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The Lean Hospital

Patient Focused Hospitals are the future.


Operate your hospital like Toyota runs their business

It is possible that Toyota is the best run company in the world. First of all, thankfully for other companies they are narrowly focused in the automobile industry. If they focused on hospitals, they would potentially run everyone else out of business. Hence, Toyota is constantly changing and adapting to their competitive environment. There is no more competitive environment than a hospital. A Lean Hospital is the next move.

If you run your hospital like Toyota runs their business consequently, your hospital will be profitable, doctors will fight to get into your surgery, your emergency room will flow patients in, your nurses will love working there, and you will drive Hospital Acquired Infections to zero.

Your Customer

Lean Six Sigma defines a customer as the entity that pays you. Usually a customer the one that rates you and this is where it gets confusing at a hospital. There are three entities that a hospital serves. First is the entity that pays the hospital, which is the insurance company. Next, our doctors who bring the revenue to the hospital. Lastly, are the patients that pay the insurance companies and feel the effect of hospital performance.

The Power of a Goal

Sometimes when you have a goal you actually end up accomplishing more than you expect (unintended consequences). Let’s use Toyota as an example. Toyota went to Lean Production (which means they manage inventory to a very low level). They originally focused on removing defects. They removed defects in order to decrease the amount of physical waste they produced. Japan was poor at that time so the company could not afford to make bad parts.

Toyota focused on defect reduction in the order to minimize defective parts. They did not focus on defect reduction to win JD Powers awards, but they did.

Patient Focused Hospital

if your hospital makes patients the primary focus, therefore patient flow increases. That will satisfy doctors. If a hospital focuses on removing defects therefore patients will exit in better health. Subsequently, your liability insurance and litigation costs will decrease. There are many ancillary advantages to becoming a Patient Focused Hospital.

The Toyota Production System benefits applied to hospitals.

The benefits of applying Lean Six Sigma to Hospitals

  • :Patient Safety Program thereby reducing trial liability and insurance costs by 74%
  • Cut Emergency Department Emergency Room stays by 50% (81.8% of unscheduled hospital admissions come through the Emergency Department)
  • Drive HAIs (Hospital Acquired Infections) to ZERO
  • Retain 98% of nurses
  • Reduce errors in surgery

The Malcolm Baldridge Award is given to businesses that have exceptional processes. There is a  Malcolm Baldridge Award that targets hospitals and hospitals that have one the Malcolm Baldridge Award are exceptional. Ask yourself, if you have great nurses, great doctors, great administration, and poor processes, are you a great hospital?
Win a Malcolm Baldridge Award

I researched a hospital in California that touted their excellence while also making patients wait 20 hours in the Emergency Department before being moved into the hospital. One Baldridge Award winning hospital averages five hours to do the same thing. To be fair, it may not be a fair direct comparison but it sure makes you wonder what’s happening to those poor patients for the extra 15 hours.

The Malcolm Baldridge Award is the type of award that you can see wonderful benefits from just attempting to get the award. One of the nice things about the Malcolm Baldridge Award is they will periodically send experts out to your hospital to give you guidance on where you stand.


  Failures of San Diego Hospitals because they don’t use Lean Six Sigma

(Misery Indexes Included)


A Lean Hospital sees the hospital from a patients point of view

A Value Stream measures the Hospital system that is made of the processes that deliver a service.  Once Value Stream performance is studied the most offending processes are targeted for improvement,  Time is then removed from processes by streamlining.  Patients spend less time in pain and have everyone at the hospital be their advocate through the PSP (Patient Safety Program).  The PSP supports patients and subsequently decreases liability and insurance costs for the hospital.


Simulate Your Flow

I spent 13 years as a Simulation engineer and manager. Simulation allows you to make changes to a model that allows you to determine how those changes would affect the real environment without affecting the real environment.

Simulation allows you to:

  • determine the impact of an unpredictable patient load,
  • determine when and where you need more or less personnel,
  • understand hospital flow with Profound Knowledge, and
  • decrease the cost of an errant change.

Building a Simulation requires multiple steps. First, you build the model and next you collect the data to populate the model. The next step is to test the simulation against real conditions and finally, continually refine and improve the Simulation.

Build the Model

The model represents the logic of the flow with all the inter-dependencies. An example could be hospital beds. Beds flow in a hospital.

The model is a computer program with a structured set of inputs, outputs, and the logic in between. As hospital performance increases and processes to improve the model needs to reflect that.

Collect the Data to Put in the Model

A model is only as good as its data. As an Example, data could represent the average time a patient spends in triage. As processes improve, data changes to reflect that. You will find over time that as the model settles down the data becomes the critical piece.

Validate, Validate, Validate

Once you have built the model and populated it with the best data then you need to determine if the simulation reflects real life. This is Simulation Validation. Quite simply, if you cannot validate your Simulation then it has no value.

Changes in the model or the data require re-validation. It is important that the Simulation accurately represents the patient flow in the hospital. The more accurately that the Simulation represents the physical environment, the more it can be relied upon as a platform for testing.

Refine the Model and Data

The hospital will improve in big steps by assessing Value Streams and small steps or big steps by implementing Continuous Improvement. The steps risk deviating the real environment from the Simulated environment.  It is important to keep the Simulation up to date.

Once Simulation methodology is called Monte Carlo. This simulation uses variation of statistical data based on its density distribution and probability. Each Monte Carlo simulation uses a new set of randomized data. The results of the Monte Carlo simulations will probably give you the information of the most likely results. If these results differ from what is seen, then the data and/or model need adjusting.


Simulation is a holistic experience that includes all significant inter-dependencies. For instance, you cannot just simulate the Emergency Department. There is movement in and out of the Emergency Department of doctors, nurses, supplies, beds and so on. These inter-dependencies are not all in the control of the Emergency Department. Therefore, the Emergency Department cannot be Simulated in isolation.


In conclusion, A Lean Six Sigma Master Black Belt is a master of the process. Let me lead healthcare to an efficient, quality driven future.


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