75Teare, Gary, 457Thiessen, Heather, 302, 387, 391, 392,

400Three-legged stool, 83, 833P. See Production preparation process3P architect, 2963P Lean design process: purpose of,

101, 1023sHealth, Saskatchewan, 46, 330, 331,

366, 448; business case devel-opment process, 381; kanban methodology, 381–82; kanban system, 380, 381; office layout and tools design, 382; provincial linen service, 380–81; shared services, 379–82

Throughput time, 73, 89Time available: Lean formula, 475Timeline, integrated, 339Time observations, 298Total lead time, 103Total quality, 60

Toyoda, Kiichiro, 4, 55, 58Toyoda, Sakichi, 55, 56Toyota Autonomous Study Group, 443Toyota Group, 56, 57Toyota Memorial Hospital, 92Toyota Motor Corporation, 326, 327Toyota Motor Works, 291Toyota Museum of Industry and

Technology, 198, 199; key VMMC learnings, 199

Toyota Production System: Beyond Large-Scale Production (Ohno), 33, 58, 129

Toyota Production System (TPS), 3, 4, 13, 55, 56–58, 72, 133, 194, 200, 200, 206, 289, 290, 313, 319, 380, 423, 428. See also Lean production

Toyota Way to Healthcare Excellence, The, 129

TPS. See Toyota Production SystemTraining Within Industry (TWI) pro-

gram: job instruction, 351; main-taining improvements with, 429

Transformational leader: traits and behaviors of, 461

Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience (Ken-ney), 322, 424

Transparency, 427, 428, 433, 435Transportation: waste in, 46, 47, 48, 52“Try-storming”: brainstorming vs., 376TWI. See Training Within Industry

(TWI) programTwo-bin kanban system, 158, 173–75,

174, 177, 188, 367

Undersea and Hyperbaric Medical Society, 165, 166

United States: healthcare costs in, 30; unaffordable healthcare in, 11; WHO health care ranking, 31

United States Armed Forces, 167Unreasonableness, 152Urgency: creating sense of, 94, 118US National Coalition on Health Care, 32


502 Index

Vachon, Beth, 317, 457Value-added: definition of, 11Value-added services: patients and, 10Value-added time: Lean formula, 475Value creation: linking pay to, 97Value stream, 214; definition of, 34,

90; global enterprise value-stream network, 105; model line, 87, 95; reorganization, 96

Value-stream map (VSM), 90, 96, 119, 297, 298, 352, 372, 379, 381, 406–7; current-state, 102; definition of, 88; future-state, 102; illustration, 87, 102–3; informa-tion flow and, 161

Vandermark, Deb, 20Venice arsenal, 55–56Virginia Mason Institute (VMI), 4, 209,

353, 429–30Virginia Mason Medical Center

(VMMC), 242, 243, 244, 280, 285, 314, 317, 326, 327, 352, 353, 355, 374, 387, 424–31, 436, 442; audit-ing and accelerating progress at, 204–5; cancer institute, 212–20, 215, 217, 218, 236; case example, 191–237; Center for Hyperbaric Medicine, 7, 166, 172, 220, 221–34, 222, 225, 228, 229, 232, 236; confronting waste, 202–3; constancy of purpose at, 431; equipment flow, 163; flu vaccina-tion issue, 426–27; implementa-tion advice, 431; information flow, 160; kaizen action plan, 199–201; kaizen events, 195, 197, 201, 206–7, 219, 229, 231; Kaizen Fellows educational program, 136; Kaizen Promotion Office, 204, 205–6; kanban system, 180, 183, 184, 188, 368; leader-ship commitment, 427–28, 430; leader turnover, 429; lead time reduction, 16; Lean implementa-tion, 191–206; Lean operations started at, 4; Lean results, 206–9; liability insurance premium

