2nd Edition (2011)

Learn more about the upcoming 3rd edition (June 2016)

Read a blog post, from the book’s author, about the second edition

Highlights of What Was New in the 2nd Edition:

• New and updated material on identifying waste, A3 problem solving, employee suggestion management, and strategy deployment
• New case studies—including a new Kanban case study (Northampton General Hospital) and another that ties together the themes of standardized work, Kanban, 5S, visual management, and Lean leadership for the prevention of patient harm
• New examples and updated data throughout, including revised chapters on patient safety and preventing medical errors

Details:

General

• “Points to Ponder” at the end of each chapter are now called “Points for Group Discussion,” with some new questions added.

Chapter 1

• Updated initial introduction (talking about “starting from need” in terms of why we use Lean methods and principles)
• Added callout talking about Toyota’s reputation and quality
• Updated lean history to reference Joan Wellman and Seattle Children’s early lean work
• Updated/new metrics that show lean improvement examples in healthcare
• Updated data on cost pressures, staff shortages, quality problems in healthcare
• New departmental case study (Children’s Medical Center Dallas – lab)
• 1^st edition case example moved to later chapter on improving flow
• The bulk of the Avera McKennan case study (from 1^st edition) moved to later chapter on getting started with lean

Chapter 2

• Various updates, including some references to ThedaCare’s lean management system
• Updated “Toyota Way” framework to change first pillar wording from “elimination of waste” to “continuous improvement” – the main idea is the same, but this is more consistent with Toyota wording
• New callout on “respect for people” pillar
• Added the “four rules in use” as a Lean definition framework

Chapter 3

• New introduction, “Waste is Not the Same as Cost”
• New data from Virginia Mason about reducing waste to free up RN time at the bedside
• Refined description of “pull” in healthcare, why pull should be about patients pulling on resources, not a unit “pulling” the patient when a room is available
• Improvements in the section on defining value, incorporating insights from Dr. Don Berwick
• Edits and, in some cases new examples, about the types of waste in healthcare
• Fuller discussion of “Required Waste”

Chapter 4

• Edits and some new examples in intro to value streams
• New callout on electronic VSM – downplaying the need for that software and technology
• New “activity of the employee” example for primary care physician, with new figure

Chapter 5

• New figure showing the “Park Nicollet System of Care” version of the “Lean House” diagram
• Edits and refined section on standardized work for healthcare
• New callout on looking at the communication process and standardized work instead of just blaming parents for not following NPO instructions properly.
• New callout on standardized work in a radiology department
• New section on determining staffing levels based on data
• New section on quick changeover as a form of standardized work (O.R. turnover, etc.)
• New material on managers coaching on standardized work, rather than being punitive when they see problems
• New material on lean, standardized work, and checklists
• New material on standardized work for managers
• New callout on standardized work and Training Within Industry (success story example)

Chapter 6

• New examples of visual management used to help manage patient flow
• New 5S callouts and small case examples
• New Kanban examples and new case study from Northampton General Hospital (UK), Seattle Children’s, Park Nicollet, Henry Ford Health System, New York HHC
• New material on Kanban vs. par levels
• New material on Kanban vs. automated inventory cabinets
• New culminating case study about the use of standardized work, 5S, Kanban, and visual management to prevent patient harm

Chapter 7

• New intro case study of the Mary McClinton case and lessons learned (Virginia Mason)
• New quality improvement data and examples from ThedaCare and others
• New examples and discussion about workarounds
• New section on A3 problem solving, with example
• New 5 Whys problem solving examples

Chapter 8

• New introduction and case example of patient harm and lessons learned (Darrie Eason case) – blame vs systems
• New examples about quality at the source and not blaming individuals
• New error proofing and quality improvement data and case examples
• New material about Lean and “Crew Resource Management”
• New material on Virginia Mason “patient safety alert” system
• New figures and photos

Chapter 9

• New intro – “Waiting: A Worldwide Problem” with data from many countries and waiting times and improvements
• New material on the “Seven Flows of Healthcare”
• New examples and data on flow improvements
• New material on matching staffing to demand in emergency departments
• New examples of E.D. flow improvement
• New case example (ThedaCare) on reducing door to balloon time

Chapter 10

• New quotes and callouts on lean leadership, including John Toussaint’s comparison of “white coat leadership” and “lean leadership.”
• New section on strategy deployment
• New material on goals versus hard targets and a warning about dysfunctions
• Additional material on daily standup meetings
• Updates on managing kaizen and continuous improvement
• Updated format for an “idea card” to be used on visual idea boards

Chapter 11

• New callouts about organizations getting started with Lean
• New material on “what do we call it?” – giving a name to a formal Lean program
• Updates on kaizen events – different formats and success/failure data updated
• Replaced LeBonheur Children’s Hospital “getting started” lean transformation case with updated/expanded version of Avera McKennan case

Chapter 12

• Updated and expanded “Vision for a lean hospital.”