Service Details

Teaching Continuous Improvement

We have extensive experience teaching Continuous Improvement in many healthcare organizations to physicians, nurses, medical staff, professional staff and office staff. We teach the Toyota Production System (Lean), Six Sigma and Change Management. The courses are customized to meet the needs of each client and include training for leaders, managers and frontline staff. The Continuous Improvement Training Journey shown below gives an overview of the content and training approach:

Coaching Continuous Improvement

We coach individuals and groups on Continuous Improvement by working together on projects and by supporting individuals in improvement work. Our coaching model includes:

  1. Setting goals for improving skills and knowledge in Continuous Improvement.
  2. Building relationships with others in the workplace to support Continuous Improvement in processes.
  3. Increase skills and knowledge in Continuous Improvement with hands-on learning.
  4. Measure outcomes to show skills have increased in Continuous Improvement.

Managing Projects for Continuous Improvement

We have extensive experience in managing projects and leading Continuous Improvement initiatives. We use Project Management tools such as the SIPOC (Supplier, Input, Process, Output and Customer) model to manage and direct Continuous Improvement projects.

Changing Culture to Continuous Improvement

We assist our clients with processes that change the culture to a Continuous Improvement Culture, using the excellent models from John Kotter on Change Management and the culture change concepts from the Toyota Production System. For Continuous Improvement to be successful, an organization’s culture must change to embrace the concepts of "We See. We Feel. We Change."

Change Management

Services in Continuous Improvement

Continuous Improvement - The Three Components

Continuous Improvement - Lean Thinking [1]

Reduce Waste in Time, Cost and Work and Improve Speed

[1] Doing More with Less: Lean Thinking and Patient Safety in Health Care - Joint Commission Resources, Inc.




1. Value

Specify value.

  1. Identify who the customers are, both externally and internally.
  2. Define value from customer's point of view.
  1. Value documentation form

2. Value Stream

Identify value stream and eliminate waste.

  1. Observe tasks and times.
  2. Document and understand process steps and types of work (value added, necessary non-value added and waste)
  3. Document waste in each category: Overproduction, waiting, transportation (unnecessary materials, products or information), overprocessing, unnecessary inventory, motion (people) and defects
  4. Conduct root cause analysis.
  5. Implement error-proofing processes.
  6. Create current state value stream map.
  7. Eliminate steps that do not add value.
  1. SIPOC model
  2. Process flow diagram
  3. Task and Time Observation Sheet
  4. Waste Walk Checklist
  5. Value stream mapping symbols
  6. Value stream map
  7. Cause-effect diagram

3. Flow

Ensure work flows smoothly from one stage to another.

  1. Ensure work is balanced for process stages.
  2. Calculate takt time [Required mean service rate] [Takt Time (Rate) = Available time/ demand]
  3. Improve layout and visual controls.
  4. Implement the 5S workplace:
    • Sort [Remove unnecessary items from area.]
    • Set in order [Organize items that remain.]
    • Shine [Clean, paint, replace or cover up.]
    • Standardize [Use standardized procedures to maintain benefits.]
    • Sustain [Ensure discipline occurs to maintain the workplace.]
  5. Design quick-change-over methods.
  6. Reduce work-in-process.
  1. Mistake proofing tools
  2. Sign boards to signal replenishing needs
  3. Visual work tools
  4. Daily process performance
  5. Use the Five Whys (5Ws)
  6. SIPOC model
  7. Little's law: Throughput time = work in process amount/average completion rate

4. Pull

Customer pulls what is needed.

  1. Create standard work processes.
  2. Move items only when needed by customer.
  3. Implement just-in-time (JIT) production.
  4. Implement JIT supply.
  1. Visual workplace systems, pull systems and just-in-time (JIT) processes.
  2. JIT tools for right items at the right time

5. Perfection

Continue reducing waste.

  1. Create continuous improvement by changing processes to eliminate new waste and new delays found in work.
  2. Always look for ways to reduce more waste.
  3. Use kaizen (continuous improvement) events.
  1. Visual controls that show waste
  2. Management reviews to control the workplace
  3. Tools for documenting and eliminating waste

Continuous Improvement - Six Sigma [1]

Reducing process variation and driving defects to near zero

[1] The Certified Six Sigma Black Belt Handbook, ASQ Quality Press, Milwaukee, Wisconsin, 2005





  1. Create goals, benefits, project charter and flowcharts.
  2. Obtain Voice of Customer data.
  3. Create project plan and communication plan.
  1. High-level process map [SIPOC] [Supplier, Input, Process, Output, Customer]
  2. Process flowcharts
  3. Customer surveys, interviews, focus groups
  4. Project management tools


  1. Define and measure process inputs and process outputs.
  2. Collect data on process performance.
  3. Define process capability.
  1. Pareto charts
  2. Statistical methods and sampling
  3. Value stream mapping
  4. Capability analysis
  5. Cycle time analysis
  6. Process efficiency cycle


  1. Analyze sources of variation.
  2. Analyze data and processes.
  3. Determine root causes to improve processes.
  1. Statistical tools
  2. Cause-Effect diagrams
  3. Pareto charts
  4. Simulation models
  5. Root-cause analysis
  6. Failure Mode Effects Analysis [FMEA]


  1. Identify changes to improve processes and reduce waste.
  2. Reduce cycle times.
  3. Improve quality and speed.
  4. Focus on customer expectations.
  1. Brainstorm solutions
  2. Simulation models
  3. The 5S method of Lean [Sort, Straighten, Scrub, Standardize, Sustain]
  4. Error proofing
  5. Failure Mode Effects Analysis [FMEA]
  6. Verify new process meet project goals and voice of customer.


  1. Prepare control plan to ensure improvements hold.
  2. Implement monitoring of key variables.
  3. Identify measures, targets, and control limits for key variables.
  4. Estimate financial benefits from improved processes.
  1. Control charts
  2. Training requirements
  3. Documented new processes
  4. Scorecard to track targets and control limits
  5. Pareto charts for key variables
  6. Calculate return on investment [ROI]

Continuous Improvement - Change Management

Healthcare Continuous Improvement Roadmap

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