reductions, 426; “Mandate for Rapid Change,” 196; medication flow, 154; movement waste, 41, 43; nurses and direct patient care at, 425; online documentation system, 34; patient flow, 144; patient safety alerts, 43–44, 77; patient-satisfaction results, 429; physician compact, 124, 445; preventive healthcare at, 425; process engineering flow, 166–67, 168; processing waste, 48–49; provider flow, 150; reduced waste of stock on hand, 39; results, 206–9; rigor to ensure continuity of the system, 428–29; shorter patient stays at, 425; stand-up meeting, 116; strategic plan, 71, 71–72; supply flow, 157; surgi-cal instruments standardization, 427; surgical specimen testing, 87, 87–88; systemic flow improve-ments, 425–26; Toyota Museum of Industry and Technology—key learnings, 199; Toyota Produc-tion System—key learnings, 200; transformational process, 211–12; transport waste, 46, 48; vision, 72; wait time reduction, 36

Virginia Mason Production System (VMPS), 198, 200, 209, 428, 430

Visibility room, 114–15, 115Vision, 72Visit planning, 256, 258Visual controls, 220; supply flow and,

159Visual cues, 348Visual daily management walls, 375,

378Visual management, 435Visual management boards, 259VMI. See Virginia Mason InstituteVMMC. See Virginia Mason Medical

CenterVMPS. See Virginia Mason Production

System


503Index

Vocabulary: Saskatchewan healthcare system, 383–84

Vornbrock, Tammy, 324, 452VSM. See Value-stream map

Wahba, Mark, 358Wait time: in Saskatchewan, 357; sur-

gery, reductions in, 361, 362, 363; waste in, 10, 36, 37, 38

Walk time: definition of, 41Wall, Brad, 382, 386, 387, 414, 457Wall Street Journal, 424Wall walk, 372, 413; definition of, 373;

patient involvement and, 400“Wash your hands” kaizen event, 93,

131–32, 244Waste: causes of, 31–32; confronting

at VMMC, 202–3; of defective products, 43–44, 45, 46, 52; defini-tion of, 8, 27; effects of, 28–31; finding, 51; in healthcare system, 28, 30–50, 52; of movement, 41, 42, 43, 52; of overproduction, 33–34, 35, 36, 52; in processing, 48–49, 50, 52; reduction, 6, 94; of stock on hand, 38–39, 40, 52; of time on hand (waiting), 36, 37, 38, 52; in transportation, 46, 47, 48, 52; types of, 13

Wasted space, 300–301Waste-elimination strategy, 96WCMS. See World-class management

systemWegleitner, Ted, 269, 272Weishaar, Mike, 296, 372, 459Wellman, Joan, 322, 352Wessner, David, 88, 117, 136, 240, 241,

244, 245, 246, 247, 248, 250, 251, 432

White, Lisa, 409Whitney, Eli, 56WHO. See World Health OrganizationWill, Andrew, 331, 369, 379, 382, 458Williams, Brent, 380, 459Witt, Bryan, 324, 452Womack, James P., 4, 129, 291, 291Workplace: kaizen events, 95; organiza-

tion, 84, 85World class, 60World Class Company Studies, Boeing,

62World-class competitiveness prin-

ciples, 61World-class healthcare, 442World-class management system

(WCMS): elements, 110–14; implementation, 97, 114, 114, 119

World Class Production System, A (Black), 129, 192

World Health Organization (WHO): healthcare ranking by country, 31; on medical errors and adverse events, 29

Wright, Debra Jane, 458

Xerox, 21

Yamatake Honeywell, 291, 326Yonan, Monica, 388

Zambory, Tracy, 387, 388Zero-defect philosophy, 311–12,

418–19Zero Quality Control: Source Inspec-

tion and the Poka-yoke System (Shingo), 313, 322

Ziola, Robert, 389


Documents

Index [account.ache.org]account.ache.org/eweb/upload/Black2e_Index-f467d9a7.pdf · Accelerating Health Care Transforma-tion with Lean and Innovation: The Virginia Mason Experience